Introduction
Cardiovascular disease remains the leading cause of death worldwide, prompting many people to turn to supplements for heart health. While a healthy lifestyle, including a balanced diet and regular exercise, is crucial for maintaining cardiovascular health, some individuals may consider using supplements to fill nutritional gaps or provide additional support. However, navigating the world of supplements can be challenging, as the evidence surrounding their efficacy and safety varies widely.
In recent years, numerous studies have investigated the potential benefits and risks of various supplements for heart health, including multivitamins, antioxidants, omega-3 fatty acids, and fiber. While some research suggests that certain supplements may help lower cholesterol levels, reduce inflammation, or support overall cardiovascular function, other studies have found no significant benefit or even potential harm associated with supplement use.
This article aims to provide a comprehensive overview of the current evidence on supplements for heart health, examining the potential benefits, risks, and limitations of popular supplements such as multivitamins, antioxidants, folic acid, omega-3 fatty acids, and fiber. By exploring the latest research findings and expert recommendations, readers can make informed decisions about whether to incorporate supplements into their heart-healthy lifestyle and discuss their individual needs with a healthcare provider.
Multivitamins and Minerals
Multivitamins and multiminerals (MVMMs) are the most commonly consumed dietary supplements among adults in the United States, with 49% reporting use (Kantor et al., 2016). Despite their popularity, the evidence supporting the use of MVMMs for cardiovascular disease (CVD) prevention is limited.
The Physicians’ Health Study II (PHS II), a large-scale, randomised, placebo-controlled trial, investigated the effects of daily multivitamin supplementation on major cardiovascular events (MACE) in 14,641 male physicians aged ≥50 years (Sesso et al., 2012). After a median follow-up of 11.2 years, the study found no significant benefit of MVMMs over placebo on MACE, cardiovascular mortality, or total mortality (Sesso et al., 2012).
Similarly, the U.S. Preventive Services Task Force (USPSTF) conducted a systematic review of the evidence on vitamin and mineral supplements for the primary prevention of CVD and cancer (Moyer, 2014). Based on the available evidence, the USPSTF currently does not recommend the use of multivitamins for the prevention of cardiovascular diseases (Moyer, 2014).
Potential Risks and Limitations
While multivitamins are generally considered safe when taken as directed, it is essential to be aware of potential risks and limitations:
- Interactions with medications: Some vitamins and minerals can interact with prescription medications, potentially reducing their effectiveness or causing adverse effects (Sunkara & Raizner, 2019).
- Excessive intake: Consuming high doses of certain vitamins and minerals through supplements can lead to toxicity and adverse health effects (Sunkara & Raizner, 2019).
- False sense of security: Relying on supplements may lead individuals to neglect other important aspects of a heart-healthy lifestyle, such as maintaining a balanced diet and engaging in regular physical activity (Victor Chang Cardiac Research Institute, 2023).
Antioxidants
Antioxidants, such as vitamins A, C, E, and beta-carotene, have been studied for their potential role in CVD risk modification. The rationale behind their use stems from their ability to prevent oxidative damage to macromolecules like low-density lipoprotein (LDL) cholesterol, which is involved in the development of atherosclerosis (Diplock, 1994).
However, clinical trials have yielded mixed results regarding the efficacy of antioxidant supplements for CVD prevention. The SU.VI.MAX study, a randomised, double-blind, placebo-controlled trial, investigated the effects of a daily antioxidant supplement containing vitamins C and E, beta-carotene, selenium, and zinc on CVD incidence in 13,017 French adults (Hercberg et al., 2004). After a median follow-up of 7.5 years, the study found no significant differences in all-cause mortality or incidence of ischemic cardiovascular disease between the antioxidant supplement and placebo groups (Hercberg et al., 2004).
A recent meta-analysis of 15 randomised controlled trials (RCTs) also found no significant benefit of antioxidants for CVD prevention or treatment (Jenkins et al., 2018). In fact, the analysis showed a trend towards increased all-cause mortality in those taking antioxidant supplements (Jenkins et al., 2018).
Potential Risks and Limitations
- Increased mortality risk: Some studies have suggested that high-dose antioxidant supplements may increase the risk of all-cause mortality (Jenkins et al., 2018).
- Interference with other treatments: Antioxidant supplements may interfere with the effectiveness of certain cancer treatments, such as chemotherapy and radiation therapy (Sunkara & Raizner, 2019).
- Lack of regulation: Dietary supplements are not subject to the same rigorous testing and regulation as prescription medications, making it difficult to ensure their purity, potency, and safety (Sunkara & Raizner, 2019).
Folic Acid
Folic acid, a B-vitamin, has been investigated for its potential role in reducing cardiovascular risk by lowering plasma levels of homocysteine, an amino acid positively associated with increased CVD risk (Boushey et al., 1995; Ganguly & Alam, 2015).
The China Stroke Primary Prevention Trial (CSPPT), a large-scale RCT involving 20,702 adults with hypertension, examined the effects of enalapril, a blood pressure-lowering medication, with or without folic acid supplementation on the risk of stroke (Huo et al., 2015). The study found that the combination of enalapril and folic acid significantly reduced the risk of first stroke by 21% compared to enalapril alone, particularly in participants with low baseline folate levels (Huo et al., 2015).
However, it is important to note that the CSPPT was conducted in China, where there is no mandatory folic acid fortification of food, and the population has lower baseline folate levels compared to countries with fortification programs, such as the United States and Australia (Huo et al., 2015). Therefore, the generalisability of these findings to populations with higher baseline folate levels may be limited.
Potential Risks and Limitations
- Limited generalisability: The benefits of folic acid supplementation may be more pronounced in populations with low baseline folate levels, such as those in countries without mandatory folic acid fortification (Huo et al., 2015).
- Masking vitamin B12 deficiency: High intake of folic acid can mask the symptoms of vitamin B12 deficiency, potentially leading to delayed diagnosis and treatment (Sunkara & Raizner, 2019).
- Interactions with medications: Folic acid supplements may interact with certain medications, such as anticonvulsants and methotrexate, potentially reducing their effectiveness (Sunkara & Raizner, 2019).
Omega-3 Fatty Acids and Fish Oil
Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been studied for their potential cardioprotective effects. These fatty acids, found in fatty fish and fish oil supplements, may help lower triglycerides, increase high-density lipoprotein (HDL) cholesterol, and slightly lower blood pressure (Sunkara & Raizner, 2019).
Prescription fish oil, containing high doses of EPA and DHA, is used to treat severe triglyceride disorders, not high cholesterol (Sunkara & Raizner, 2019). These medications can reduce triglyceride levels by 30-50% in individuals with levels ≥500 mg/dL (Sunkara & Raizner, 2019). However, over-the-counter fish oil supplements may contain lower doses of active ingredients and unwanted saturated fats that could increase LDL cholesterol levels (Sunkara & Raizner, 2019).
The evidence supporting the use of fish oil supplements for CVD prevention in the general population is mixed. A recent meta-analysis of 79 RCTs found that omega-3 fatty acid supplementation had little or no effect on cardiovascular mortality, coronary heart disease events, or major vascular events (Abdelhamid et al., 2020).
Potential Risks and Limitations
- Increased LDL cholesterol: Some over-the-counter fish oil supplements may contain saturated fats that can increase LDL cholesterol levels (Sunkara & Raizner, 2019).
- Interactions with medications: Omega-3 fatty acids can interact with blood thinners, such as warfarin, increasing the risk of bleeding (Sunkara & Raizner, 2019).
- Contaminants: Fish oil supplements may contain contaminants, such as mercury and polychlorinated biphenyls (PCBs), which can have harmful health effects (Sunkara & Raizner, 2019).
Fiber
Dietary fiber, particularly soluble fiber, has been shown to help improve LDL cholesterol levels, control blood sugar, and decrease the risk of type 2 diabetes (Hodson, 2023). While it is best to obtain fiber through a diet rich in fruits, vegetables, whole grains, and legumes, some individuals may benefit from fiber supplements if they struggle to meet their daily fiber needs through diet alone (Hodson, 2023).
A meta-analysis of 28 RCTs found that soluble fiber supplementation significantly reduced total and LDL cholesterol levels in both healthy individuals and those with hypercholesterolemia (Surampudi et al., 2016). The analysis also found that higher doses of soluble fiber (>3 g/day) and longer durations of supplementation (>4 weeks) were associated with greater reductions in cholesterol levels (Surampudi et al., 2016).
However, it is essential to note that fiber supplements should not be used as a substitute for a healthy diet and lifestyle. Consuming a variety of fiber-rich foods provides additional nutrients and health benefits that may not be obtained through supplements alone (Hodson, 2023).
Potential Risks and Limitations
- Gastrointestinal side effects: Fiber supplements can cause gastrointestinal side effects, such as bloating, gas, and abdominal discomfort, particularly when initiated at high doses (Hodson, 2023).
- Interactions with medications: Fiber supplements may interact with certain medications, such as antidepressants and cholesterol-lowering drugs, potentially reducing their absorption and effectiveness (Hodson, 2023).
- Choking risk: Fiber supplements in tablet or capsule form can pose a choking risk, particularly in older adults or those with swallowing difficulties (Hodson, 2023).
Magnesium
Magnesium is an essential mineral involved in numerous physiological processes, including heart function. Higher magnesium intake has been associated with a lower risk of diabetes, high blood pressure, and metabolic syndrome (Sunkara & Raizner, 2019).
A 2022 study published in Scientific Reports investigated the effects of daily magnesium supplementation on cardiometabolic markers in individuals with prediabetes (Salehidoost et al., 2022). The double-blind, randomised controlled trial found that 12 weeks of magnesium supplementation (250 mg/day) was associated with a significant increase in HDL cholesterol levels compared to placebo (Salehidoost et al., 2022).
However, more research is needed to determine the optimal dosage and duration of magnesium supplementation for cardiovascular health, as well as its long-term effects on CVD risk and outcomes.
Potential Risks and Limitations
- Gastrointestinal side effects: High doses of magnesium supplements can cause diarrhoea, nausea, and abdominal cramping (Sunkara & Raizner, 2019).
- Interactions with medications: Magnesium supplements can interact with certain medications, such as antibiotics and diuretics, potentially reducing their effectiveness or increasing the risk of side effects (Sunkara & Raizner, 2019).
- Kidney function: Individuals with impaired kidney function may be at risk of magnesium toxicity when taking supplements, as the kidneys play a crucial role in regulating magnesium balance (Sunkara & Raizner, 2019).
Coenzyme Q10 (CoQ10)
Coenzyme Q10 (CoQ10) is an antioxidant naturally produced by the body and involved in energy production within cells. Some studies suggest that CoQ10 supplementation may help lower blood pressure and reduce the side effects of statin drugs, such as muscle pain and weakness (Sunkara & Raizner, 2019).
However, the evidence supporting the use of CoQ10 for CVD prevention or treatment is limited. A meta-analysis of 12 RCTs found that CoQ10 supplementation had no significant effect on CVD risk factors, such as total cholesterol, LDL cholesterol, HDL cholesterol, or triglycerides (Flowers et al., 2014).
Additionally, while some individuals take CoQ10 to help alleviate statin-induced muscle pain, the overall scientific evidence does not support its use for this purpose (Sunkara & Raizner, 2019).
Potential Risks and Limitations
- Interactions with medications: CoQ10 can interact with blood thinners, such as warfarin, potentially increasing the risk of bleeding (Sunkara & Raizner, 2019).
- Lack of regulation: As with other dietary supplements, CoQ10 products are not subject to the same rigorous testing and regulation as prescription medications, making it difficult to ensure their purity, potency, and safety (Sunkara & Raizner, 2019).
- Limited evidence: While some studies suggest potential benefits of CoQ10 supplementation for cardiovascular health, the overall evidence is limited, and more research is needed to establish its efficacy and safety (Flowers et al., 2014).
Conclusion
In summary, the current evidence fails to support the use of most vitamin and mineral supplements for the prevention or treatment of cardiovascular disease (Sunkara & Raizner, 2019). While some supplements, such as folic acid and magnesium, may offer potential benefits for specific populations or individuals with certain risk factors, the overall evidence for their efficacy in CVD prevention is limited.
It is important to emphasise that a healthy diet rich in fruits, vegetables, whole grains, and lean proteins remains one of the best defences against heart disease (Victor Chang Cardiac Research Institute, 2023). Supplements should be used to address existing nutrient deficiencies identified through blood tests and should be discussed with a healthcare provider to ensure safety and appropriateness (Victor Chang Cardiac Research Institute, 2023; Sunkara & Raizner, 2019).
Certain dietary modifications, such as consuming fatty fish, increasing fiber intake, and maintaining adequate magnesium levels through diet or supplementation, may provide some heart health benefits (Sunkara & Raizner, 2019; Hodson, 2023). However, it is crucial to approach supplements with caution, as they can interact with medications, cause adverse effects, and may not be subject to the same rigorous regulation as prescription drugs (Sunkara & Raizner, 2019).
Ultimately, the decision to use supplements for heart health should be made in consultation with a healthcare provider, taking into account an individual’s unique risk factors, dietary habits, and medical history. By prioritising a healthy lifestyle and evidence-based interventions, individuals can take proactive steps towards maintaining cardiovascular health and reducing their risk of heart disease.
Conclusion
The current evidence surrounding supplements for heart health is complex and often inconclusive. While some supplements, such as folic acid and magnesium, have shown potential benefits in specific populations or for certain cardiovascular risk factors, the overall efficacy of most vitamin and mineral supplements in preventing or treating cardiovascular disease remains limited.
It is crucial to emphasise that a healthy diet, rich in fruits, vegetables, whole grains, and lean proteins, is one of the most powerful tools in maintaining cardiovascular health. Supplements should not be viewed as a substitute for a balanced diet and lifestyle, but rather as a targeted approach to address specific nutrient deficiencies, as identified through blood tests and in consultation with a healthcare provider.
Certain dietary modifications, such as increasing intake of fatty fish, fiber, and magnesium-rich foods, may offer some benefits for heart health. However, it is essential to approach supplements with caution, as they can interact with medications, cause adverse effects, and are not subject to the same rigorous regulation as prescription drugs.
Ultimately, the decision to incorporate supplements into a heart-healthy lifestyle should be made on an individual basis, taking into account personal risk factors, dietary habits, and medical history. By prioritising evidence-based interventions and working closely with healthcare providers, individuals can take proactive steps towards maintaining cardiovascular health and reducing their risk of heart disease.
Key Highlights and Actionable Tips
- No vitamin can prevent heart disease if you don’t control other risk factors like poor diet, smoking, high cholesterol, and diabetes.
- Some studies suggest certain vitamins like folic acid, vitamin C, and vitamin E may lower heart disease risk, but larger clinical trials haven’t proven this definitively.
- The American Heart Association and US Preventive Services Task Force don’t advise taking vitamins to prevent heart disease.
- Most healthy people who eat a good diet don’t need a daily vitamin supplement.
- The best way to protect your heart is to eat a healthy diet with plenty of vegetables, fruits, nuts, healthy oils, whole grains, and fish, while limiting salt, added sugars, trans fats, and saturated fats.
Can taking a multivitamin make up for an unhealthy diet?
No, taking a multivitamin cannot compensate for an unhealthy diet. While vitamins and minerals are essential nutrients, they are best obtained through eating a variety of nutritious whole foods. Supplements should not be relied upon as a substitute for a balanced diet. Focus on improving your overall eating pattern with plenty of fruits, vegetables, whole grains, lean proteins, and healthy fats to support heart health.
Are there any vitamins that have been proven to prevent heart attacks?
Currently, there is insufficient evidence to recommend any specific vitamin supplement for the prevention of heart attacks. While some observational studies have suggested potential benefits for certain vitamins like folic acid, vitamin C, and vitamin E, larger randomised controlled trials have not consistently supported these findings. The most effective way to reduce heart attack risk is to manage known risk factors through lifestyle changes and medical treatment as needed.
Should I have my vitamin D level checked for heart health?
Some research has shown a link between low vitamin D levels and heart disease, but most studies have not found that vitamin D supplementation lowers the risk of heart disease or related complications. Routine vitamin D testing is not currently recommended for heart disease prevention. However, if you have concerns about your vitamin D status or risk factors for deficiency, it’s best to discuss this with your healthcare provider, who can assess your individual situation and advise on the need for testing or supplementation.
Can taking fish oil supplements help protect against heart disease?
Fish oil supplements, which contain omega-3 fatty acids, have been studied for their potential cardiovascular benefits. Some research suggests they may help lower triglyceride levels and slightly raise “good” HDL cholesterol. However, the overall evidence for fish oil supplements in preventing heart disease is mixed, and they are not routinely recommended for this purpose. Eating fish as part of a healthy diet is generally the preferred way to obtain omega-3s. If you’re considering fish oil supplements, it’s important to discuss this with your healthcare provider first.
Are there any vitamins or supplements that could interfere with my heart medications?
Yes, some supplements can interact with heart medications, potentially altering their effectiveness or causing adverse effects. For example, vitamin K can interfere with the action of blood-thinning medications like warfarin, while certain herbal supplements like St. John’s wort can interact with a variety of drugs. It’s crucial to inform your healthcare provider about all the supplements you are taking or considering, so they can assess the safety and appropriateness of these products in combination with your prescribed medications. Do not start or stop any supplements without first consulting your healthcare team.
References
Boden, W. E., Probstfield, J. L., Anderson, T., Chaitman, B. R., Desvignes-Nickens, P., Koprowicz, K., McBride, R., Teo, K., & Weintraub, W. (2011). Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. New England Journal of Medicine, 365(24), 2255-2267. https://doi.org/10.1056/nejmoa1107579
Boushey, C. J., Beresford, S. A., Omenn, G. S., & Motulsky, A. G. (1995). A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes. JAMA, 274(13), 1049-1057. https://doi.org/10.1001/jama.1995.03530130055028
Diplock, A. T. (1994). Antioxidants and disease prevention. Molecular Aspects of Medicine, 15(4), 293-376. https://doi.org/10.1016/0098-2997(94)90005-1
Ganguly, P., & Alam, S. F. (2015). Role of homocysteine in the development of cardiovascular disease. Nutrition Journal, 14, 6. https://doi.org/10.1186/1475-2891-14-6
Hennekens, C. H., Buring, J. E., Manson, J. E., Stampfer, M., Rosner, B., Cook, N. R., Belanger, C., LaMotte, F., Gaziano, J. M., Ridker, P. M., Willett, W., & Peto, R. (1996). Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease. New England Journal of Medicine, 334(18), 1145-1149. https://doi.org/10.1056/nejm199605023341801
Hercberg, S., Galan, P., Preziosi, P., Bertrais, S., Mennen, L., Malvy, D., Roussel, A. M., Favier, A., & Briançon, S. (2004). The SU.VI.MAX Study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Archives of Internal Medicine, 164(21), 2335-2342. https://doi.org/10.1001/archinte.164.21.2335
Huo, Y., Li, J., Qin, X., Huang, Y., Wang, X., Gottesman, R. F., Tang, G., Wang, B., Chen, D., He, M., Fu, J., Cai, Y., Shi, X., Zhang, Y., Cui, Y., Sun, N., Li, X., Cheng, X., Wang, J., … Hou, F. F. (2015). Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial. JAMA, 313(13), 1325-1335. https://doi.org/10.1001/jama.2015.2274
Jenkins, D. J. A., Spence, J. D., Giovannucci, E. L., Kim, Y. I., Josse, R., Vieth, R., Blanco Mejia, S., Viguiliouk, E., Nishi, S., Sahye-Pudaruth, S., Paquette, M., Patel, D., Mitchell, S., Kavanagh, M., Tsirakis, T., Bachiri, L., Maran, A., Umatheva, N., McKay, T., … Sievenpiper, J. L. (2018). Supplemental Vitamins and Minerals for CVD Prevention and Treatment. Journal of the American College of Cardiology, 71(22), 2570-2584. https://doi.org/10.1016/j.jacc.2018.04.020
Kantor, E. D., Rehm, C. D., Du, M., White, E., & Giovannucci, E. L. (2016). Trends in Dietary Supplement Use Among US Adults From 1999-2012. JAMA, 316(14), 1464-1474. https://doi.org/10.1001/jama.2016.14403
Lee, I. M., Cook, N. R., Manson, J. E., Buring, J. E., & Hennekens, C. H. (1999). Beta-carotene supplementation and incidence of cancer and cardiovascular disease: the Women’s Health Study. Journal of the National Cancer Institute, 91(24), 2102-2106. https://doi.org/10.1093/jnci/91.24.2102
Lee, I. M., Cook, N. R., Gaziano, J. M., Gordon, D., Ridker, P. M., Manson, J. E., Hennekens, C. H., & Buring, J. E. (2005). Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women’s Health Study: a randomized controlled trial. JAMA, 294(1), 56-65. https://doi.org/10.1001/jama.294.1.56
Lonn, E., Bosch, J., Yusuf, S., Sheridan, P., Pogue, J., Arnold, J. M., Ross, C., Arnold, A., Sleight, P., Probstfield, J., Dagenais, G. R., & HOPE and HOPE-TOO Trial Investigators (2005). Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA, 293(11), 1338-1347. https://doi.org/10.1001/jama.293.11.1338
Moyer, V. A., & U.S. Preventive Services Task Force (2014). Vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer: U.S. Preventive services Task Force recommendation statement. Annals of Internal Medicine, 160(8), 558-564. https://doi.org/10.7326/M14-0198
Omenn, G. S., Goodman, G. E., Thornquist, M. D., Balmes, J., Cullen, M. R., Glass, A., Keogh, J. P., Meyskens, F. L., Jr, Valanis, B., Williams, J. H., Jr, Barnhart, S., Cherniack, M. G., Brodkin, C. A., & Hammar, S. (1996). Risk factors for lung cancer and for intervention effects in CARET, the Beta-Carotene and Retinol Efficacy Trial. Journal of the National Cancer Institute, 88(21), 1550-1559. https://doi.org/10.1093/jnci/88.21.1550
Sesso, H. D., Christen, W. G., Bubes, V., Smith, J. P., MacFadyen, J., Schvartz, M., Manson, J. E., Glynn, R. J., Buring, J. E., & Gaziano, J. M. (2012). Multivitamins in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial. JAMA, 308(17), 1751-1760. https://doi.org/10.1001/jama.2012.14805
