Evidence supporting the use of: N-acetylcysteine
For the health condition: Congestive Heart Failure

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Synopsis

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

N-acetylcysteine (NAC) has been investigated as a potential adjunctive therapy in congestive heart failure (CHF) due to its antioxidant and vasodilatory properties. Scientific interest in NAC for CHF is based on its ability to replenish intracellular glutathione, a key antioxidant, and its role as a precursor for nitric oxide-mediated vasodilation. Several small clinical studies and some randomized controlled trials have suggested possible benefits, such as improved hemodynamics, reduced oxidative stress, and enhanced response to standard heart failure therapies, particularly intravenous nitroglycerin. For example, a 1997 study published in Circulation showed that NAC, when combined with nitroglycerin, preserved vascular responsiveness and renal function better than nitroglycerin alone in patients with severe CHF. Other studies have suggested potential improvements in endothelial function and reductions in symptoms, but these findings have not been consistently replicated in larger or long-term trials. Major heart failure guidelines do not currently recommend NAC as a standard therapy because the overall body of evidence is limited, with small sample sizes and methodological variations. While the theoretical rationale is strong and some early data are promising, robust scientific validation is lacking, and further large-scale studies are needed to clarify its clinical efficacy and safety in CHF.

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