Cardiovascular disease has long been and continues to be the number one killer in the U.S. Cholesterol and blood pressure-lowering medications are routinely prescribed to reduce risk factors for heart disease and high blood pressure. Medications can be expensive and are often associated with side effects. Dietary supplements are overlooked preventives and therapeutic alternatives to manage cardiovascular health and provide a powerful weapon in the fight against this devastating disease.
EPA and DHA (Fish Oil)
EPA and DHA are omega-3 fatty acids, rich in fatty fish, that have widespread health-promoting effects, especially for heart disease and diabetes. Several hundred studies have shown cardio-protective effects of fish oil and numerous reviews have summarized this body of work. Unlike most of the other supplements described here that have shown efficacy in reducing risk factors for heart disease, fish oil supplementation has actually been shown to decrease the risk of coronary artery disease death. EPA and DHA are effective at reducing blood triglyceride levels on average 25-30%.
Fish oil works through several mechanisms to promote heart health such as improving heart rhythm and preventing clot formation and plaque build-up in arteries. Fish oil may also lower blood pressure and increase plasma levels of “good” HDL cholesterol.
Omega-3 fats potently reduce inflammation and therefore have therapeutic applications in a number of diseases that are associated with pro-inflammatory mechanisms such as rheumatoid arthritis and other joint-related diseases. These fats have also been shown to protect against muscle loss and even enhance fat breakdown.
A review of the findings of randomized, controlled trials published through August 2005 shows that omega-3 fatty acids of marine origin consistently lower elevated plasma triglyceride levels in a dose-dependent fashion with greater efficacy at higher triglyceride levels. Improvements can be obtained with 300 mg per day of EPA and DHA, while even better results may be achieved with 2,000-3,000 mg per day.
In many studies, plant sterols (phytosterols) have been shown to reduce cholesterol and prevent cardiovascular disease. They have a structure that is similar to cholesterol, causing it to decrease gut absorption and to enhance elimination of dietary cholesterol. A comprehensive review of 41 trials comparing plant sterols to placebo concluded that intake of 2 grams per day of sterols reduced “bad” LDL cholesterol by 10% with the effects independent of diet. The same study concluded that the cholesterol-lowering properties are above and beyond that achieved with diet or medications that also lower cholesterol. Plant sterols have therefore been recommended by the National Cholesterol Education Program and the American Heart Association for reducing cholesterol.
Lecithin is an excellent and inexpensive source of beneficial phospholipids and a rich source of choline. Lecithin or choline supplementation has been shown to result in a slight decrease in cholesterol. Choline may also reduce the risk for heart disease though another mechanism involving lowering homocysteine levels. In one study, subjects with moderately elevated homocysteine levels given 2.6 grams per day of choline had a 30% reduction in homocysteine levels compared to placebo. Choline is also the precursor for a very important neurotransmitter called acetylcholine. Studies indicate that choline can help improve memory and cognitive function.
Coenzyme Q10 (CoQ10)
CoQ10 functions in the mitochondria, the “powerhouse” of the cell, to assist in making energy (called adenosine triphosphate or ATP) from carbohydrates and fats.
CoQ10 primarily acts as an antioxidant in the heart and is involved in the synthesis of energy, but it also has other important functions inside the mitochondria such as stabilizing membranes. CoQ10 protects the “bad” LDL cholesterol that is implicated in atherosclerosis from oxidizing. Because of CoQ10’s role in oxidative stress, energy production and stabilization, it is useful in preventing damage to the heart during periods of stress.
CoQ10 levels have been shown to be depleted in patients with a variety of heart conditions and in those taking cholesterol-lowering statin drugs. Research of CoQ10 spanning over 30 years shows potential for use in the prevention and treatment of cardiovascular disease in these patients.
Preventive doses usually range from 30-100 mg per day whereas therapeutic doses are usually greater than 100 mg per day. CoQ10 may be appropriate as an adjunct to conventional treatment or as a preventive treatment.
Policosanol is derived from the wax of sugar cane. It is commonly used as a method to reduce circulating cholesterol levels and has been evaluated in a large number of scientific studies. A recent extensive and critical review of 29 policosanol studies concluded that daily doses in the range of 5-40 mg over an average treatment period of 30 weeks was associated with a 24% reduction in “bad” LDL cholesterol levels.
In addition, this review found that policosanol decreased triglyceride levels and increased “good” HDL cholesterol by 11%, which is on par with results obtained from statin drugs.
Red Yeast Rice
Red yeast rice has also shown promise as a dietary supplement that may reduce several different risk factors for cardiovascular disease. Several risk factors include reductions in total cholesterol, “bad” LDL cholesterol, fasting triglycerides and triglyceride responses to meals.
One study showed that red yeast rice (1,200 mg per day) reduced the triglyceride response to a fat-rich meal 45%-50%, which has been shown to be an independent risk factor for coronary artery disease.
Lycopene is found in many fruits and vegetables, but tomatoes and tomato products are the main sources of lycopene in the diet. Lycopene has been shown to have strong antioxidant properties. Studies indicate that people with high levels of lycopene in their blood have reduced risk of cardiovascular disease. A recent study showed that men with the lowest levels of lycopene had more than a 3-fold greater risk of having an acute coronary event or stroke.
The study also showed that low plasma levels of lycopene were associated with increased thickness of plaque in the arterial wall. Critical analysis on the role of lycopene in the prevention of coronary heart disease has been described as strongly suggestive.
Similar to CoQ10, carnitine levels are depleted in patients with various heart conditions and therefore supplementation may be beneficial. Carnitine assists in transporting fat into the mitochondria to be burned as fuel in the heart. The most promising research with carnitine supplementation is in conditions of reduced oxygen like ischemia. Carnitine supplementation may have positive effects on symptoms of heart failure and may improve exercise tolerance and oxygen consumption in moderate to severe heart failure. Effective doses are around 2 grams per day.
Several studies have suggested that garlic and garlic extracts could lower blood cholesterol and triglycerides as well as slightly elevate “good” HDL cholesterol. A recent study also showed that supplementation with garlic extract (1.2 grams 3 times per day for 2 weeks) significantly reduced the oxidation of “bad” LDL cholesterol,
which is known to contribute to vascular dysfunction. Garlic has antioxidant properties, particularly aged garlic extract, which is rich in several organosulfur compounds that are powerful antioxidants.
Niacin, also known as vitamin B3, is naturally involved in carbohydrate and fat (lipid) metabolism. In supplemental doses, niacin is a potent vasodilator that causes blood vessels to increase in diameter. Niacin also significantly and consistently lowers blood levels of “bad” LDL cholesterol and triglycerides and increases “good” HDL cholesterol. Effective doses can be achieved with 50-200 mg per day.
Arginine is a natural amino acid. It is currently being promoted for heart health mainly because it is needed to synthesize a very potent substance called nitric oxide that causes dilation of blood vessels. It also has favorable effects on blood pressure. Arginine supplementation prevented the vascular dysfunction associated with consumption of a high fat meal in one recent study.
The dose of arginine was 6 grams per day (2 grams consumed three times per day) for 10 days. A recent review of arginine studies concluded that the main benefit of arginine supplementation is to restore vascular function and to improve the clinical symptoms of various diseases associated with vascular dysfunction.
Flowers and berries of the hawthorn plant contain several bioactive compounds and have been used in traditional medicine to treat a variety of cardiovascular conditions. The most well-documented effect of hawthorn is to cause vasodilation and increased blood flow. A recent randomized study showed that 1,200 mg per day of hawthorn extract for 16 weeks significantly reduced blood pressure in patients with diabetes compared to placebo.
Bioactive components of the diet can have a potent effect on many of the risk factors for heart disease. Basic and applied research on a variety of dietary supplements has shown great promise for safe and effective management of cardiovascular risk factors.
While all these dietary supplements have evidence-based research to support efficacy in certain conditions, the evidence is particularly strong for a protective effect of fish oil. In addition, significant research supports the total and “bad” LDL cholesterol-lowering effects of policosanol and plant sterols. Niacin is particularly effective at increasing “good” HDL cholesterol levels, whereas arginine and hawthorn extract can positively impact blood pressure and vascular health.
There is a tremendous amount of variability in the way people respond to dietary supplements and medications. It is therefore recommended that you regularly check your cholesterol and lipid levels in order to determine what is working and to help fine-tune the optimal therapeutic dose for you.