Help Patients Navigate Array of Heart Health Supplements

Although cardiovascular disease (CVD) continues to be the leading cause of death among all ethnic groups globally, including in the United States, many cases are preventable. “Heart disease is 90% treatable. Everyone can prevent heart disease anywhere in the world, especially by eating foods that are low in salt and cholesterol, exercising regularly, and not smoking. Even if a person has a family history of heart disease, we can still prevent and treat heart disease, thanks to incredible advances in medicine,” Leslie Cho, MD, section head for preventive cardiology and cardiac rehabilitation at Cleveland Clinic in Ohio, said recently.¹

Because many individuals take proactive roles in their overall health, pharmacists can help them select and use nutritional supplements marketed for cardiovascular health. Examples include coenzyme Q10 (CoQ10), garlic, omega-3 fatty acids, and plant sterols, as well as specialty mineral and multivitamin supplements that are formulated with a blend of essential nutrients specifically targeted for cardiovascular health.

Recent News and Clinical Studies

Research results show some supplements may decrease the risk of CVD, whereas others may cause harm to individuals with CVD risk factors. Findings from clinical trials have also produced mixed results.

Manufacturer Piper Biosciences recently released clinical data demonstrating the efficacy of its Cholesterol Wellness gummies, which contain plant sterols that help lower cholesterol. Results show that among participants who completed the 3-month study, there was a statistically significant (P =.03) reduction in low-density lipoprotein cholesterol (LDL-C) of 5.8%, and more than 90% of participants indicated interest in using the gummies long term if recommended by their physicians. The investigators concluded that supplementation with plant sterols can be effective in lowering LDL-C levels.²

Another recent publication on the Cleveland Clinic website explored the benefits associated with cardiovascular health supplements based on clinical data. The cardiologist featured in the article indicated that patients should always discuss the use of these supplements with their primary health care providers to ascertain appropriateness. The cardiologist also indicated that although some supplements may not be harmful, some may carry risks that can affect cardiac function.³

The results of a study assessing the use of CoQ10 in individuals with congestive heart failure show that participants who took 100 μg per day had fewer major adverse cardiac events than those who took a placebo.⁴ Although other studies that involved a small number of patients indicate that use of CoQ10 was associated with improvements in cardiovascular risk factors, such as blood glucose control, hyperlipidemia, and hypertension, more research is warranted.⁵

The results of a study published in the European Heart Journal indicated that individuals with vitamin D deficiency are more likely to have CVD and hypertension. The findings show that for participants with the lowest concentrations of vitamin D, the risk of CVD was more than double than in those with sufficient concentrations.⁶

However, the results of a meta-analysis of clinical trials and prospective cohort studies conducted by the American Heart Association (AHA) showed that mineral/multivitamin supplementation does not improve cardiovascular outcomes in the general population.⁷ The results of another AHA study showed that no effect was observed for commonly used multivitamins, vitamins C and D, calcium, and, to date, there is no conclusive evidence for the benefits of supplements. The authors of the study also noted that consuming plant-based food is a safe approach to increasing micronutrient intake.⁸

An article in Current Cardiology Reports noted that, despite the popular use of supplements, there is no evidence to support the routine supplementation of oral multivitamins and minerals for the prevention or treatment of CVD.⁹

Conclusion

Patients with preexisting medical conditions and/or those taking other medications should always consult their primary health care providers before using any supplements. Encourage patients to discuss individual nutritional needs based on their medical and medication history. During counseling, pharmacists can remind patients about the importance of knowing about and discussing their modifiable and nonmodifiable CVD risk factors, including blood pressure values, family history, and lipid levels with their primary health care providers. Pharmacists can also encourage patients to implement healthy dietary and lifestyle measures into their daily routine, lose weight if needed, and maintain routine health care visits, which are essential to overall cardiovascular health. It is also important to remind patients who use prescription medications for the prevention and treatment of CVD to adhere to these medications as directed by their primary health care providers.

Yvette C. Terrie, BSPharm, RPh, is a consulting pharmacist and a medical writer in Haymarket, Virginia.

References

1. 90 percent of heart disease is preventable through healthier diet, regular exercise, and not smoking. News release. Cleveland Clinic; September 29, 2021. Accessed January 12, 2022. https://newsroom.clevelandclinic.org/2021/09/29/90-percent-of-heart-disease-is-preventable-through-healthier-diet-regular-exercise-and-not-smoking/

2. Clinical study shows gummy containing plant sterols significantly lowers cholesterol. News release. Piper Biosciences; September 27, 2021. Accessed January 12, 2022. https://www.prnewswire.com/ news-releases/clinical-study-shows-gummy-containing-plant-sterols-significantly-lowers-cholesterol-301385051.html

3. Do heart health vitamins work? Cleveland Clinic. December 23, 2021. Accessed January 12, 2022. https://health.clevelandclinic.org/ heart-health-vitamins-ally-or-false-friend/

4. Mortensen AL, Rosenfeldt F, Filipiak KJ. Effect of coenzyme Q10 in Europeans with chronic heart failure: a sub-group analysis of the Q-SYMBIO randomized double-blind trial. Cardiol J. 2019;26(2):147- 156. doi:10.5603/CJ.a2019.0022

5. Ayers J, Cook J, Koenig RA, Sisson EM, Dixon DL. Recent developments in the role of coenzyme Q10 for coronary heart disease: a systematic review. Curr Atheroscler Rep. 2018;20(6):29. doi:10.1007/ s11883-018-0730-1

6. Zhou A, Selvanayagam JB, Hyppönen E. Non-linear Mendelian randomization analyses support a role for vitamin D deficiency in cardiovascular disease risk. Eur Heart J. Published online December 5, 2021. doi:10.1093/eurheartj/ehab809

7. Kim J, Choi J, Kwon SY, et al. Association of multivitamin and mineral supplementation and risk of cardiovascular disease: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2018;11(7):e004224. doi:10.1161/CIRCOUTCOMES.117.004224

8. Jenkins DJA, Spence JD, Giovannucci EL, et al. Supplemental vitamins and minerals for cardiovascular disease prevention and treatment: JACC Focus Seminar. J Am Coll Cardiol. 2021;77(4):423-436. doi:10.1016/j.jacc.2020.09.619

9. Ingles DP, Cruz Rodriguez JB, Garcia H. Supplemental vitamins and minerals for cardiovascular disease prevention and treatment. Curr Cardiol Rep. 2020;22(4):22. doi:10.1007/s11886-020-1270-1