From the Guidelines
The most evidence-based dietary supplement for reducing cardiovascular events is omega-3 fatty acids, specifically EPA and DHA, at a dose of 1-2 grams daily. This recommendation is based on the strongest and most recent evidence from the American Heart Association, which suggests that omega-3 fatty acids have strong evidence for cardiovascular benefits, reducing inflammation, and supporting brain health 1. However, it's essential to note that the 2023 AHA/ACC/ACCp/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease states that the use of nonprescription or dietary supplements, including fish oil and omega-3 fatty acids or vitamins, is not recommended in patients with CCD given the lack of benefit in reducing cardiovascular events 1.
Despite this, the benefits of omega-3 fatty acids for primary and secondary prevention of coronary disease, as well as the treatment of hypertriglyceridemia, have been consistently demonstrated in previous studies 1. The optimal dose of omega-3 fatty acids for these benefits is still being researched, but a dose of 1-2 grams daily of EPA and DHA is commonly recommended.
Other supplements, such as vitamin D, magnesium, creatine, and probiotics, may also have benefits for overall health and wellness, but the evidence for their use is not as strong as it is for omega-3 fatty acids. Vitamin D supplementation (1000-2000 IU daily) may be beneficial for bone health, immune function, and mood regulation, particularly for those with limited sun exposure or deficiency. Magnesium (300-400mg daily) has been shown to improve sleep quality, muscle function, and stress management. Creatine monohydrate (3-5g daily) is extensively researched for enhancing muscle strength, power, and recovery, especially for athletes. Probiotics containing Lactobacillus and Bifidobacterium strains can improve gut health and immune function when taken regularly.
Before starting any supplement regimen, it's advisable to assess your specific deficiencies through bloodwork and consult with a healthcare provider, as supplements should complement rather than replace a balanced diet. Key points to consider when selecting dietary supplements include:
- The potential benefits and risks of each supplement
- The optimal dose and duration of treatment
- The potential interactions with other medications or health conditions
- The quality and purity of the supplement product.
From the Research
Evidence-Based Dietary Supplements
The most evidence-based dietary supplements available are omega-3 fatty acids, which have been shown to have numerous cardiovascular benefits.
- Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been found to reduce cardiovascular events by 19% to 45% in large controlled trials of 32,000 participants 2.
- The target consumption levels for omega-3 fatty acids are about 1 g/d for those with known coronary artery disease and at least 500 mg/d for those without disease 2.
- Combination therapy with omega-3 fatty acids and a statin is a safe and effective way to improve lipid levels and cardiovascular prognosis beyond the benefits provided by statin therapy alone 2.
Sources of Omega-3 Fatty Acids
Omega-3 fatty acids can be obtained from dietary sources, such as:
- Fatty fish, which contain EPA and DHA 3, 4.
- Nuts, seeds, and vegetable oils, which contain α-linolenic acid (ALA) 3.
- Fish oil supplements, which can provide a concentrated source of EPA and DHA 2, 3, 5, 4.
Recommendations for Use
The recommendations for the use of omega-3 fatty acids vary depending on the individual's cardiovascular risk profile:
- For primary prevention of cardiovascular disease, one serving (200-400 g) of fatty fish two times per week and a diet that includes foods rich in ALA are recommended 3.
- For patients with known cardiovascular disease or congestive heart failure, one serving (200-400 g) of fatty fish or a fish oil supplement containing 900 mg of EPA + DHA every day and a diet rich in ALA are recommended 3.
- For patients with very high triglyceride levels (> 500 mg/dL), omega-3 fatty acid formulations (both in the ethyl ester form) have been approved by the US Food and Drug Administration (FDA) for treatment 5.