Those of us who treat heart disease deal with controversies on a daily basis; but I am not sure that any topic provokes more passion and controversy than a discussion about the use of supplements for the treatment and prevention of cardiovascular (and other) disease. As medical doctors, we are trained to promote therapies grounded in ‘evidence” – that is, clinical trials and investigation. Unfortunately, most supplements and minerals have never been studied as thoroughly as drugs, so the “evidence” either for or against their use is lacking. Confusing this picture is that the proponents of supplement use may have an economic bias for their use, or their preference is based on their personal experience with a limited number of patients.
I am not a pharmacologist or nutritionist, but I do have an immense interest in any and all therapies that can improve my patients’ long-term health. Unfortunately, there is just not the evidence to recommend any specific supplement for the long-term prevention of cardiovascular disease, or any disease or complication for that matter. The preponderance of evidence suggests that eating a healthy and balanced diet, and of course improving lifestyle through weight control and exercise, is far more important than the potential effect of any specific supplement. This is even the case for a general multivitamin. This editorial article, which was just published in the last few months, summarizes the largest analysis to date of all the major research involving supplements in healthy patients. It summarizes a new analysis in over 100,000 subjects, and reaches the conclusion that none of the studied supplements can clearly prevent chronic disease. Fortunately very few of them are harmful as well (the exceptions are B-carotene and possibly Vitamin E, which may cause cancer). Here is a quote from the authors (including the Johns Hopkins School of Public Health):
In conclusion, β-carotene, vitamin E, and possibly high doses of vitamin A supplements are harmful. Other antioxidants, folic acid and B vitamins, and multivitamin and mineral supplements are ineffective for preventing mortality or morbidity due to major chronic diseases. Although available evidence does not rule out small benefits or harms or large benefits or harms in a small subgroup of the population, we believe that the case is closed— supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. Enough is enough.
For this reason, I do not recommend the routine use of supplements by any of my patients, including a daily multivitamin; but I don’t discourage their use, unless a specific interaction is seen that could be harmful. Certainly, for patients with a specific chronic condition, it is worth looking for nutritional deficiency that can contribute but that can only be done by your physician or care provider. Here is some information about specific supplements:
Folate, Vitamin B6, and B12: A well done study recently showed that these agents did not prevent vascular disease or cancer.
Fish Oil (omega-3 fatty acids): Here is our video which addresses the potential role of Fish Oil in prevention of heart disease.
Vitamin D: Vitamin D deficiency, diagnosed by a low blood level, is a potentially serious condition that benefits from replacement therapy. For those without a true deficiency, there does not seem to be a benefit to taking supplemental doses. Here is a recent article from USA Today which references a recent large study which pooled the results from 40 earlier studies. The conclusion is that Vitamin D supplementation does not seem to prevent chronic disease, except in those with a true deficiency documented by a blood test.
Selenium: The conclusion form the lead researcher of a recent study: “At this time, we cannot support using selenium supplements as a means of preventing cardiovascular disease in healthy people”.
We will address other specific supplements in future posts. In the meantime, consider skipping some (or all) of those supplements, and instead focus on daily activity (see article here) and a heart healthy diet (see article here). As always, we appreciate your comments and are happy to provide references.
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Hi, I don’t have the citation but didn’t Q10 show benefit in patients with heart failure several years ago? The first ‘supplement’ to show any advantage in cv health.
Although some early study suggested a benefit of coenzyme Q10, more thorough reviews have not really shown much benefit. This reference is to one of the largest “meta analyses” and concluded that there was no benefit in heart failure.
“Co-enzyme Q10 supplementation for the primary prevention of cardiovascular disease.”. The Cochrane database of systematic reviews 12: CD010405. PMID 25474484
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