Dietary supplements for heart health

It is well documented that eating a diet high in fruits, vegetables and whole grains is beneficial for heart health. These choices are optimal because they are high in fiber and nutrients and low in saturated and trans fats. In addition to a healthy diet, research indicates promising results from a few supplements, particularly for individuals who are at risk for or have cardiovascular disease, including those with high cholesterol or high blood pressure.

Omega-3 fatty acids have been researched for various reasons including heart health and inflammation. The two most common dietary forms of omega-3 are docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Both DHA and EHA have been shown to reduce the risk of an adverse event in those with coronary artery disease. The American Heart Association in 2010 urged federal governing bodies to make specific daily Dietary Reference Intakes (DRIs – minimal amounts) for EPA and DHA (consuming 250 to 500 mg/day), however to date there are still no formal DRIs for EPA and DHA.

Additional research indicates those with high cholesterol levels who consume 1,800 mg of EPA per day have a reduced risk of a cardiac event. Also, those with high triglycerides have improved levels by consuming 1,200-4,000 mg of DHA daily(4,5,6,7). These values are much higher than the proposed DRI, which most Americans are not even consuming. For Americans to obtain a protective benefit for their heart, it is imperative we change our diets to include fatty fish at least two times per week, such as 3-4 oz. salmon, herring, mackerel and albacore tuna(19). If Americans cannot meet the proposed DRIs with their food consumption, it may be beneficial to consider an omega-3 supplement. Omega-3 supplements are well tolerated and largely free from serious adverse effects, liver toxicity and drug-drug interactions. However, always speak to your physician before taking any new supplements. Omega-3 supplements are not recommended for those taking blood thinners, such as Coumadin.

When choosing an omega-3 supplement check to be sure the supplement contains 1-4g of omega-3's. Also, check the label to make sure it provides 250-500 mg each of EPA and DHA(20, 21). In addition, the bioavailability of supplements varies depending on the form of omega-3's. Be sure to look for a supplement that is listed as a triglyceride, the most bioavailable form. Lastly, be sure your supplement is third-party tested for a high quality product.

Co-enzyme Q10 (CoQ10) is another highly researched supplement considered for heart health. This stems from doctors observing that many patients with heart failure had low CoQ10 levels(9,10). Recently, a large multiyear clinical trial found that CoQ10 was safe for long-term use, reduced symptoms and major cardiac events(18). Additional research also indicates that CoQ10 taken alone or in addition to other anti-hypertensives may significantly lower blood pressure. Most of the research provided patients with 100-300 mg/day(15-17).

Additional Considerations:

The following supplements are touted to aid in heart health, however there is insufficient evidence to make any specific recommendations. Additional research is needed to determine how effective the following supplements are at promoting heart health.

Preliminary research on flax seed has shown a reduction in total cholesterol and low-density lipoprotein (LDL) cholesterol in healthy individuals and those with high cholesterol or peripheral artery disease(22-27). These studies included flax seeds in many varieties, including raw, ground and even flaxseed in bread and muffins.

Tumeric also has been shown to reduce total cholesterol, low-density lipoprotein (LDL) cholesterol, very low-density lipoprotein (VLDL) cholesterol and triglycerides in patients with elevated levels(29). Further research is needed to determine how frequently and how much would need to be consumed to see benefits.

Lastly, green tea or green tea extract appears to lower cholesterol, low-density lipoprotein (LDL) and triglycerides(28,30,31). Clinical research noted a decrease can be seen in patients with hyperlipidemia within 24 weeks if taken daily(32). As mentioned earlier, further research is needed for all of these additional considerations, however current research is showing promising results. Note there have been a few case studies of individuals taking weight loss supplements containing high amounts of green tea extract who had liver damage.

For more information on supplements visit: Operation Supplement Safety (OPSS).

About the authors: Patricia Deuster is professor and director, at the Consortium for Health and Military Performance (CHAMP), a Defense Department Center of Excellence; Melissa Rittenhouse is a nutritionist and exercise scientist with CHAMP (HJF contract employee); Andrea Lindsey is a senior nutrition scientist with CHAMP (HJF contract employee) and director of Operation Supplement Safety.

References

1. Obarzanek, E., et al., Effects on blood lipids of a blood pressure-lowering diet: the Dietary Approaches to Stop Hypertension (DASH) Trial. Am J Clin Nutr, 2001. 74(1): p. 80-9.
2. Sacks, F.M., et al., Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med, 2001. 344(1): p. 3-10.
3. Vollmer, W.M., et al., Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial. Ann Intern Med, 2001. 135(12): p. 1019-28.
4. Djousse, L., et al., Fish consumption, omega-3 fatty acids and risk of heart failure: a meta-analysis. Clin Nutr, 2012. 31(6): p. 846-53.
5. Mori, T.A., et al., Purified eicosapentaenoic and docosahexaenoic acids have differential effects on serum lipids and lipoproteins, LDL particle size, glucose, and insulin in mildly hyperlipidemic men. Am J Clin Nutr, 2000. 71(5): p. 1085-94.
6. Alexander, D.D., et al., A Meta-Analysis of Randomized Controlled Trials and Prospective Cohort Studies of Eicosapentaenoic and Docosahexaenoic Long-Chain Omega-3 Fatty Acids and Coronary Heart Disease Risk. Mayo Clin Proc, 2017. 92(1): p. 15-29.
7. O'Keefe, J.H., D. Jacob, and C.J. Lavie, Omega-3 Fatty Acid Therapy: The Tide Turns for a Fish Story. Mayo Clin Proc, 2017. 92(1): p. 1-3.
8. Backes, J., et al., The clinical relevance of omega-3 fatty acids in the management of hypertriglyceridemia. Lipids Health Dis, 2016. 15(1): p. 118.
9. Mortensen, S.A., et al., Coenzyme Q10: clinical benefits with biochemical correlates suggesting a scientific breakthrough in the management of chronic heart failure. Int J Tissue React, 1990. 12(3): p. 155-62.
10. Molyneux, S.L., et al., Coenzyme Q10: an independent predictor of mortality in chronic heart failure. J Am Coll Cardiol, 2008. 52(18): p. 1435-41.
11. Baggio, E., et al., Italian multicenter study on the safety and efficacy of coenzyme Q10 as adjunctive therapy in heart failure (interim analysis). The CoQ10 Drug Surveillance Investigators. Clin Investig, 1993. 71(8 Suppl): p. S145-9.
12. Lampertico, M. and S. Comis, Italian multicenter study on the efficacy and safety of coenzyme Q10 as adjuvant therapy in heart failure. Clin Investig, 1993. 71(8 Suppl): p. S129-33.
13. Morisco, C., B. Trimarco, and M. Condorelli, Effect of coenzyme Q10 therapy in patients with congestive heart failure: a long-term multicenter randomized study. Clin Investig, 1993. 71(8 Suppl): p. S134-6.
14. Rengo, F., et al., Role of metabolic therapy in cardiovascular disease. Clin Investig, 1993. 71(8 Suppl): p. S124-8.
15. Ho, M.J., A. Bellusci, and J.M. Wright, Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension. Cochrane Database Syst Rev, 2009(4): p. CD007435.
16. Singh, R.B., et al., Effect of hydrosoluble coenzyme Q10 on blood pressures and insulin resistance in hypertensive patients with coronary artery disease. J Hum Hypertens, 1999. 13(3): p. 203-8.
17. Langsjoen, P., et al., Treatment of essential hypertension with coenzyme Q10. Mol Aspects Med, 1994. 15 Suppl: p. S265-72.
18. Mortensen, S.A., et al., The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial. JACC Heart Fail, 2014. 2(6): p. 641-9.
19. The American Heart Association: http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/HealthyDietGoals/Fish-and-Omega-3-Fatty-Acids_UCM_303248_Article.jsp#.WLQtttIrLIU
20. Kris-Etherton PM Harris WS and Appel LJ for the American Heart Association Nutrition Committee (2002). Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease [published correction appears in Circulation 2003;107:512]. Circulation 106:2747-2757.
21. American Heart Association. https://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_312853.pdf
22. Cunnane SC, Ganguli S, Menard C, et al. High alpha-linolenic acid flaxseed (Linum usitatissimum): some nutritional properties in humans. Br J Nutr 1993;69:443-53.
23. Demark-Wahnefried W, Robertson CN, Walther PJ, et al. Pilot study to explore effects of low-fat, flaxseed-supplemented diet on proliferation of benign prostatic epithelium and prostate-specific antigen. Urology 2004;63:900-4.
24. Bierenbaum ML, Reichstein R, Watkins TR. Reducing atherogenic risk in hyperlipemic humans with flaxseed supplementation: a preliminary report. J Am Coll Nutr 1993;12:501-4.
25. Jenkins DJ, Kendall CW, Vidgen E, et al. Health aspects of partially defatted flaxseed, including effects on serum lipids, oxidative measures, and ex vivo androgen and progestin activity: a controlled, crossover trial. Am J Clin Nutr 1999;69:395-402.
26. Pan A, Yu D, Demark-Wahnefried W, et al. Meta-analysis of the effects of flaxseed interventions on blood lipids. Am J Clin Nutr 2009;90:288-97.
27. Edel AL, Rodriguez-Leyva D, Maddaford TG, Caligiuri SP, Austria JA, Weighell W, Guzman R, Aliani M, Pierce GN. Dietary flaxseed independently lowers circulating cholesterol and lowers it beyond the effects of cholesterol-lowering medications alone in patients with peripheral artery disease. J Nutr. 2015 Apr;145(4):749-57.
28. Imai K. Nakachi K. Cross-sectional study of effects of drinking green tea on cardiovascular and liver diseases. BMJ 1995;310:693-6.
29. Effects of curcumin on HDL functionality. Pharmacological Research 2017; May 119: 208-218. http://dx.doi.org.lrc1.usuhs.edu/10.1016/j.phrs.2017.02.008.
30. Kim A, Chiu A, Barone MK, et al. Green tea catechins decrease total and low-density lipoprotein cholesterol: a systematic review and meta-analysis. J.Am.Diet.Assoc. 2011;111:1720-1729.