Supplements and Cardiovascular Disease: Helpful? Harmful?

Podcast Transcript

Announcer:
Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy and information about diseases and treatment options. Enjoy.

Luke Laffin, MD:
My name's Luke Laffin, and I am a preventive cardiologist at the main campus of the Cleveland Clinic. It's great to speak with you today about a topic that I get asked about at least a few times a week from my patients that see me. And really that topic is supplements and cardiovascular disease. Are they helpful? Are they harmful? Am I wasting my money? Am I not?

Luke Laffin, MD:
These are all really good questions. Unfortunately, we don't have a lot of great data to guide us, but we'll review some of the data that we may have to help us make the right decision about whether we should be taking supplements or not for our heart health. In general, patients with established cardiovascular disease, so history of stroke, heart attack, maybe they've had bypass surgery before, in those scenarios really the data for supplements in preventing future cardiovascular disease is pretty minimal.

Luke Laffin, MD:
Multivitamin is rarely a wrong choice, so people can definitely take an over-the-counter multivitamin, particularly if your doctor prescribes it or if your diet is not really a diet of moderation or doesn't have a rich component of vegetables, fruits, whole grains and then protein as well. So multivitamin oftentimes is very acceptable.

Luke Laffin, MD:
Other things that are commonly prescribed such as fish oil, so omega-3 fatty acids. CoQ10 is a very common supplement as well. The real take home on that is that we don't have enough data to tell us that they're helpful or not. Now, some people swear by CoQ10 and that it helps prevent some of the statin-associated muscle symptoms that we can see in about 5% of people that take statins. The data doesn't necessarily reflect that when you look at large clinical trials. That being said, I don't think it's hurting anyone if you take it. If it does seem to help you, that is a reasonable option in that setting.

Luke Laffin, MD:
Over-the-counter fish oil. That's a little bit more controversial. We know that it can have a small impact on serum triglyceride levels, but how much it actually affects LDL cholesterol lowering is a little bit questionable, and how it impacts ultimately the reduction of cardiovascular events is also questionable. Most of the time, I like to say to people that it's probably not hurting you from a physiology perspective, but it's hurting you from a wallet perspective because you may not be getting a benefit and you're just paying more for these supplements. There is purified forms of fish oil that have been studied and those are actually prescription, so those aren't supplements, and they have been studied in a variety of clinical trials most recently. The data is a little bit mixed. Fish oil typically is two things, DHA and EPA, and certain supplements that are pure EPA have shown a benefit. So that's something you can definitely talk to your doctor about if you're at high risk for cardiovascular disease.

Luke Laffin, MD:
Now, in those individuals that have never had a stroke or heart attack, but have talked about with their physician or their nurse practitioner about what the next steps are for reducing your future risk of strokes and heart attacks, there's a few options out there. Obviously we need to have the healthy diet and the diet of moderation and the exercise component that we always talk about. Are there supplements that are helpful for "heart health?" Well, we don't really know. As you may know, many of these supplements or the vast majority of them, are not regulated by the FDA. They can't be marketed as lowering cholesterol or preventing cardiovascular disease. Oftentimes you'll see on the package, helpful with heart health. What does that really mean? Well, your guess is as good as mine. Okay. The data is pretty limited when we look at any studies of them.

Luke Laffin, MD:
Now, sure, you can point to one small study in a small group of healthy patients or in some animal model that may show a beneficial effect, but unfortunately the data for most of these supplements is lacking. We do know that supplements such as red yeast rice can lower LDL cholesterol, so that is something that a fair number of my patients take on their own. We don't necessarily recommend it, but it's a potential option. It's important to know that red yeast rice is monacolin K, that's one of the components of it, and that's the active ingredient that lowers LDL cholesterol. That's the same as prescription lovastatin, which is a statin. The problem with red yeast rice in certain circumstances that we just don't know what's exactly in it because it's not well regulated in many circumstances

Luke Laffin, MD:
Other things that we think about, garlic, cinnamon, et cetera, we don't really know at this point. That really has prompted one of the more important clinical trials that we're doing at the Cleveland Clinic in this calendar year 2020. It's called the SPORT study. SPORT is an acronym for supplements, placebo, or rosuvastatin trial. What it's looking at is, it's a short trial, it's only 200 patients and it's only 28 days in length, and what we're looking at is patients without a history of cardiovascular disease, but have been recommended to at least consider taking cholesterol-lowering medicines. They have a certain cardiovascular risk in their future, typically defined as a greater than 5% risk of a stroke or heart attack over 10 years, but less than 20% risk.

Luke Laffin, MD:
What we're doing is we're randomizing individuals to either a very low dose of a FDA approved statin called rosuvastatin, so 5 mg, placebo, or one of six supplements: turmeric, garlic, cinnamon, red yeast rice, plant sterols and an over-the-counter fish oil and we're seeing really, if we can establish some data, do these effectively lower LDL cholesterol compared to placebo and compared to the FDA approved rosuvastatin. It's an interesting study. We're looking forward to getting patients enrolled. We're only enrolling patients in Ohio, but if you're interested in participating, you can always reach out to us by via email. The email address is the c5Rclinicaltrials@ccf.org.

Luke Laffin, MD:
So thanks very much for the opportunity to give a little background on supplements and cardiovascular disease. The take-home point is that we really don't know how these supplements impact or at least reduce cardiovascular disease. As always, it's really important to talk with your treating physician about the risks and benefits of supplements, and also understand that some of these supplements can interact with current medications that you're taking. It's always worthwhile to discuss them with your physician before starting. Thank you very much.

Announcer:
Thank you for listening. We hope you enjoyed the podcast. We welcome your comments and feedback. Please contact us at heart@ccf.org. Like what you heard? Subscribe wherever you get your podcasts or listen at clevelandclinic.org/loveyourheartpodcast.