Optimal DX Supplement Series: A Sampling of Cardiovascular Support Supplements

Atherosclerosis is a progressive inflammatory condition wherein a sticky plaque builds up in the arteries' inner layers.This plaque comprises cholesterol, fat, oxidized LDL, calcium, fibrotic tissue, and other substances (NHLBI, Neels 2023).

The process of atherosclerosis is thought to be initiated by deposits of cholesterol-rich low-density lipoprotein (LDL) within the artery’s muscle layers (Rafieian-Kopaei, 2014). These “trapped” LDLs become oxidized, which, in turn, triggers an immune response. Oxidation of LDL is the first step in atherosclerosis development. Macrophages engulf the oxidized LDL, forming foam cells that accumulate (Rafieian-Kopaei, 2014). As the process continues, the plaque grows into the artery, blocking the passage of blood and oxygen. 

The reduced blood flow caused by the narrowing of arteries as plaque builds up can cause symptoms such as angina, which is chest pain resulting from the heart not getting enough blood or oxygen. Blood clots also present a significant risk. When plaques burst, accumulation and adhesion of platelets can form blood clots that can completely block the flow of blood in the artery or travel to smaller blood vessels and block those. Complications of atherosclerosis include heart attack, stroke, vascular dementia, and erectile dysfunction (NHLBI, Rafieian-Kopaei, 2014).

Supportive Supplements

Omega-3 Fatty Acids

3,000 mg to 6,000 mg/d (Stengler 2016)

• A meta-analysis of randomized, double-blind, placebo-controlled trials indicated that 1 g/d to 6 g/d of omega-3s resulted in protective effects for cardiac death, sudden death, and myocardial infarction (Casula 2014).
• In another meta-analysis, six studies meeting the criteria showed that high-dose omega-3 for six or more months significantly slowed the progression of atherosclerosis (Sekikawa 2019).
• Patients with higher coronary artery calcification had significantly lower Omega-3 Index, EPA, and DHA levels, suggesting an inverse relationship between Omega-3 Index and early onset of coronary artery calcification, independent of other factors (Bittner 2020).

Niacin (vitamin B3)

500 mg two to three times daily (Stengler 2016)

• In a meta-analysis of seven trials, niacin was associated with a significant reduction in cardiovascular events, including stroke, coronary artery revascularization, nonfatal myocardial infarction, and transient ischemic attack along with possible small but non-significant decreases in coronary and cardiovascular mortality (Duggal 2010)
• 1,000 mg/d of extended-release niacin for 12 weeks improved triglycerides, LDL, and HDL. Post-hoc analysis revealed an improvement in flow-mediated dilation of the brachial artery in patients with low HDL-C at baseline (Warnholtz 2009)
• 1,000 mg of extended-release niacin for 12 months increased HDL-C by 21%. Carotid intima-media thickness was unchanged in the treatment group but significantly increased in the placebo group (Taylor 2004).

Garlic

300 mg to 500 mg twice daily (Stengler 2016)

• 600 mg/d of garlic (Allicor) for 12 weeks in persons with high cholesterol resulted in a significant decrease of 7.6% in total cholesterol and 13.8% in LDL, with an 11.5% increase in HDL (Sobenin 2008).
• After 12 months of treatment with 300 mg/d of garlic (Allicor), the cardiovascular risk decreased significantly: 1.5-fold in men and 1.3-fold in women. This decrease was primarily mediated by a reduction of LDL cholesterol, 32.9 mg/dl in men and 27.3 mg/dl in women (Sobenin 2010).
• Garlic powder tablets (1,200 mcg allicin/tab) taken twice daily for 3 months significantly reduced the thickness of the carotid intima-media in the treatment group compared with the placebo group (Mahdavi-Roshan 2013).

Coenzyme Q10

100 mg to 300 mg daily (Stengler 2016)

• Patients taking 120 mg of CoQ10 daily for one year had significantly increased plasma vitamins E and C, reduced lipid peroxidation products, increased HDL, and decreased total cardiac events (Singh 2003).
• 300 mg/day of CoQ10 significantly increased plasma coenzyme Q10 and antioxidant enzymes and reduced inflammation in patients with coronary artery disease on statin therapy (Lee 2013).
• Results of a systematic review and meta-analysis of randomized controlled trials demonstrated that supplementation with CoQ10 enhanced potential to lower CVD risk in diabetic patients by reducing total cholesterol, LDL, and oxidative stress and improving endothelial health (Dludla 2020).

References

Atherosclerosis Fact Sheet. National Heart, Lung, and Blood Institute (NHLBI). Accessed June 24, 2024. https://www.nhlbi.nih.gov/health/atherosclerosis#:~:text=Fact%20sheets%20and%20handouts,an%20artery%20with%20plaque%20buildup.

Bittner, D. O., et al. "Early-onset coronary atherosclerosis in patients with low levels of omega-3 fatty acids." European journal of clinical nutrition 74.4 (2020): 651-656.

Casula, Manuela, et al. "Long-term effect of high dose omega-3 fatty acid supplementation for secondary prevention of cardiovascular outcomes: A meta-analysis of randomized, double blind, placebo controlled trials." Atherosclerosis Supplements 14.2 (2013): 243-251.

Dludla, Phiwayinkosi V., et al. "The impact of coenzyme Q10 on metabolic and cardiovascular disease profiles in diabetic patients: A systematic review and meta‐analysis of randomized controlled trials." Endocrinology, diabetes & metabolism 3.2 (2020): e00118.

Duggal, Jasleen K., et al. "Effect of niacin therapy on cardiovascular outcomes in patients with coronary artery disease." Journal of cardiovascular pharmacology and therapeutics 15.2 (2010): 158-166.

Lee, Bor-Jen, et al. "Effects of coenzyme Q10 supplementation (300 mg/day) on antioxidation and anti-inflammation in coronary artery disease patients during statins therapy: a randomized, placebo-controlled trial." Nutrition journal 12 (2013): 1-9.

Mahdavi-Roshan, Marjan et al. “Effect of garlic powder tablet on carotid intima-media thickness in patients with coronary artery disease: a preliminary randomized controlled trial.” Nutrition and health vol. 22,2 (2013): 143-55. doi:10.1177/0260106014563446 

Neels, Jaap G et al. “Atherosclerosis Calcification: Focus on Lipoproteins.” Metabolites vol. 13,3 457. 21 Mar. 2023, doi:10.3390/metabo13030457

Rafieian-Kopaei, Mahmoud et al. “Atherosclerosis: process, indicators, risk factors and new hopes.” International journal of preventive medicine vol. 5,8 (2014): 927-46.

Sekikawa, Akira, et al. "Effect of high-dose marine omega-3 fatty acids on atherosclerosis: a systematic review and meta-analysis of randomized clinical trials." Nutrients 11.11 (2019): 2599.

Stengler M, et al. Prescription for Natural Cures: A Self-care Guide for Treating Health Problems With Natural Remedies Including Diet, Nutrition, Supplements, and Other Holistic Methods. Third ed. Turner Publishing Co, 2016.

Singh, Ram B et al. “Effect of coenzyme Q10 on risk of atherosclerosis in patients with recent myocardial infarction.” Molecular and cellular biochemistry vol. 246,1-2 (2003): 75-82.

Sobenin, Igor A et al. “Lipid-lowering effects of time-released garlic powder tablets in double-blinded placebo-controlled randomized study.” Journal of atherosclerosis and thrombosis vol. 15,6 (2008): 334-8. doi:10.5551/jat.e550

Sobenin, Igor A et al. “The effects of time-released garlic powder tablets on multifunctional cardiovascular risk in patients with coronary artery disease.” Lipids in health and disease vol. 9 119. 19 Oct. 2010, doi:10.1186/1476-511X-9-119

Taylor, Allen J., et al. "Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2: a double-blind, placebo-controlled study of extended-release niacin on atherosclerosis progression in secondary prevention patients treated with statins." Circulation 110.23 (2004): 3512-3517.

Warnholtz, Ascan, et al. "Effects of oral niacin on endothelial dysfunction in patients with coronary artery disease: results of the randomized, double-blind, placebo-controlled INEF study." Atherosclerosis 204.1 (2009): 216-221.