Evidence supporting the use of: N-acetyl-cysteine (NAC)
For the health condition: Congestive Heart Failure

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Synopsis

Source of validity: Scientific
Rating (out of 5): 2

N-acetyl-cysteine (NAC) has been studied as an adjunctive therapy in Congestive Heart Failure (CHF) primarily due to its antioxidant properties and its role in replenishing intracellular glutathione, a key molecule in combating oxidative stress. Oxidative stress is believed to contribute to the pathophysiology of CHF by promoting myocardial damage, inflammation, and endothelial dysfunction. Several small clinical studies and pilot trials have investigated NAC’s effects in this setting. For example, some trials suggest that intravenous and oral NAC may improve hemodynamics, reduce oxidative stress markers, and enhance the efficacy of diuretic therapy in patients with heart failure. These effects are thought to result from NAC’s ability to vasodilate via increased nitric oxide bioavailability and to reduce oxidative injury in cardiac tissues.

However, the overall quality and size of the evidence base are modest. Many studies are small, have short durations, and often lack rigorous controls. Systematic reviews and meta-analyses indicate potential benefits but frequently highlight the need for larger, high-quality randomized controlled trials to confirm clinical outcomes such as mortality, hospitalization rates, and improved exercise capacity. As a result, while there is some scientific rationale and preliminary evidence supporting NAC’s use in CHF, it is not a standard or widely endorsed therapy in major heart failure guidelines. Its use remains experimental and should be considered only as an adjunct to evidence-based treatments.

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