A month to change your heart: Day 15

Many people take supplements, often without telling their doctors. But which supplements are proven to help the heart?  Let’s go over some of the important supplements that you should know about.

Red yeast rice is a naturally occurring product that was first used in ancient Chinese medicine in the year 700 A.D.  I first became interested in this supplement when a few of my patients told me about it.  These patients had stopped their statin, often because of side effects, and their cholesterol levels were just as good because they had started taking red yeast rice.  Since then, patients who have gone through the Healthy Change of Heart Program have participated in four research studies that have shown:

  1. Participants who were taking red yeast rice and omega 3 fatty acids, along with making lifestyle changes, were able to decrease their cholesterol levels 43%, the same as people taking simvastatin
  2. Red yeast rice seems to cause less muscle aching than statins
  3. It is an over the counter supplement, not well regulated, and not all preparations are the same
  4. The correct amount to take is 2 pills twice per day, each pill is 600 mg
  5. You should never take red yeast rice with any statin, as they work in a similar manner
  6. All of these studies were done in participants who had no known coronary artery disease, so we do not know if red yeast rice is good for someone with a history of heart attack, bypass surgery, stents, or stroke- we do know that statins for these folks are safe and effective

If you want to read more about red yeast rice, all of the studies can be viewed here.

Another important supplement for the heart is omega 3 fatty acids. I believe they continue to be an important supplement, at doses of 1-2 grams once or twice per day, to both prevent and treat coronary disease.  Though this has been controversial in recent years, as several trials have found no clear beneficial effect.  High quality omega 3’s can help with inflammation, may help mildly raise HDL and will dramatically lower triglycerides. There are several omega 3’s that are available by prescription only, and also some excellent brands that are available over the counter. 

Co-enzyme Q10 may help the muscle cramping and aching that some people experience with statins.  I continue to recommend them to people with that problem, at the dose of 100 mg/day, although the scientific evidence behind this supplement is controversial.

Vitamin D may also help the muscle aching seen with statins, but evidence for this is also controversial. Vitamin D is the “hot” vitamin right now, seemingly good for everything. A safe dose for most people is 1000-2000 IU per day.

There is no doubt that taking a daily aspirin is important if you have heart disease.  Usually, the lower dose of 81 mg is enough, and has a decreased chance of gastrointestinal side-effects.  Although aspirin is good for the heart, medicines called non- steroidal anti-inflammatory drugs (NSAIDS) such as Motrin, ibuprofen, Aleve, Naprosyn, are associated with some slight increased cardiac risk, especially if taken every day.  If you have a heart problem do not stop your aspirin when you begin an NSAID.  I recommend taking the aspirin first thing in the morning, or at night, at least an hour or two from when you take your NSAID.

Plant sterols are found in margarines like Benecol, Promise Take Control, and Smart Balance.  They may lower cholesterol a bit, but a study that I did suggests that they do not add much cholesterol lowering when you are already taking statins or red yeast rice.

Niacin is available over the counter and by prescription.  Recent information suggests that adding niacin to a statin may actually be harmful, but it may be helpful for some people not on statins.

Things to remember from Day 15:

  1. Do not stop your statin and switch to red yeast rice without discussing it with your doctor.  If you are taking a statin, you can supplement with any of the other products mentioned without too much concern.  Remember to tell your doctor what supplement you are taking, as many can interact with prescription medication
  2. Red yeast rice may cause less muscle cramping than statins, and should only be taken to try to prevent heart disease.  If you already have coronary disease, you should be on a statin
  3. Co-enzyme Q 10 may help muscle cramping from statins, but the evidence for this is shaky
  4. NSAIDs like ibuprofen  can increase your heart risk when taken every day

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