Best Supplements For Heart Health.

Uncovering the real evidence on supplements and heart health.

As a cardiologist, I am frequently asked about supplements and heart health.

In general, I am not a fan.

Personally, I take two supplements.

1. Whey protein for hitting my daily protein targets.

2. Creatine for improving exercise performance and muscle mass.

Neither of these supplements is for improving ‘heart health’.

During the winter months, I will occasionally take vitamin D if my levels are low, but generally, if I get enough time outside, even during the winter months, I do not need to take any.

What Does The Evidence Say?

In general, the world of supplements is a murky place with little regulatory oversight and often very inconsistent production standards.

Big Pharma might get a bad rap for some of its sketchy practices, but they pale in comparison to what goes on in the world of supplements.

In some studies looking at the advertised ingredients on supplements¹:

1. 89% of the supplements did not contain what was on the label.

2. 12% contained prohibited and potentially dangerous compounds.

3. In comparison to what is claimed on the label, the concentration of the active ingredient varied wildly from 0.02% to 334%.

So when it comes to supplements, you need to tread with a LOT of caution.

With that in mind, let's see what the research says about supplements and heart health.

A recent systematic review and meta-analysis examined a range of commonly used supplements and whether they improved cardiovascular risk factors like blood pressure and cardiovascular events such as heart attacks and stroke.

Four Supplements Stood Out As Beneficial.

1. Omega 3 fatty acids.

2. Folic acid.

3. Alpha Lipolic Acid.

4. Genistein.

Twenty-two others showed either no benefit, harm or benefit with very low-quality evidence.

Below is a graphic outlining all of the supplements tested and where they showed benefit.

It’s a busy graphic, but in general, what you are looking for is an arrow of improvement, usually down in a blue or green box, i.e. strong evidence for benefit.

I have circled the ones that meet these criteria.

Other supplements improved markers such as total cholesterol or triglycerides. I do not find these particularly useful.

The savvy readers among you will have noticed that I also circled coenzyme Q10, but we will get back to that one.

Let’s look at each of these in general.

Omega 3 Fatty Acids.

You will probably know these as fish oils or omega 3.

While they did improve HDL-C and triglycerides, suggesting an improvement in insulin resistance, the studies that interest me are those with reductions in heart disease mortality, heart attacks and coronary artery disease.

Heart attacks (Myocardial infarctions) were reduced by 15%, and coronary artery disease was reduced by 14%.

Overall, the evidence for omega 3 supplementation has been mixed, but a meta-analysis of studies does suggest benefit.

In general, I think this is a very low-risk supplement with potential benefits.

However, some research suggests that the benefit is best obtained by eating more fish rather than supplementing alone.

Folic Acid.

Supplementing with folic acid is common and generally safe.

What was surprising to me was to see a 14% reduction in the risk of stroke.

My view on this is that certainly if your levels are low, it is worth supplementing up to normal levels.

Alpha Lipolic Acid.

This one was new to me.

But hey, there are about a bazillion supplements out there and no one can keep up with all the shoddy research on them.

Alpha Lipoic Acid is an antioxidant, and in systematic reviews of randomised controlled trials, it has been shown to reduce systolic blood pressure by about 5 mmHg, which is impressive, to be fair².

It will not address the epidemic of hypertension, but it just might get someone those additional few points of blood pressure lowering to keep them off a medication.

It is important to note, however, that people's responses to this supplement may vary, and as far as I am aware, there are no trials that show a reduction in cardiovascular events, i.e. heart attacks, etc., with its use.

Genistein.

Again. I had never even heard of this supplement before.

Genistein is a polyphenol found primarily in soy and fava beans.

The benefit of genistein was primarily in reducing blood pressure with a 5-7 mmHg reduction in systolic blood pressure³.

Once again, not insignificant but comes with all the same caveats as Alpha Lipoic Acid.

What About Co-Enzyme Q10?

Co-Enzyme Q10 is often suggested for reducing muscle aches and joint pains related to statin therapy.

I do not use it for this purpose for two reasons.

1. The majority of statin-associated muscle aches are related to the nocebo effect so we just end up chasing our tail.

2. If someone develops muscle aches or joint pains on statin therapy, I just switch them to something else after an appropriate period of retrial with an alternate or lower dose of statin therapy.

The study mentioned above showed that supplementation with Co-Enzyme Q10 resulted in a 32% reduction in all-cause mortality, i.e. the chances of dying from any condition, not just heart disease.

This is a spectacular reduction in all-cause mortality risk.

So why not just put it in the water supply?!

The reason is that the evidence for this benefit comes from the supplementation of Co-Enzyme Q10 in those with heart failure, not the general population.

So why not use it in heart failure patients?

It is probably a pretty low-risk intervention, but even though the graphic above highlights the benefit in a green box, therefore suggesting at least a moderate level of evidence, it still does not meet the bar for broader use⁴.

It also seems rather implausible that a supplement could make such a spectacular difference to all-cause mortality risk.

Usually, when something seems too good to be true, it probably is.

So What Should You Take?

Only YOU can answer that question, but at the outset of this article, I told you what I take.

You will notice that I do not take any of the five listed supplements described above.

Would I consider adding one?

Maybe omega-3 fish oils.

I have done so in the past to get my omega 3 levels up to target, but I also try to consume more fish.

Additionally, before answering this question for yourself, you have to ask if the supplement you buy actually contains what it says on the label.

The answer is that it probably doesn’t.

Every supplement company says that it does but the research seems to keep contradicting that claim.

So, in general, I keep supplements to a minimum.

For the money most people pay for supplements I think it would be much better spent on a personal trainer or something similar.

Price is what you pay, and value is what you get.

When it comes to supplements they are usually high price and low value.

The key is finding something at the same price but a much higher value.

In general, it won’t be a supplement.

At least not for me.

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In Case You Missed Them:

1. Presence and Quantity of Botanical Ingredients With Purported Performance-Enhancing Properties in Sports Supplements. JAMA Netw Open. 2023;6(7):e2323879.

2. The effects of alpha lipoic acid (ALA) supplementation on blood pressure in adults: a GRADE-assessed systematic review and dose-response meta-analysis of randomized controlled trials. Front Cardiovasc Med. 2023 Oct 24;10:1272837.

3. Effect of soy isoflavone supplementation on blood pressure: a meta-analysis of randomized controlled trials. Nutr J 23, 32 (2024).

4. Coenzyme Q10 to manage chronic heart failure with a reduced ejection fraction: a systematic review and economic evaluation. Health Technol Assess. 2022 Jan;26(4):1-128.