Vitamin aisle favorites may not be as powerful as you think—but some could have a protective effect.
Heart disease is the top cause of death in the United States, killing about 647,000 men and women annually and making up one-quarter of U.S. deaths overall. High blood pressure and high cholesterol (along with smoking) are the leading risk factors, and 47 percent of us have at least one of these.
Since these conditions 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 lower high cholesterol.
Some research supports that notion. For instance, in a new March 2020 study in BMJ, scientists found that regularly taking fish oil supplements (omega-3 polyunsaturated fatty acids) was linked to a 16 percent lower risk of dying from heart disease, and a 13 percent lower risk of all-cause mortality. To reach their conclusions, researchers from China and the U.S. looked at data from almost 428,000 adults between ages 40 and 69. They also found that participants had a 7 percent lower risk of cardiovascular events, such as a heart attack or stroke, than the general population.
Most research, however, has found that the majority of people don’t benefit from taking supplements for heart disease prevention. For example, according to research published in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes, multivitamins don’t prevent heart attack or stroke. Researchers analyzed 18 studies including more than 2 million participants with an average follow-up of 12 years to draw a conclusion: There are no heart-related benefits to taking a multivitamin.
But what about taking other supplements for heart health?
Supplements that may have some benefits Way before the 2020 BMJ study came out, many experts believed that fish oil supplements were good for your heart. Clinical trials in the 1990s suggested they did offer some preventive benefits, explains Geoffrey Zarrella, DO, a cardiologist from Lourdes Health System in Willingboro, 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 is not as powerful in terms of absolute cardiovascular risk reduction. In fact, a 2017 scientific advisory statement from the American Heart Association noted there wasn't evidence omega-3 supplements helped the general public—those not at risk for cardiovascular disease—at all.
That's not to say they're useless, however, especially for people with existing conditions, like heart failure. Dr. Zarrella says if you already have heart disease, fish oil supplements may play a small role in preventing a second heart event.
Another 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.
Supplements that don’t work or are questionable 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 pupureus, 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.
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 doctor 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 A generally healthy lifestyle is more important than taking supplements, Zarrella says. Following the AHA’s Life’s Simple 7, a set of guidelines designed to improve your overall wellbeing—and especially your heart health—can help. They are:
“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.
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 and not smoking.
Sources: Centers for Disease Control and Prevention. “Heart Disease Facts.” L Zhi-Hao, Z Wen-Fang, et al. “Associations of habitual fish oil supplementation with cardiovascular outcomes and all cause mortality: evidence from a large population based cohort study.” BMJ. 2020; 368 :m456. American Board of Internal Medicine/ChoosingWisely.org. “Dietary Supplements to Prevent Heart Disease or Cancer.” DS Siscovick, TA Barringer, et al. “Omega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the Prevention of Clinical Cardiovascular Disease.” Circulation. 2017;135:e867–e884. American Heart Association Science Advisory. “Fish oil supplements may help prevent death after a heart attack but lack evidence of cardiovascular benefit for the general population.” March 13, 2017. Emily M. Ambizas. “OTC Supplements for the Management of High Cholesterol.” U.S. Pharmacist. 2017;42(2):8-11. NIH National Center for Complementary and Integrative Health. “Red Yeast Rice.” PA Cohen, B Avula, IA Khan. “Variability in strength of red yeast rice supplements purchased from mainstream retailers.” European Journal of Preventive Cardiology. 2017 Sep;24(13):1431-1434. American Heart Association. “Vitamin Supplements: Hype or Help for Healthy Eating.” R Estruch, E Ros, et al. “Primary Prevention of Cardiovascular Disease with a Mediterranean Diet.” The New England Journal of Medicine. 2013; 368:1279-1290.