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Heart health is well-known to be impacted by diet, including Mediterranean-style diets, which prioritize the consumption of plant-based foods. Studies suggest that the heart health benefits of such diets include improving high-density lipoprotein quality,1 inflammation profiles in some populations,2 and survival rates in individuals with a history of cardiovascular disease (CVD).3 While a colorful, plant-based food approach is optimal, supplementation may also be appropriate for a targeted and personalized intervention to improve cardiovascular function. What is the role of specific dietary nutrients in the prevention and treatment of cardiovascular disease and metabolic dysfunction?
Nutrients for the Heart
The American Heart Association encourages individuals to include fruits and vegetables at every meal in order to consume a range of heart-healthy nutrients, including magnesium, potassium, B vitamins, vitamin D, omega-3 fatty acids, and selenium, as well as other antioxidants and soluble fiber. A 2020 meta-analysis of 117 prospective cohort studies that included over four million individuals emphasizes the established conclusion that higher intakes of fruits and vegetables result in lower risk of coronary heart disease, stroke, and overall incidence of cardiovascular diseases.4 In addition, a recent meta-analysis of 16 studies (12 randomized controlled trials (RCTs) and four randomized cross-over studies; n=1,161) found that diets high in fruits, vegetables, and plant oils significantly reduced measurements of the inflammatory biomarker C-reactive protein (CRP) in healthy populations as well as in those with cardiovascular and metabolic dysfunctions.5
A diet that prioritizes colorful, plant-based foods reflects a more robust intake of antioxidant and anti-inflammatory micronutrients and phytonutrients that support cardiovascular and metabolic pathways. At the same time, research studies continue to investigate specific nutrients and their value as supplements in heart health. For example:
- A 2020 meta-analysis of 43 RCTs found that a selenium/antioxidant mixture decreased CVD mortality risk by 23% among individuals of differing risk factors for chronic disease.6 The noted mixtures primarily consisted of vitamin C (120 mg to 1,000 mg), vitamin E (15 to 30 mg or 200 to 800 IU), zinc (20 to 30 mg), beta-carotene (6 to 25 mg), and selenium (50 to 200 mcg) given in capsule or pill form.
- A 2021 meta-analysis of 25 prospective cohort studies (approximately two million participants) evaluated the association between the consumption of marine omega-3 fatty acids, fish, and CVD mortality risk and found both dietary intakes to be inversely associated with the outcome.7 Investigators further detailed a nonlinear dose response relationship suggesting an increase of 20 grams of fish or 80 milligrams of omega-3 fatty acid intake per day reduced CVD mortality risk by four percent.7
- An older but still relevant Cochrane review and meta-analysis of double-blinded RCTs supported the use of the hawthorn berry and its extract as an adjunctive treatment option for patients with congestive heart failure.8 Significant benefits were found for physiologic outcomes, exercise tolerance, and symptom control (e.g., improvement of symptoms such as shortness of breath and fatigue).8
MICRONutrient insufficiencies & CVD Risk
Deficiencies in one or more micronutrients are commonly reported worldwide9 and can lead to a range of health issues, including chronic illnesses such as CVD. In addition, only an approximate one in ten adults in the United States eats the recommended amounts of fruits and vegetables,10 despite the heart health benefits of phytonutrients. A recent editorial in the Journal of the American Heart Association stated that insufficient intake of dietary micronutrients such as vitamin A, magnesium, selenium, and vitamin D is common in adults with heart failure.11
Observational studies continue to report a higher risk of cardiovascular diseases as well as cardiovascular and all-cause mortality associated with lower vitamin D levels,12 as well as an inverse association between circulating magnesium levels and incidence of coronary heart disease, hypertension, and type 2 diabetes.13 Nutrients work simultaneously in the body as cofactors to ensure healthy cardiovascular and metabolic pathways, as well as the health of other body systems; therefore, it is important to consume enough of each of them. An approach to eating that incorporates a variety of foods and adequate amounts of nutrients from plant-based foods helps to ensure a balanced intake of nutrients that support both heart and whole-body health.
Along with diet, supplementation may also be indicated to address nutrient deficiencies, and studies continue to investigate the impact and benefits of this intervention specific to heart health. A 2021 systematic review of 49 clinical trials exploring magnesium supplementation for blood pressure impact found beneficial yet conflicting results.14 Participants with untreated hypertension showed a blood pressure decrease when treatments were more than 600 mg of magnesium/day; half of the included studies (120 to 486 mg of magnesium/day) showed systolic or diastolic blood pressure decreases, but not both, while others at the same dosage reported no change in blood pressure; in ten studies with participants concurrently taking antihypertensive medications, all magnesium doses (240 to 607 mg/day) led to a decrease in blood pressure measurements.14
CoQ10, Red Yeast Rice, & Statins
Statins are a standard pharmacological treatment to help lower cholesterol and protect against heart attack and stroke for high-risk patients; however, side effects such as muscle pain and weakness are common. Studies suggest that certain nutrients used in conjunction with statins may reduce adverse effects such as muscle-related symptoms and may help patients maintain a prescribed statin intervention. Coenzyme Q10 (CoQ10) is an antioxidant found in many foods, including fruits and vegetables, and research suggests that this nutrient supports optimal cardiovascular performance in patients with heart conditions15 and may help to counteract some statin-related side-effects.16
Red yeast rice (RYR) is a fermented food well-known in traditional Chinese medicine for its beneficial effects in cardiovascular disease.17 The fermented rice naturally contains monacolins, including monacolin K, which is identical to the pharmaceutical drug lovastatin, and research suggests that RYR may be comparable to statin therapy, helping to lower lipid levels in patients with high cholesterol.17,18 A 2020 meta-analysis of RCTs (n=10,699 patients with myocardial infarction and borderline hypercholesterolemia) found that RYR extract as an adjunctive treatment improved cardiovascular outcomes and lipid profiles.19 Six out of seven of the included studies were double-blinded RCTs, and studies administered 1,200 mg of RYR extract orally per day with a treatment course and follow-up from four weeks to four and a half years.19
Many foods and their nutrients help to support heart function through impacting levels of cholesterol. Oatmeal and its soluble fiber are just one common example. For optimal heart health and overall wellness, a functional medicine approach prioritizes nutrient-dense diets rich in antioxidants and anti-inflammatory agents, along with targeted supplementation when indicated. For the latest research on cardiovascular and metabolic health, dietary approaches, and personalized, effective, and sustainable treatment strategies, learn more from functional medicine experts at IFM’s Cardiometabolic Advanced Practice Module (APM).
- Grao-Cruces E, Varela LM, Martin ME, Bermudez B, Montserrat-de la Paz S. High-density lipoproteins and Mediterranean diet: a systematic review. Nutrients. 2021;13(3):955. doi:10.3390/nu13030955.
- Antoniazzi L, Arroyo-Olivares R, Bittencourt MS, et al. Adherence to a Mediterranean diet, dyslipidemia and inflammation in familial hypercholesterolemia. Nutr Metab Cardiovasc Dis. 2021;31(7):2014-2022. doi:10.1016/j.numecd.2021.04.006.
- Tang C, Wang X, Qin L-Q, Dong J-Y. Mediterranean diet and mortality in people with cardiovascular disease: a meta-analysis of prospective cohort studies. Nutrients. 2021;13(8):2623. doi:10.3390/nu13082623.
- Zurbau A, Au-Yeung F, Blanco Mejia S, et al. Relation of different fruit and vegetable sources with incident cardiovascular outcomes: a systematic review and meta-analysis of prospective cohort studies. J Am Heart Assoc. 2020;9(19):e017728. doi:10.1161/JAHA.120.017728.
- Poulsen NB, Lambert MNT, Jeppesen PB. The effect of plant derived bioactive compounds on inflammation: a systematic review and meta-analysis. Mol Nutr Food Res. 2020;64(18):e2000473. doi:10.1002/mnfr.202000473.
- Jenkins DJA, Kitts D, Giovannucci EL, et al. Selenium, antioxidants, cardiovascular disease, and all-cause mortality: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2020;112(6):1642-1652. doi:10.1093/ajcn/nqaa245.
- Jiang L, Wang J, Xiong K, Xu L, Zhang B, Ma A. Intake of fish and marine n-3 polyunsaturated fatty acids and risk of cardiovascular disease mortality: a meta-analysis of prospective cohort studies. Nutrients. 2021;13(7):2342. doi:10.3390/nu13072342.
- Pittler MH, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev. 2008;(1):CD5312. doi:10.1002/14651858.CD005312.pub2.
- Bailey RL, West Jr. KP, Black RE. The epidemiology of global micronutrient deficiencies. Ann Nutr Metab. 2015;66(S2):22-33. doi:10.1159/000371618.
- Only 1 in 10 adults get enough fruits and vegetables. Centers for Disease Control and Prevention. https://www.cdc.gov/nccdphp/dnpao/division-information/media-tools/adults-fruits-vegetables.html. Published February 21, 2021. Accessed December 8, 2021.
- Cascino TM, Hummel SL. Nutrient deficiencies in heart failure: a micro problem with macro effects? J Am Heart Assoc. 2018;7(17):e010447. doi:10.1161/JAHA.118.010447.
- Kheiri B, Abdalla A, Osman M, Ahmed S, Hassan M, Bachuwa G. Vitamin D deficiency and risk of cardiovascular diseases: a narrative review. Clin Hypertens. 2018;24:9. doi:10.1186/s40885-018-0094-4.
- Wu J, Xun P, Tang Q, Cai W, He K. Circulating magnesium levels and incidence of coronary heart diseases, hypertension, and type 2 diabetes mellitus: a meta-analysis of prospective cohort studies. Nutr J. 2017;16(1):60. doi:10.1186/s12937-017-0280-3.
- Rosanoff A, Costello RB, Johnson GH. Effectively prescribing oral magnesium therapy for hypertension: a categorized systematic review of 49 clinical trials. Nutrients. 2021;13(1):195. doi:10.3390/nu13010195.
- Khan MS, Khan F, Fonarow GC, et al. Dietary interventions and nutritional supplements for heart failure: a systematic appraisal and evidence map. Eur J Heart Fail. 2021;23(9):1468-1476. doi:10.1002/ejhf.2278.
- Qu H, Guo M, Chai H, Wang W, Gao Z, Shi D. Effects of coenzyme Q10 on statin-induced myopathy: an updated meta-analysis of randomized controlled trials. J Am Heart Assoc. 2018;7(19):e009835. doi:10.1161/JAHA.118.009835.
- Gerards MC, Terlou RJ, Yu H, Koks CH, Gerdes VE. Traditional Chinese lipid-lowering agent red yeast rice results in significant LDL reduction but safety is uncertain – a systematic review and meta-analysis. Atherosclerosis. 2015;240(2):415-423. doi:10.1016/j.atherosclerosis.2015.04.004.
- Minamizuka T, Koshizaka M, Shoji M, et al. Low dose red yeast rice with monacolin K lowers LDL cholesterol and blood pressure in Japanese with mild dyslipidemia: a multicenter, randomized trial. Asia Pac J Clin Nutr. 2021;30(3):424-435. doi:10.6133/apjcn.202109_30(3).0009.
- Sungthong B, Yoothaekool C, Promphamorn S, Phimarn W. Efficacy of red yeast rice extract on myocardial infarction patients with borderline hypercholesterolemia: a meta-analysis of randomized controlled trials. Sci Rep. 2020;10(1):2769. doi:10.1038/s41598-020-59796-5.