What is the relationship between Pycnogenol, Gotu Kola, Vitamin K2, Tocotrienols, Berberine, and Niacin and arterial plaque formation?

Relationship Between Supplements and Arterial Plaque Formation

Based on current evidence, niacin is not recommended for arterial plaque management due to lack of cardiovascular benefit and increased risk of side effects including stroke, while berberine, vitamin K2, tocotrienols, pycnogenol, and gotu kola have limited high-quality evidence supporting their use for preventing arterial plaque formation.

Niacin and Arterial Plaque

• Niacin (nicotinic acid) was historically considered for raising HDL cholesterol and lowering triglycerides, but recent guidelines strongly discourage its use 1
• The HPS2-THRIVE trial showed niacin therapy failed to reduce cardiovascular events compared to placebo (13.2% vs. 13.7%) and was associated with increased adverse effects 1
• Niacin therapy increased the risk of new-onset diabetes, gastrointestinal issues, musculoskeletal problems, skin reactions, and unexpectedly, infections and bleeding 1
• The AHA/ASA guidelines specifically state that niacin may be considered for patients with low HDL cholesterol or elevated lipoprotein(a), but its efficacy in preventing ischemic stroke is not established, and it increases the risk of myopathy 1
• Combination therapy with statins and niacin is not recommended due to lack of efficacy on major cardiovascular outcomes and increased side effects 1

Pycnogenol and Arterial Plaque

• Pycnogenol® (French maritime pine bark extract) has shown potential benefits in small studies for reducing atherosclerotic plaque progression 2
• A 4-year study found that Pycnogenol® (100 mg/day) reduced the progression of arterial plaques and associated clinical events compared to controls 2
• The combination of Pycnogenol® with Centella asiatica showed even greater benefits in reducing plaque progression than Pycnogenol® alone 2, 3
• Pycnogenol® supplementation (150 mg/day) has been shown to improve metabolic syndrome risk factors including waist circumference, triglycerides, blood pressure, and HDL cholesterol 4
• The supplement appears to work partly through reduction of oxidative stress, which was significantly lower in supplemented groups compared to controls 2, 4

Gotu Kola (Centella Asiatica) and Arterial Plaque

• Centella asiatica, when combined with Pycnogenol®, has shown synergistic effects in reducing arterial plaque progression compared to Pycnogenol® alone 2, 3
• A 12-month study demonstrated that the combination of Pycnogenol® (150 mg/day) and Centella asiatica (450 mg/day) decreased coronary calcifications by 9.95%, while control subjects showed a 34.88% increase 3
• This combination appears to not only block the increase in calcified areas but potentially decrease the number of calcified spots over time 3

Vitamin K2 and Arterial Plaque

• While vitamin K antagonists (warfarin) are mentioned in guidelines regarding pharmacogenetic dosing 1, specific evidence on vitamin K2 supplementation for arterial plaque prevention is not addressed in current cardiovascular guidelines
• The AHA/ASA guidelines mention pharmacogenetic dosing of vitamin K antagonists may be considered when therapy is initiated (Class IIb; Level of Evidence C) 1, but this relates to dosing of anticoagulants rather than supplementation for plaque prevention

Tocotrienols and Arterial Plaque

• Current cardiovascular guidelines do not specifically address tocotrienols for arterial plaque management
• The focus of lipid management in guidelines remains primarily on statins as first-line therapy for atherosclerotic cardiovascular disease risk reduction 1

Berberine and Arterial Plaque

• Berberine is not specifically addressed in current cardiovascular guidelines for arterial plaque management
• Guidelines focus primarily on established lipid-lowering therapies such as statins, with nonstatin therapies considered only when statins cannot be tolerated 1

Omega-3 Fatty Acids (For Context)

• For patients with elevated triglycerides (135-499 mg/dL) on a statin with controlled LDL cholesterol, the addition of icosapent ethyl (a purified form of EPA) can be considered to reduce cardiovascular risk 1
• Marine-derived omega-3 fatty acids at doses of 2-4g/day can decrease serum triglyceride concentrations by 25-30% 5
• Higher doses of omega-3 fatty acid supplementation (>1g/day) have been associated with a 25% increase in risk for atrial fibrillation 5

Clinical Implications and Recommendations

• For primary prevention of cardiovascular disease, statins remain the cornerstone of therapy for those at elevated risk 1
• Mediterranean diet supplemented with nuts may be considered for lowering stroke risk (Class IIb; Level of Evidence B) 1
• While some supplements show promise in small studies (particularly Pycnogenol® and Centella asiatica), they have not been incorporated into major cardiovascular guidelines 2, 3
• Patients should be cautioned about potential interactions between supplements and medications, as highlighted in thrombocytopenia management guidelines 6
• Regular blood pressure screening, appropriate treatment of hypertension, and lifestyle modifications remain essential components of cardiovascular disease prevention 1