Do supplements lower heart disease risk?

Heart disease is the top cause of death in the United States, killing nearly 700,000 men and women annually. High blood pressure and high cholesterol (along with smoking) are the leading risk factors, and about half of U.S. adults have at least one of these.

Since having high blood pressure and high cholesterol can increase your risk for heart attack, stroke, and cardiovascular-related death, many adults turn to vitamins and supplements to reduce their chances of developing them—especially to reduce high cholesterol.

Some research supports that notion. However, most research has found little or no benefit from taking supplements to prevent heart disease.

Even with the lack of evidence, heart health supplements remain popular. Before trying them, it’s important to know which ones might offer some benefit, and which may carry risks.

Fish oil

In years past, many experts believed that fish oil supplements were good for you, since they contained heart-healthy omega-3 fatty acids. Clinical trials in the 1990s suggested they did offer some preventive benefits, explains Geoffrey Zarrella, DO, a cardiologist in Collingswood, New Jersey.

“At that time, medical therapy was in a more primitive state and the percentage of patients referred for complete revascularization (restoring blood to the heart via angioplasty versus coronary artery bypass surgery) wasn’t the same as it is today.”

Now, he says, more people undergo revascularization procedures, more people are on statins (drugs that lower cholesterol), and those statins are even more potent than their earlier versions. Therefore, fish oil supplements are not as powerful in terms of absolute cardiovascular risk reduction—and expert guidelines don't recommend using them. In certain cases, prescription omega-3 fatty acids may be used to help manage triglycerides, a type of fat in the blood.

Psyllium

A potentially helpful heart supplement is psyllium, a soluble fiber that binds up cholesterol in the intestines so you can then pass it in your stool. This, in turn, causes the liver to take more LDL ("bad" cholesterol) out of your blood. So, “taking psyllium will help lower cholesterol levels somewhere between 5 and 8 percent," explains Zarrella.

Red yeast rice

Red yeast rice is a traditional Chinese medicine product that helps lower cholesterol by reducing how much of it the liver produces. It's made using a fungus named Monascus purpureus, which produces a chemical called monacolin K. “Red yeast rice is really a low-potency statin,” Zarrella says.

Clinical trials have shown that monacolin K can lower cholesterol and LDL, but at doses much higher than supplements typically provide. In fact, studies by the U.S. Food and Drug Administration (FDA) have found that many current red yeast rice products contain little or no monacolin K at all, rendering their lipid-lowering effects null.

Other supplements

Red yeast rice isn't the only questionable heart supplement. Zarrella says the evidence is weak to non-existent for many popular products—including garlic, coenzyme Q10, vitamins D and E, folic acid, and niacin—and urges consumers to be skeptical of supplements in general. The FDA does not regulate them, so we don’t know we’re actually getting what the label says we are.

Furthermore, some supplements can cause harm, so you should always discuss the potential benefits and risks with your physician or other healthcare provider (HCP) before taking them. Zarrella encourages his patients to bring their supplements with them to visits, so the ingredients can be vetted.

How to lower your risk of heart disease

A generally healthy lifestyle is more important than taking supplements, Zarrella says. Following the AHA’s Life’s Essential 8, a set of guidelines designed to improve your overall well-being—and especially your heart health—can help. They are:

• Manage your blood pressure
• Control your cholesterol
• Manage your blood sugar
• Follow a healthy eating pattern
• Don’t smoke
• Exercise regularly
• Maintain a healthy body weight
• Get healthy sleep

“Unfortunately, only about 2 to 3 percent of the population meets all of these metrics,” Zarrella says. But if you can hit all of them, he notes, it goes a long way toward protecting yourself against cardiovascular disease.

Limiting alcohol or avoiding it completely is another move that can help protect your heart. If you don’t drink, don’t start. If you drink, do so in moderation. That’s no more than two alcoholic beverages per day for men and one for women.

Zarrella says the best trial on nutrition and heart disease, the PREDIMED Trial, found that people who followed a Mediterranean-style diet—heavy on fruits and vegetables and lean protein sources, supplemented with nuts or extra virgin olive oil—had fewer major cardiac events.

Bottom line: Rather than investing in supplements, prevent heart disease by eating a nutritious diet, maintaining a healthy weight, getting regular physical activity, limiting alcohol, and not smoking.