What You Need to Know About ATTR-CM and Vitamin A Supplementation
Cardiovascular DiseasesHeart Disease

ATTR-CM and Vitamin A Supplementation: What You Need to Know

ATTR-CM and Vitamin A Supplementation: What You Need to Know
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Published on July 7, 2026
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Note: The U.S. Food and Drug Administration (FDA) does not approve supplements for safety or effectiveness. Talk to a healthcare professional about whether a supplement is the right fit for your individual health and about any potential drug interactions or safety concerns.

Transthyretin amyloid cardiomyopathy (ATTR-CM), a rare form of heart failure, changes the behavior of transthyretin (TTR), a protein that normally carries vitamin A around your body.

 This can stiffen your heart muscle, making it hard to pump enough blood with each heartbeat.

Some ATTR-CM treatments decrease how much TTR you make, which can slow the disease progression but also cause low levels of vitamin A, says Albert Hicks, MD, a cardiologist and the medical director of cardiac transplantation at the University of Maryland School of Medicine in Baltimore.

Vitamin A deficiency can cause health problems of its own, like vision and skin changes.

 But with the right treatment and provider-approved supplements, you can treat ATTR-CM and keep your vitamin A at healthy levels.

How ATTR-CM Affects Vitamin A Levels

In ATTR-CM, transthyretin proteins become unstable and fold the wrong way.

 You can picture TTR protein folding like making a paper airplane. If you fold one wing in the opposite direction, your airplane won’t fly.
When TTR proteins don’t fold right, they can’t move like they should. Then, they build up in your organs, including your heart, says Tadeo Diaz Balderrama, MD, a cardiologist for SSM Health in Fond du Lac, Wisconsin.

 This can lead to symptoms of heart failure, like shortness of breath and swelling in your legs.

Vitamin A fits into this equation when you treat ATTR-CM with medications that decrease the amount of the TTR proteins that transport it.

“Vitamin A (retinol) does not circulate freely in the blood,” says Julia Zumpano, RD, who specializes in metabolic nutrition and clinical nutrition at Cleveland Clinic in Ohio. “Instead, retinol binds to a carrier protein called retinol-binding protein (RBP).”

 Then, this combination connects to TTR, which helps your body use vitamin A, says Zumpano.

ATTR-CM treatments work in two ways:

  • Stabilizers hold TTR proteins in place so they can’t fold incorrectly.
  • Silencers lower the amount of TTR proteins made by your liver.

“Silencers can cause a functional vitamin A deficiency since they reduce the overall production of TTR, the primary vitamin A protein transporter,” says Dr. Hicks.

ATTR-CM silencers include:

  • patisiran (Onpattro)
  • inotersen (Tegsedi)
  • vutrisiran (Amvuttra)

Why Vitamin A Is Important

You need vitamin A to keep all your organs running smoothly and your vision sharp.

 Vitamin A also plays an important role in your immune and reproductive systems.

As a vital building block in a protein called rhodopsin, vitamin A helps your eye respond to light levels and see better in low light. You can find vitamin A in foods like:

  • Salmon
  • Beef liver
  • Cantaloupe
  • Mango
  • Spinach
  • Sweet potatoes
  • Broccoli
  • Milk
  • Cheese
  • Eggs
But you can’t always get enough vitamin A through your diet alone when you have ATTR-CM. If you take a TTR silencer, your provider may also recommend a vitamin A supplement.

Signs of Vitamin A Deficiency to Watch For

If you notice symptoms of low vitamin A, let your provider know right away. Signs of vitamin A deficiency include:

  • Worse vision at night (“night blindness”)
  • More frequent infections (lung, gastrointestinal, or urinary)
  • Thick, rough skin on your knees, elbows, shoulders, or buttocks
  • Spots or wrinkles on the whites of your eyes

Your provider may check your vitamin A levels with a blood test. But a low vitamin A result doesn’t always mean this vitamin isn’t there, says Zumpano.

“The medication changes vitamin A transport in the bloodstream, so laboratory values can be harder to interpret than in people not taking these drugs,” says Zumpano, who relies on both symptoms and lab monitoring rather than simply trying to normalize blood levels with supplements.

How to Supplement Vitamin A Safely

The provider who prescribes your ATTR-CM medication will tell you how much vitamin A to take.

 “This supplement should be started with the first dose of the medication to prevent vitamin A deficiency,” says Jacqueline Dowe, MD, a cardiologist at Orlando Health Heart and Vascular Institute in Orlando, Florida.
Experts recommend taking 3,000 international units (IU) of vitamin A daily while taking a TTR-silencing medication.

 But too much vitamin A can cause its own issues, says Dr. Dowe.

Very high vitamin A levels can cause:

The FDA doesn’t approve over-the-counter supplements for safety or effectiveness, so when you buy vitamin A from your local store or online, you may not get what the label says. Certain supplements can also interact with other drugs, so always talk to your doctor before starting any new supplements.

To choose a quality supplement, check the label for USP, NSF, or ConsumerLab approval. This means the product has undergone third-party testing for quality and purity. You can also ask your provider for a prescription or a recommendation for vitamin A supplements.

It’s also important to take your vitamin A every day, says Dr. Balderrama, who doesn’t recommend taking it at any specific time of day. “The key is to be consistent with the supplementation.”

Questions to Ask Your Doctor

If you want to know more about how your ATTR-CM treatments might affect your vitamin A levels, you can ask your provider about it. At your next visit, bring a list of questions. These could include:

  • How often will you check my vitamin A levels?
  • What symptoms of low or high vitamin A should I tell you about right away?
  • How much vitamin A should I take every day?
  • Where can I get a vitamin A supplement I can trust?
  • What foods would you recommend I add to my diet for more vitamin A?

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Gregory SY. Vitamin A: What You Should Know About Supplements and ATTR-CM Treatments. Mayo Clinic. February 13, 2026.
  2. Transthyretin Amyloid Cardiomyopathy (ATTR-CM). American Heart Association. May 29, 2024.
  3. Hodge C et al. Vitamin A Deficiency. StatPearls. January 2, 2023.
  4. Kittleson MM et al. 2023 ACC Expert Consensus Decision Pathway on Comprehensive Multidisciplinary Care for the Patient With Cardiac Amyloidosis: A Report of the American College of Cardiology Solution Set Oversight Committee. JACC. January 23, 2023.
  5. Mortaji P et al. Chapter 4 - Biomarkers in Diabetic Kidney Disease. Kidney Biomarkers: Clinical Aspects and Laboratory Determination. 2020.
  6. Gregory SY. Managing ATTR-CM: Your Guide to Current Treatment Options. Mayo Clinic. February 13, 2026.
  7. Kittleson MM et al. Transthyretin Cardiac Amyloidosis Evaluation and Management: 2025 ACC Concise Clinical Guidance. JACC. October 31, 2025.
  8. Vitamin A and Carotenoids Fact Sheet for Consumers. Office of Dietary Supplements. March 10, 2025.
  9. Vitamin A and Carotenoids Fact Sheet for Health Professionals. Office of Dietary Supplements. March 10, 2025.
  10. Griffin JM et al. Current Landscape of Therapies for Transthyretin Amyloid Cardiomyopathy. JACC: Heart Failure. May 5, 2025.
  11. Margolin E et al. Current and Future Treatment Landscape of Transthyretin Amyloid Cardiomyopathy. Cardiology and Therapy. July 19, 2025.
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Chung Yoon, MD

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Chung Yoon, MD, is a noninvasive cardiologist with a passion for diagnosis, prevention, intervention, and treatment of a wide range of heart and cardiovascular disorders. He enjoys...
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