The heart is the most energy demanding organ in the body, pumping approximately 2000 gallons of blood per day and beating an estimated 2.5 billion times in an average lifetime.³ It’s one of the most important organs in terms of keeping the human body alive. Yet cardiovascular disease remains a leading cause of morbidity and mortality globally.⁴ Lifestyle modifications, including a heart-healthy diet, regular exercise, and stress management, are fundamental for preventing heart-related issues. In addition to these lifestyle factors, dietary supplements have gained attention as a potential strategy to support heart health. Given this growing interest in dietary supplements, it’s important for clinicians to stay informed on research, examining their potential mechanisms of action and the scientific evidence supporting their use. In this article, we will summarize the evidence linking two commonly used dietary supplements to cardiovascular disease, with a special focus on novel insights from an emerging
probiotic.

Omega 3’s

Omega-3 fatty acids have been extensively studied for their cardiovascular benefits, ranging from reduced inflammation to supporting a reduction in blood pressure, yet most people in the U.S. don’t get adequate amounts in their diets.⁵ 

There are 11 different omega-3 fatty acids that can be found in nature, but when it comes to human physiology, only three of these omega-3’s are important: α-Linolenic Acid (ALA), Eicosapentaenoic Acid (EPA), and Docosahexaenoic Acid (DHA). These fatty acids have several responsibilities in our body, but we cannot synthesize them ourselves. Instead, we must get them through dietary sources or supplements, making them essential nutrients. The preferred sources are DHA and EPA, the fatty acids found in seafood sources like salmon and sardines. ALA, on the other hand, is typically found in certain plant foods like flaxseeds, chia seeds and walnuts and is often easier to acquire in the diet. While the human body is able to turn ALA into usable DHA and EPA, the conversion rate is low and isn’t as efficient as getting DHA and EPA from direct sources.6 For most people, this means consuming fatty fish or taking marine-based omega-3 supplements. Fish rich in omega-3’s include salmon, sardines, mackerel and anchovy. Since these cold-water fatty fish can’t synthesize their own EPA and DHA, they must obtain them from eating marine algae or other organisms that have consumed algae. In fact, many species of microalgae do synthesize their own omega-3’s, making algae oil that is rich in EPA and DHA a suitable vegan alternative for fish oil supplementation.⁷ In fact, supplements containing the omega-3 fatty acids EPA and DHA have been shown to have many beneficial effects on human health, including cardiovascular disease and associated risk factors.

Cardiovascular Disease (CVD) 

A recent meta-analysis of 40 clinical trials found that EPA and DHA intake was associated with significant reductions in the risk for CVD deaths.⁸ Specifically, this study found that EPA and DHA supplementation is associated with a reduced risk of:

• Fatal heart attack (35%) 
• Heart attack (13%) 
• Coronary heart disease events (10%) 
• Coronary heart disease mortality (9%) 

Dyslipidemia

Oral supplementation with 3-4g EPA/DHA daily has been shown to reduce triglyceride (TG) levels by up to 50%.^9,10 Fish oil has also demonstrated significant increases in high-density lipoprotein (HDL) cholesterol as well as decreases in very-low-density lipoprotein (VLDL) cholesterol, but not low-density lipoprotein (LDL) cholesterol.^11,12

High Blood Pressure

A meta-analysis of 71 clinical trials looked at the relationship between blood pressure and EPA and DHA. The analysis showed that individuals who consumed approximately 3g daily of EPA/DHA through diet or supplementation significantly reduced their systolic and diastolic blood pressure compared to those who did not consume EPA and DHA.¹³

The American Heart Association (AHA) recommends the consumption of omega-3 fatty acids to decrease the risk factors associated with heart disease, such as hypertension, high triglycerides and atherosclerosis.¹⁴

• The AHA recommends that adults eat one to two servings per week of fatty fish high in omega-3 fatty acids to reduce the risk of CVD.
• For individuals with existing coronary heart disease, the AHA recommends 1g/day EPA+DHA from fish or dietary supplements under the direction of a physician.
• For individuals with elevated triglycerides, the AHA recommends 4g/day of EPA+DHA or EPA from fish or dietary supplements under the direction of a physician.

While there are many studies on the combined intake of DHA and EPA in reducing cardiovascular risk factors, they use a varied ratio and dose. At this time, it remains unclear whether the ratio of EPA to DHA in omega-3 supplementation affects their efficacy as modulators for cardiovascular risk factors. However, there is a large body of evidence that supports the benefits of both EPA and DHA for heart health. A recent analysis from 17 studies found that higher circulating levels of EPA and DHA, both separately and together, were associated with a lower risk of premature death from cardiovascular disease.¹⁵

Healthcare practitioners counseling clients on cardiovascular health should guide patients and clients to consume direct sources of EPA and DHA from fish or algae when appropriate because the conversion from ALA is less efficient. For individuals not getting adequate EPA and DHA from diet, supplements prove to be an effective alternative. 

Coenzyme Q10 (CoQ10)

Coenzyme Q10 (CoQ10) is another popular dietary supplement for heart health. This fat-soluble, vitamin-like molecule is found naturally in every cell in our bodies. Cellular levels of CoQ10 are especially important in cardiac tissue. The heart is an organ with high energy demands, and CoQ10 plays a crucial role in cellular energy production and antioxidant protection. While it can be obtained from dietary sources such as meats, fish and nuts, the amount obtained from food isn’t enough to significantly increase levels in the body. It is also endogenously synthesized with the highest concentrations observed in the heart, kidneys, and liver. However, these levels decrease with age and can be impacted by certain medications and specific health conditions.¹⁶ Despite this, there is growing evidence that CoQ10 is tightly linked to cardiovascular health and its supplementation, either alone or combined with other therapies, appears to have potential benefits. Healthcare professionals may consider CoQ10 supplementation or advise its use based on individual patient’s needs. Here are some scenarios where CoQ10 might be considered:

High Blood Pressure

In an analysis of 12 clinical studies, researchers reported that CoQ10 has the potential to lower systolic blood pressure up to 17 mm Hg and diastolic pressure by 10 mm Hg without significant side effects.¹⁷

Cardiovascular Disease 

A meta-analysis of 50 randomized control trials revealed that CoQ10 supplementation decreased the total cholesterol (TC), LDL, and TG levels, and increased HDL levels in adults.18 CoQ10 supplementation was also shown to lower C-reactive protein, an inflammatory biomarker shown to be a risk factor for CVD.¹⁹

Heart Failure (HF) 

According to a multi-center randomized study, CoQ10 reduced mortality rates by half in patients with moderate to severe heart failure compared to the control group.²⁰

Myocardial Infarction (MI)

One randomized clinical trial found that patients who took daily CoQ10 soon after an MI or heart attack were less likely to have subsequent heart attacks and chest pain. They were also less likely to die of heart disease than those who did not take the supplements.²¹ 

According to research, the dosage of CoQ10 for cardiovascular conditions typically ranges from 100-300mg a day. As supplements, there are two primary types of CoQ10; ubiquinone and ubiquinol. In the body, CoQ10 naturally shifts back and forth between these two forms in a continuous cycle via an enzymatic conversion process depending on which form is needed at the time.²² This conversion typically occurs within the inner mitochondrial membrane, where 80% of CoQ10 in the cell resides, with the remainder distributed in other cellular membranes.²³

Ubiquinone is the oxidized form of CoQ10 and is more stable, the most studied and least expensive supplemental form. Ubiquinol is the electron-rich (reduced) form of CoQ10. It is easily oxidized and more expensive in supplemental form due to its unstable nature. Currently, research has not proven one supplemental form of CoQ10 to be better than the other. Both forms are considered important and play an important role in the body. Ubiquinone is essential for ATP energy production and ubiquinol is an important fat-soluble antioxidant protecting against free radical damage. Given the body naturally converts between these two forms as needed, it’s generally advisable to start with the form that is more affordable.²⁴ The exception to this would be individuals with a genetic mutation causing a lack of the enzymes necessary to make the conversion.

Akkermansia Muciniphila

Akkermansia muciniphila (A. muciniphila) Akkermansia muciniphila (A. muciniphila) is touted as being a novel functional microbe and probiotic. Since its discovery in 2004, this unique microbe has garnered considerable attention as a promising probiotic strategy for improved metabolic health. This beneficial bacterium is a resident of the human gut and makes up 1-3% of the total gut microbiota in healthy individuals, but as with many beneficial gut microbes, its presence in the gut can be negatively impacted by dietary factors, inflammation, antibiotic usage and age.²⁵ In recent years, evidence has shown promise of its therapeutic properties against metabolic disorders with promising associations with cardiovascular health.²⁶ A proof of concept study recently published, explored the potential benefits of supplementation with A. muciniphilia in obese and overweight human volunteers. The findings revealed consumption of A. muciniphila resulted in an improvement in insulin resistance and a reduction in blood levels of insulin and total cholesterol. It also reduced body weight, fat mass and hip circumference in study participants supplementing with A. muciniphila. In contrast, participants who had not consumed the probiotic exhibited a gradual deterioration of metabolic and cardiovascular functions.²⁰

While this study is promising, more research is needed to further substantiate whether this bacterium can truly be used to effectively moderate metabolic and cardiovascular risk factors. Larger scale studies are needed to fully understand the mechanisms of action and establish a clear cause-and-effect relationship between A. muciniphila and cardiovascular health. While this probiotic is currently available in retail, the use of A. muciniphila as a supplement for cardiovascular health remains an area of ongoing investigation, and its efficacy needs further exploration.

Recommendations for Practitioners

Impressive scientific evidence continues to accumulate supporting the use of dietary supplements like omega-3 fatty acids and CoQ10 in the treatment and/or prevention of CVD. Despite promising findings from a growing body of evidence, controversy and confusion remain amongst practitioners concerning if or how supplements ought to be utilized. Staying up to date with current supplement trends and research is increasingly important when considering dietary supplements with patients or clients. Healthcare practitioners can use tools such as PubMed, Cochrane review and Google Scholar to stay current on scholarly literature.

Of course, any dietary supplement recommendations should be personalized based on an individual’s specific needs, health goals, lifestyle and medical history. While certain supplements may be beneficial for cardiovascular disease, there are no magic pills. Dietary supplements are meant to “supplement” a diet, and without first addressing any underlying deleterious dietary issues, supplements alone are unlikely to yield desired health benefits. As such, practitioners should focus their initial efforts on helping patients and clients optimize lifestyle and dietary habits, in order to meet personalized nutrient needs, before or in conjunction with any supplementation guidance.

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