Supplements are among the most common topics of discussion in 21st century medical offices. The world of alternative medicine is full of bold claims of health and rejuvenation; consumers and physicians alike can be easily overwhelmed a trip to the health store. Many products target the prevention and treatment of cardiovascular disease, the leading cause of death in the United States adult population. Prescription medications must be tested for efficacy and safety through randomized clinical control trials, making it possible for physicians to provide concrete answers to patients regarding their cardiovascular benefits and their potential adverse effects. By comparison, few randomized controlled clinical trials have looked into the safety and efficacy of supplements.
This review will examine existing scientific evidence behind some common cardiovascular health products with the hope of providing guidance to consumers and health practitioners alike in terms of making appropriate choices to best meet their health needs.
Omega-3 Fatty Acids (Fish Oil): Tried and True
Commonly touted as the key to a healthy heart, omega-3’s are the most commonly purchased supplements on the market. Fish oil contains docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), both of which are believed to promote the synthesis of healthy fats in the body and to improve metabolic efficiency.
These claims come with good reason. Scientific data exists demonstrating that omega-3’s may lower the risk of death, heart attack, and stroke in people suffering from known atherosclerotic disease. Strong evidence suggests that these supplements lead to significant reductions in triglycerides and small increases in HDL or “good cholesterol” levels. Taken in higher doses, trials in humans have also shown that fish oil may improve blood pressure control.
Potential side effects include a higher risk of bleeding and increased blood sugars. People with diabetes or who take blood thinning medications should consult their doctor before starting omega-3’s as they may be at increased risk of these adverse effects. Pregnant women and women who intend to become pregnant should avoid taking fish oil supplements as they may contain traces of mercury, a known teratogen.
The Murky World of Coenzyme Q10
Advertisements over the last decade have portrayed Coenzyme Q10 as a miracle drug. Marketed as the definitive treatment for a number of neurological and cardiovascular conditions ranging from high blood pressure to Parkinson Disease, unfortunately the evidence to support Coenzyme Q10’s benefit is quite sparse. The most compelling trials exist for a small but positive benefit on blood pressure. Studies have shown that people diagnosed with high blood pressure tend to have lower blood levels of Coenzyme Q10. Limited data support that supplementation may lead to small improvements in blood pressure. It should be noted that these improvements in blood pressure have not been translated into an overall cardiovascular mortality benefit.
Common adverse reactions include nausea, heartburn, and muscle cramps. Coenzyme Q10 also tends to be quite expensive with monthly supply costs exceeding $30. Overall, Coenzyme Q10’s proven benefits probably don’t measure up to its hefty price tag.
The Unregulated Potential of Red Yeast Rice
Derived naturally from the yeast Monascus purpureus that grows on rice, red yeast rice has been used for thousands of years by traditional Chinese healers to promote healthy circulation. This supplement contains compounds called monacolins that are believed to inhibit cholesterol synthesis in the body. Monacolin k is chemically identical to the prescription medication lovastatin, which is commonly used in the treatment of high cholesterol.
Several studies performed a in the 1970’s consistently demonstrated that red yeast rice effectively lowers LDL or “bad cholesterol” levels in people using it regularly. In the 1990’s the Federal Drug Administration issued a statement outlawing the sale of red yeast rice supplements containing lovastatin. In reality, this regulation is loosely enforced; later trials showed that common brands contain highly variable amounts of lovastatin. Red yeast rice is likely to provide beneficial LDL-lowering effects but given the highly variable lovastatin content in different brands, the exact degree of benefit is inconsistent. The role of other monacolin compounds in reducing cholesterol also remains unclear.
Adverse effects are similar to those of statin medications and include liver and muscle damage.
A Glass of Red Wine a Day…
Red wine contains compounds called phenols that may provide significant cardiovascular benefits. Resveratrol, the most studied of the phenols, has been linked with a number of positive cardiac outcomes. Indeed, there have been several recent studies suggesting that a glass of red wine on most days of the week may improve blood pressure control and HDL or “good cholesterol” levels. Furthermore, these benefits have been linked to a lower rate of adverse cardiovascular events such as heart attacks.
All of this enthusiasm should be tempered, however, by the fact that excessive alcohol intake has consistently been associated with increased blood pressure and higher rates of strokes and heart attacks. Moderate red wine consumption, meaning no more than one glass per day for women and one to two glasses per day for men, is probably associated with cardiovascular benefit.
