Do supplements help to prevent heart disease?

There is a lot of confusion about the role of supplements to prevent heart disease. But one thing is certain: it is big business, with lots of ads competing for our attention.  My patients often ask me about the pros and cons of taking supplements to prevent heart problems. Here are answers to their top five questions:

1.  “Will taking calcium supplements for osteoporosis worsen heart disease?”    
In 2013, a report in the British Medical Journal suggested that high calcium intake might increase a women’s chance of dying from a heart problem. As almost 60 percent of older American women take some form of calcium supplementation, this report scared a lot of people.  However, new information released in April 2016 now suggests that taking calcium is not harmful to the heart.  In the largest study to date, there was no association between calcium intake (and Vitamin D) and the risk of developing heart disease. The message:  If you need to take calcium for osteoporosis, it looks like it is safe for your heart.

2.  “Are fish oil supplements good or bad for the heart?“  
The truth is, we really don’t know.  More than 10 percent of Americans take fish oil to help their heart health.  We know that taking high quality omega 3 fatty acids (another name for fish oil) can lower triglyceride levels, and may slightly elevate HDL (good) cholesterol levels, but evidence that it will decrease the chance of having a heart attack is not convincing.  So, should someone still take these supplements?  New studies are in progress to definitively answer this question. Until then, the answer is probably yes, with a couple of provisos.  First, know that all fish oil is not the same.  The amount of two ingredients in the oil, DHA and EPA, is crucial, as they may decrease inflammation, decrease arthritis, and help lower triglycerides.  There are two prescription brands of omega 3 fatty acids available.  Over the counter fish oil is unregulated and may not contain any helpful ingredients, have an unpleasant aftertaste, and spoil in the heat.  The message:  if you take an omega 3 product, be careful what you buy as they are all not the same.

3.  “Do any supplements help high blood pressure?” 
A recent review concluded that the DASH and Mediterranean diets (low in salt, rich in fruits and vegetables) have clearly been shown to lower blood pressure, and some supplements may modestly help.  In particular, this review suggested that potassium, magnesium, L-arginine, vitamin C, cocoa flavonoids, beetroot juice, coenzyme Q10, controlled-release melatonin, and aged garlic extract have been used to help lower blood pressure. In my experience, the effect of any of these supplements is mild, and medications are often needed if dietary changes and exercise do not lower your blood pressure.  The message: effects of supplements used for high BP are modest at best, do not put off treatment if your pressure is high.

4.  “Should I be taking Vitamin D to help my heart?”   
Vitamin D is a hot topic these days. Vitamin D deficiency is very common, and has been associated with medical problems including depression, stroke and arthritis.  But, does taking a Vitamin D supplement actually help decrease your chance of developing heart disease?  Here are the facts:  Low vitamin D3 levels have been associated with an increased chance of developing heart disease and high blood pressure. If you have diabetes, then having a low vitamin D3 level is also associated with a high risk of having a cardiac problem.  But, at this time we do not know if taking a Vitamin D supplement will lower your risk. 

Several years ago, we routinely measured homocysteine levels in almost everyone, as they were associated with similar bad outcomes to those with low Vitamin D levels. But, studies have shown that even though having these high levels was associated with poor cardiac outcomes, supplementing with folic acid and B vitamins to lower homocysteine did not change cardiac risk.  Unfortunately, Vitamin D could be a similar situation. The message: Until more studies are done, we do not know for sure that taking Vitamin D helps.  But if you are deficient, there seems to be little downside to asking your doctor to check a Vitamin D3 level, and thinking about supplementing with Vitamin D 3 1000 units per day.  It is inexpensive, may help, and is unlikely to hurt.

5.  “Is taking aspirin every day a good idea?”  
We often do not think of aspirin as a supplement, but low dose aspirin, 81 mg per day, is crucial for someone who has had a heart attack, bypass surgery or stent.  (There seems to be no added benefit of taking higher doses.)  But, what about someone who is looking to prevent a heart problem?  New recommendations, released just a few weeks ago, suggest that taking 81 mg of aspirin per day is beneficial if you are an adult between 50 and 59 and have risk factors for heart disease.  But a caution: although low dose aspirin can prevent heart attacks, ischemic stroke and colon cancer, it can cause gastrointestinal bleeding and hemorrhagic strokes. If you are older than 60, the risks seem to outweigh the benefits.  This confusing recommendation points out the lack of consensus among health professionals when it comes to the pros and cons of preventive aspirin. The truth is we just don’t know. The message:  If you are between 50-60 years old and have cardiac risk factors, talk to your doctor about being on low dose aspirin. 

There just is not a lot of evidence that taking supplements other than calcium, vitamin D, omega 3 fatty acids and aspirin make a big difference.  Many people rely on other supplements such as phytosterols, co-enzyme Q 10, garlic, and niacin, but the jury is still out about any major long-term benefits.

Dr. David Becker is a board certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown, Pa. and has been in practice for 25 years. In 1993, after extensive research, Dr. Becker launched Healthy Change of Heart™, an innovative 10-week program designed to reverse heart disease and improve quality of life through diet, exercise, and stress management. Since then, thousands of patients have participated in the program, achieving significant results in improving cardiac wellness.

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