Advise Patients on Supplements for Cardiovascular Health

Many individuals try to take a proactive approach to their overall health and cardiovascular (CV) health by eating a balanced diet, exercising regularly, getting enough sleep, and reducing stress. Unfortunately, as the obesity epidemic increases, the number of individuals at risk for developing CV disease (CVD) also expands, and the growing number of individuals receiving a diagnosis of diabetes also raises the risk of CVD.¹

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According to findings from a recent study published in the Journal of the American Heart Association, between 1999 and 2020 there has been a 3-fold increase in obesity-related deaths from CVD.1 The authors indicated that obesity remains a global public health crisis and is a significant risk factor for CVD.1 According to 2023 American Heart Association statistics, obesity affects approximately 42% of the US population, an increase of almost 10% from the preceding decade.¹

Another recent publication indicated that nearly 50% of the US adult population reported using dietary supplements because they believed they would help prevent CVD.2 Because CVD continues to be the leading cause of preventable death among men and women in all racial and ethnic groups in the United States and globally, pharmacists are likely to encounter patients seeking advice on the various nutritional supplements marketed for the promotion of CV health. Pharmacists are in a pivotal position to advise patients about the proper selection and use of these supplements as well as encourage patients to discuss their risk factors for CVD and the appropriateness of using any nutritional supplements for CV health with their primary health care provider.

There are several nutritional supplements marketed for the promotion of CV health, including Ω-3 fatty acids, plant sterols coenzyme Q10, garlic, ginger, beetroot powder, resveratrol, turmeric, and specialty mineral and multivitamin supplements formulated with certain nutrients precisely targeted to promote heart health. These supplements are available in several formulations as singleentity or multi-ingredient products to meet the needs of a broad spectrum of individuals.²

Patients should also be encouraged to implement healthy lifestyle measures into their daily routine and be aware of the modifiable (blood pressure level, smoking, cholesterol level, diabetes, etc) and nonmodifiable risk factors (age, family history, and race) for CVD. Patients should also maintain routine health care to monitor and control cholesterol levels to lessen the risk of hyperlipidemia and maintain healthy blood pressure ranges, weight, and blood glucose levels. During counseling, pharmacists can remind patients that employing preventive measures by controlling modifiable risk factors early on can be instrumental in preventing and diminishing the risk of developing CVD.

RECENT NEWS AND CLINICAL DATA

Findings from a recent study published in BMJ revealed that vitamin D supplements may aid in protecting older adults from major adverse CV events, especially myocardial infarction and coronary revascularization, although the absolute risk was negligible.³ The authors also noted that further studies are needed, especially in individuals taking statins and other CV medications.³

In a dose-response meta-analysis published in the Journal of the American Heart Association, authors indicated that the ideal combined intake of Ω-3 fatty acids for lowering blood pressure level is probably between 2 and 3 g daily, although doses of Ω-3 fatty acid intake above the recommended 3 g daily may be linked with additional benefits in lowering blood pressure level among groups at elevated risk for CVD.⁴

In September 2023, the company Nutrartis announced the release of a new product known as Cardiosmile, a supplement formulated with scientifically proven natural plant sterols that are available in a liquid sachet format using water-dispersible phytosterols to provide a convenient and practical approach to supporting healthy cholesterol management and heart health. The product is intended to be added to beverages and food.⁵

A pivotal study conducted at the University of Manitoba in Winnipeg, Canada, validated the product’s ability to diminish low-density lipoprotein cholesterol level by 12% and triglyceride level by 14% within 28 days of daily use.⁵ Additionally, findings from a study published in Nutrients demonstrated that Cardiosmile decreased waist circumference in patients with metabolic syndrome, probably by beneficially regulating fatty acid and cholesterol metabolism.⁶

In a study published in Heart Lung and Circulation, researchers indicated that findings from some observational studies and randomized controlled trials (RCTs) have reported a correlation between calcium supplementation and augmented risk of CVD; however, the results have been inconsistent. As a result, researchers conducted a metaanalysis to ascertain the variances in associated risks of calcium supplementation with CVD and stroke documented in RCTs.⁷ Results revealed that the use of calcium supplementation was not associated with myocardial infarction, total stroke, heart failure admission, and CV/allcause mortality.⁷ The authors also indicated that additional studies are warranted to investigate any associations.⁷

CONCLUSION

Before recommending any supplements, pharmacists should always screen for potential drug or supplement interactions and contraindications. Individuals treated for chronic medical conditions and those taking other medications should be encouraged to consult their primary health care provider to ascertain the appropriateness of supplements and obtain their recommendations.

Although many patients elect to use nutritional supplements to meet their nutritional needs, patients must understand that the best tools to reduce modifiable CVD risk factors include adhering to a healthy diet that is low in fat, sugar, and refined carbohydrates; lifestyle measures such as exercising at least 30 minutes daily or 150 minutes weekly; smoking cessation and limited alcohol use; getting adequate sleep each night; managing stress; taking medications when needed; and monitoring blood pressure and cholesterol levels. Taking a proactive approach to CV health can be instrumental in lowering some risk factors for CVD.

Through effective patient education strategies, pharmacists can empower patients with knowledge about the significance of CV health to improve overall outcomes and health-related quality of life. Patients should be encouraged to discuss their individual CV risks with their primary health care provider and to devise a management plan tailored to their individual needs and risks.

About the Author

Yvette C. Terrie, BSPHARM, RPH, is a clinical pharmacist and medical writer based in northern Virginia.

References

1. Raisi-Estabragh Z, Kobo O, Mieres JH, et al. Racial disparities in obesityrelated cardiovascular mortality in the United States: temporal trends from 1999 to 2020. J Am Heart Assoc. 2023;12(18):e028409. doi:10.1161/JAHA.122.028409
2. Sunkara A, Raizner A. Supplemental vitamins and minerals for cardiovascular disease prevention and treatment. Methodist Debakey Cardiovasc J. 2019;15(3):179-184. doi:10.14797/mdcj-15-3-179
3. Thompson B, Waterhouse M, English DR, et al. Vitamin D supplementation and major cardiovascular events: D-Health randomised controlled trial. BMJ. 2023;381:e075230. doi:10.1136/bmj-2023-075230
4. Zhang X, Ritonja JA, Zhou N, Chen BE, Li X. Omega-3 polyunsaturated fatty acids intake and blood pressure: a dose-response meta-analysis of randomized controlled trials. J Am Heart Assoc. 2022;11(11):e025071.doi:10.1161/JAHA.121.025071
5. Nutrartis launches plant sterol to manage cholesterol and heart health. Nutraceutical Business Review. September 14, 2023. Accessed November 7, 2023. https://nutraceuticalbusinessreview.com/news/article_page/Nutrartis_launches_plant_sterol_to_manage_cholesterol_and_heart_health/211348
6. Palmeiro-Silva YK, Aravena RI, Ossio L, Fluxa JP. Effects of daily consumption of an aqueous dispersion of free-phytosterols nanoparticles on individuals with metabolic syndrome: a randomised, double-blind, placebo-controlled clinical trial. Nutrients. 2020;12(8):2392. doi:10.3390/nu12082392
7. Sim MG, Teo YN, Teo YH, et al. Association between calcium supplementation and the risk of cardiovascular disease and stroke: a systematic review and meta-analysis. Heart Lung Circ. 2023;S1443-9506(23)04281-6. doi:10.1016/j.hlc.2023.07.008