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Heart Health Supplements: What Works and What Doesn’t

Heart disease is the leading cause of death for people of most racial and ethnic groups in the U.S., according to Centers for Disease Control and Prevention data. Cardiovascular diseases, or diseases that stem from the heart or blood vessels, affect an estimated 18.2 million U.S. adults. Approximately 695,000 people in the U.S. died from heart disease in 2021.

In the United States, dietary supplements contain one or more of the following ingredients: vitamins, minerals, amino acids, herbs or botanicals, enzymes, or dietary substances. Supplements can be consumed in many forms. They are not intended to treat, diagnose, cure, or prevent diseases.

Some supplements are not found in a typical diet. These substances are typically consumed to support a biological process, address a specific health need, or fill a deficiency. For example, adaptogens are natural substances derived from plants used by traditional herbal medicine practitioners to buffer against mental and physical stress.1

Supplements can support cardiovascular function, reduce risk factors for heart disease, and improve overall health and well-being. Supplements, if used, should supplement a heart-healthy lifestyle, including regular exercise and a nutritious, balanced diet. Over-consuming alcohol, using illegal drugs, smoking, and having poor stress management skills can increase your risk of heart disease.

Since the 1990s, interest in supplements has increased. Publications and scholarly articles discussing supplements have increased 100 fold. As information about supplements and their use increases, it is essential to look at the current research regularly as an understanding of supplement risks and benefits is quickly evolving.2  

Before starting a supplement, determine the likelihood that your diet is deficient in the supplement and that the supplement will fill its advertised purpose for you. If you take prescription or over-the-counter medications, talk to your doctor to verify whether a supplement is safe for you and not known to interact with medications you are taking.

Best Heart Health Supplements

Overall, information on vitamin supplements is readily available, but information on non-vitamins is less readily accessible. Few good-quality clinical trials focused on supplements are available. Questions about dosage standardization, selection bias, and a lack of controls abound. Interest in dietary supplements has increased as concerns about the availability and consumption of quality food have increased.2

Heart health supplements with the greatest evidence-based support include:

Omega-3 fatty acids

Omega-3 fatty acids are essential because they are not produced in the human body. Alpha-linolenic acid (ALA)is a plant-based omega-3 fatty acid that the body cannot produce on its own and must be obtained from the diet. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are primarily found in fatty fish and seafood. Omega-3 fatty acids are available in supplement forms.

DHA and EPA consumption can decrease triglyceride levels in the blood and increase high-density lipoprotein (HDL, good cholesterol). Omega-3 fatty acids can also decrease blood pressure in people with high blood pressure.

In one study, 11,000 participants took 850 mg of combined EPA and DHA daily for over three years. Researchers noted a 25% reduction in heart attacks and a 45% reduction in sudden death.8

More research is needed to determine whether omega-3 fatty acids prevent heart disease. Large randomized controlled studies support its benefits for people with heart disease. However, convincing evidence is lacking for people without heart disease.9

A wide variation in fish oil supplement quality and safety exists. The International Fish Oil Standards certification is a marker of transparency and quality consumers can use when choosing a fish oil supplement. Dosage recommendations vary from 500mg for everyday health benefits to 1,000 mg for people with heart disease and 4,000 mg per day for people with high triglycerides.10  Talk to your doctor before starting omega-3 fatty acid supplements, especially if you take medications to reduce your risk of blood clotting.

Foods rich in omega-3 fatty acids

Magnesium

Magnesium supports muscle and nerve function, calcium metabolism, and energy use. It is involved in over three hundred chemical reactions in the body. Americans consuming a Western-style diet consume less than 30% to 50% of the recommended daily allowance for magnesium. Dark, leafy greens are high in magnesium and calcium.15

Magnesium dilates blood vessels and, therefore, can help regulate blood pressure.14  Research supports the premise that magnesium deficiency is linked to high blood pressure and atherosclerosis (hardening of the arteries). Magnesium may improve blood vessel function and reduce inflammation.15 However, the total effect of magnesium on blood pressure is small.16

Magnesium also plays a role in stabilizing your heart rate and rhythm, according to the National Institutes of Health Office of Dietary Supplements. An analysis of studies indicated that magnesium supplementation could reduce the risk of ventricular and supraventricular arrhythmias.18 Low magnesium levels are associated with palpitations, arrhythmias, and heart failure.17

foods rich in fiber

Fiber

Soluble fiber can lower your cholesterol levels, especially low-density lipoproteins (LDLs). Soluble fibers bind to bile acids and cholesterol in your intestine, increasing their excretion in stool. Since cholesterol is used to produce bile acids, increasing bile acid excretion may reduce cholesterol levels.

Fiber may also improve gut microbiota, reduce blood pressure, improve colonic function, and reduce blood glucose.11

Observational and randomized controlled studies support the benefits of dietary fiber in reducing the risk of cardiovascular disease.

Fiber sources are generally plant-based foods. Approximately half of dietary fiber comes from cereals and one-third from fruits and vegetables.11 About 95% of U.S. adults do not consume the recommended amount of fiber in their diet.12

Folate

Folate or folic acid is a water-soluble B vitamin. Folate must be obtained from the diet and is found in both plant and animal sources. Folate is necessary for DNA synthesis and repair, red blood cell maturation, protein production, and cellular maturation and division.

Increased homocysteine levels are associated with heart disease. Folate is essential for homocysteine metabolism. Researchers believe that folate reduces the risk of heart disease by lowering homocysteine levels.19

In a review of 30 studies, researchers noted that folate supplementation reduced overall heart disease risk by 4% and stroke risk by 10%.20

Coenzyme Q10

Coenzyme Q10 (CoQ10) is involved in energy production in cells, and it functions as an antioxidant. CoQ10 is produced in the body and consumed in the diet. CoQ10 supplementation may improve mitochondrial function. Mitochondria are the power-producing organelles in cells.

Supplementing with CoQ10 may also improve heart muscle function and energy and, therefore, may be helpful in people with congestive heart failure. It may improve symptoms such as fatigue and shortness of breath.6 More research is needed. Benefits are not consistent across studies.7

foods rich in vitamin E

Vitamin E

Vitamin E is a fat-soluble vitamin that scavenges free radicals and protects lipids from oxidation. Vitamin E may prevent the formation of fatty plaques in the lining of blood vessels. Fatty plaques stiffen and narrow blood vessels. Reducing fatty plaques can lower the incidence of coronary artery disease and heart attacks. When blood vessels are narrowed and stiff, they are more likely to develop clots, which decrease blood flow to heart muscle.2

Study results:

  • In two studies, participants taking 100IU of vitamin E had a 37% to 41% decrease in heart disease risk.3,4
  • In another study, participants with a history of coronary artery disease taking 400IU to 800IU per day had a 77% decrease in non-fatal heart attacks.

The optimal dosage of these supplements to reduce heart disease risk is unclear. Recommended daily allowances (RDAs) are based on the amount of a substance required to prevent a specific nutritionally based disease or condition, which is not necessarily the optimal amount for health.2

Supplements to Avoid

Some supplements advertised for their heart health benefits do not have adequate scientific support for their claims. Others may actually worsen heart disease risk in select populations. Unless prescribed by your doctor, supplements to potentially avoid include the following.

L-Carnitine

The effectiveness and safety of L-carnitine for preventing and treating heart disease is unclear. Some studies suggest potential benefits, and others suggest harm. These variations in potential benefit may be because of genetic predisposition or sex based.21 More research is needed.  

Calcium

Calcium is essential for proper nerve and muscle function and for maintaining bone density. However, there is some evidence that calcium supplementation may increase the risk of heart disease by increasing calcium deposits in blood vessels.22

Dietary calcium does not seem to increase heart disease risk.22 To maximize calcium benefits and lower risks, consume calcium-rich foods such as dairy and green leafy vegetables instead of supplements. Talk to your doctor before starting or increasing calcium supplement use.

Grapefruit juice

Grapefruit juice is a healthy source of potassium and natural plant compounds called phytochemicals, specifically flavonoids, beta-carotene, and lycopene. This makes grapefruits an excellent dietary option for heart health. Grapefruit may improve total and low-density lipoprotein (LDL, bad) cholesterol. Since grapefruit is also rich in potassium and fiber, it can help lower blood pressure.23,24

The problem is that grapefruit, and grapefruit juice, can interfere with some medication’s metabolism. It inhibits cytochrome P450, an enzyme in your liver that metabolizes certain drugs and changes how some medications are absorbed from the intestine. This could increase or decrease your medication levels, causing side effects.

Caffeine 

Caffeine can raise blood pressure and heart rate and can increase the risk for abnormal heart rhythms, such as atrial fibrillation, in sensitive people. However, the evidence potentially linking caffeine to heart disease is lacking.

Studies indicate that average caffeine consumption, 400 to 600 mg of caffeine daily, does not have any effect on the heart or blood vessels.25 Some studies show that higher doses of caffeine reduce the risk of heart disease by changing enzyme activity and increasing LDL cholesterol transport from the blood to liver cells. This makes it possible to clear more cholesterol from the blood.

coffee press

How to Choose the Right Heart Health Supplement

There is convincing evidence that a heart-healthy lifestyle, including a nutritious diet and exercise, will have the greatest impact on your risk of heart disease. Several supplements, especially omega-3 fatty acids, magnesium, and fiber, can also decrease your risk for heart disease.  

All supplements do not have the same benefits and risks for everyone who takes them. Factors such as chronic health conditions, lifestyle choices, and medication use can affect whether a supplement will benefit your heart health. Contact a doctor on call or a registered dietician at Telegra MD to learn more about supplements and their potential benefits. Telehealth is a convenient option for a doctor’s visit that is typically less costly than an in-person visit. If your online doctor determines that a prescription medication is a better choice for you. They can write and transmit an online prescription to your local pharmacy. Online doctors frequently prescribe blood pressure medications, evaluate heart health, and develop personalized treatment plans to improve your heart health.

Supplements are not regulated in the same way as prescription medications. Choosing reputable brands that follow quality control standards and have undergone third-party testing is important. Look for certifications and seals such as the United States Pharmacopeia (USP) seal.

 Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References:

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2. Massey PB. Dietary supplements. Med Clin North Am. 2002 Jan;86(1):127-47. doi: 10.1016/s0025-7125(03)00076-2. PMID: 11795085.

3. Rimm, E. B., Stampfer, M. J., Ascherio, A., Giovannucci, E., Colditz, G. A., & Willett, W. C. (1993). Vitamin E consumption and the risk of coronary heart disease in men. New England Journal of Medicine328(20), 1450-1456.

4. Stampfer, M. J., Hennekens, C. H., Manson, J. E., Colditz, G. A., Rosner, B., & Willett, W. C. (1993). Vitamin E consumption and the risk of coronary disease in women. New England Journal of Medicine328(20), 1444-1449.

5. Stephens, N. G., Parsons, A., Brown, M. J., Schofield, P. M., Kelly, F., Cheeseman, K., & Mitchinson, M. J. (1996). Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). The Lancet347(9004), 781-786.

6. Gaby, A. R. (1996). The role of coenzyme Q10 in clinical medicine: Part II. Cardiovascular disease, hypertension, diabetes mellitus, and infertility. Altern Med Rev, 1(3), 168-175.

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8. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico. Lancet. 1999 Aug 7;354(9177):447-55. Erratum in: Lancet 2001 Feb 24;357(9256):642. Erratum in: Lancet. 2007 Jan 13;369(9556):106. PMID: 10465168.

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12. Quagliani D, Felt-Gunderson P. Closing America’s Fiber Intake Gap: Communication Strategies From a Food and Fiber Summit. Am J Lifestyle Med. 2016 Jul 7;11(1):80-85. doi: 10.1177/1559827615588079. PMID: 30202317; PMCID: PMC6124841.

13. Soliman GA. Dietary Fiber, Atherosclerosis, and Cardiovascular Disease. Nutrients. 2019; 11(5):1155. https://doi.org/10.3390/nu11051155

14. Murata, T., Dietrich, H.H., Horiuchi, T., Hongo, K., Dacey, R.G., 2016. Mechanisms of magnesium-induced vasodilation in cerebral penetrating arterioles. Neuroscience Research 107, 57–62.. https://doi.org/10.1016/j.neures.2015.12.005

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16. Dickinson HO, Nicolson D, Campbell F, Cook JV, Beyer FR, Ford GA, Mason J. Magnesium supplementation for the management of primary hypertension in adults. Cochrane Database of Systematic Reviews 2006: CD004640.

17. Tangvoraphonkchai K, Davenport A. Magnesium and Cardiovascular Disease. Adv Chronic Kidney Dis. 2018 May;25(3):251-260. doi: 10.1053/j.ackd.2018.02.010. PMID: 29793664.

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19. Bailey LB, Caudill MA. Folate. In: Erdman JW, Macdonald IA, Zeisel S.H., eds. Present Knowledge in Nutrition. 10th ed. Washington, DC: Wiley-Blackwell; 2012:321-42.

20. Li, Y., Huang, T., Zheng, Y., Muka, T., Troup, J., Hu, F.B., 2016. Folic Acid Supplementation and the Risk of Cardiovascular Diseases: A Meta‐Analysis of Randomized Controlled Trials. Journal of the American Heart Association 5, e003768.. https://doi.org/10.1161/jaha.116.003768

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25. Turnbull, D., Rodricks, J. V., Mariano, G. F. & Chowdhury, F. Caffeine and cardiovascular health. Regul. Toxicol. Pharm. 89, 165–185 (2017).

26. Lebeau, P.F., Byun, J.H., Platko, K. et al. Caffeine blocks SREBP2-induced hepatic PCSK9 expression to enhance LDLR-mediated cholesterol clearance. Nat Commun 13, 770 (2022). https://doi.org/10.1038/s41467-022-28240-9