Supplements for Heart Health: What You Need to Know

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Cardiovascular disease includes heart attack, stroke, and heart failure. It's the leading cause of death in the world. But it doesn't have to be this way. Often cardiovascular disease can be avoided with a healthy lifestyle, plus preventive medical care when needed.

Dietary supplements are often marketed to people hoping to reduce the risk of heart disease, lower blood pressure, and drop cholesterol levels. But there's limited evidence that supplements can make a difference. And, unlike prescription medications, supplements are not closely regulated by the FDA. That means you can't always be certain what you're getting when you take a supplement. The listed dose and ingredients may not be accurate.

In this article, we'll review a range of supplements that are marketed for heart health. We'll examine the evidence for and against their use. And we'll talk about some supplements that might even be harmful.

Can vitamins and supplements protect you from heart disease?

Some supplements might lower the risk of heart disease for certain people, usually by affecting risk factors like blood pressure and cholesterol. Other supplements may not hurt, but won't provide much benefit for heart health either. Some supplements may even cause harm.

Since each person is different, it's important to discuss your supplement use with your physician or healthcare professional. Reports from both the American College of Cardiology and the American Heart Association caution that more research is needed before recommending supplements. There are some supplements that can interact with prescription medications. And certain supplements can make pre-existing problems worse.

Most importantly, supplements can't replace good nutrition, regular exercise, and a healthy lifestyle. But they can be a helpful addition in some situations. Let's review some of the possible benefits of supplements.

Supplements that may support heart health

1. Fiber

Fiber comes from plant-based foods like fruits, vegetables, whole grains, and nuts. Since fiber is not digested, it might not seem important. But a certain type of fiber, known as soluble fiber, can help to lower your cholesterol. It may also reduce inflammation in the heart and other organs. Studies show that people who eat more fiber have a lower risk for heart disease.

It's always a good idea to get plenty of fiber from food. But you can also take fiber supplements like psyllium (Metamucil). Psyllium is often used as a laxative. But research has found that these supplements can lower your cholesterol by over 6%. That's not a lot, but if you take a fiber supplement along with a statin, it may have the same impact as doubling the dose of medication.

It's important to drink plenty of water when you take a fiber supplement. That can help to reduce your chances of gastrointestinal (GI) upset.

2. Red yeast rice

Red yeast rice is very similar to the statin medication known as lovastatin. Studies have shown that supplements of red yeast rice can lower your cholesterol and may reduce the risk of heart disease. Most people can take red yeast rice safely. But this supplement may have the same side effects as statins.

Some red yeast rice supplements may also contain a chemical that can harm the kidneys. Since the supplements are not closely regulated by the FDA, you cannot be certain that it's safe.

If you choose to take a red yeast rice supplement, check in with your doctor or your primary care provider to be sure it's safe for you. They can order regular blood testing to check your cholesterol levels, and liver and kidney function.

3. Garlic

Garlic is a great addition to a nutritious and balanced diet. And there's some evidence that supplements may improve blood pressure and cholesterol. Currently the research is very limited, and the impact of garlic is still being studied.

Most people can take garlic supplements safely. But garlic can interact with a few medications, including some blood thinners and HIV medications. Of course, garlic can affect your breath and body odor, too.

Supplements to approach with caution

1. Fish oil

Fish oil is an omega-3 fatty acid found in cold water fish. People who eat fish high in omega-3s (including salmon, tuna, and mackerel) tend to have a lower risk for heart disease. Since many people don't eat fish regularly, fish oil capsules are popular supplements.

At prescription strength doses, omega-3s from fish oil can lower triglyceride levels. They might also lower your blood pressure by a few points. Some studies suggest that taking high dose omega-3s can lower heart attack risk. But others have found no benefit. Experts agree that fish oil supplements don't provide the same benefits as eating fatty fish regularly.

The major problem with fish oil supplements is that they may raise your risk for atrial fibrillation. This risk has shown up in multiple studies. One study published in 2024 that looked at over 400,000 individuals found that people without heart disease who took fish oil supplements regularly were more likely to develop atrial fibrillation. They were also at greater risk for stroke. Yet for people who already had heart disease, those who took fish oil had a lower risk of heart attack and death.

So fish oil supplements might be beneficial for some people. But they may also cause harm for others.

2. Folate (vitamin B9)

Folate, also called vitamin B9 or folic acid, is an essential vitamin. Spinach and other green leafy vegetables are great sources of folate. So are many fortified breakfast cereals.

Some people with low levels of folate and abnormally high levels of the amino acid homocysteine may have a higher risk of stroke. Your physician can test your blood for homocysteine if needed. If the level is high, it's possible that supplementing with folate may help to lower your risk for stroke.

Folate doesn't appear to protect against heart attacks. There's even some evidence that for people with coronary artery stents, high doses of folate may raise the risk of complications.

3. Coenzyme Q10

Coenzyme Q10, also known as CoQ10 and ubiquinone, is naturally produced by your body. You also get it from fatty fish, whole grains, nuts, and organ meats. A study in 2014 reported that CoQ10 seemed to improve symptoms of heart failure. But a later analysis of this and other studies found that there was no definite benefit.

CoQ10 was once thought to reduce muscle aches in people who take statins. That's because for some people statins seem to lower CoQ10 levels. And some people who take statins get muscle pain. Because muscles need CoQ10 to function normally, it's possible that low levels are responsible for the pain. But when all the studies looking at this question were analyzed together, there didn't seem to be any benefit of taking CoQ10 supplements.

There are a few important downsides to CoQ10, including interactions with blood thinners and cancer chemotherapy. It can also unpredictably lower your blood pressure, especially at doses over 100 mg.

4. Antioxidants

Antioxidants are found in a variety of plant-based foods. They can help neutralize some of the harmful substances in our diet and environment that contribute to heart disease, inflammation, and cancer.

But taking high doses of antioxidant supplements is not recommended for preventing heart disease. That's because there's no good evidence that antioxidants in supplement form can help. For athletes, high doses of antioxidants may prevent the natural recovery process. And antioxidant supplements may even interfere with some cancer treatments.

Food is different from supplements. The amount of antioxidants in foods like fruits and vegetables is something your body is designed to handle. And foods include a wide range of nutrients, instead of just a single antioxidant. Adding them to your diet may help lower your risk of heart disease and other chronic conditions.

5. Magnesium and potassium

Potassium and magnesium supplements may help to lower blood pressure in some people taking blood pressure medication. But they are not right for everyone. That's because these electrolytes are managed by the kidneys. If you have kidney disease, your kidneys may not be able to process them normally. And some medications can affect the way your body handles potassium and magnesium.

Check with your physician before taking one of these supplements. They can order blood work and monitor your levels. In some cases, you may need a prescription for potassium or magnesium. That way you can be certain of the exact dose that you're taking.

6. Green tea extract

Both black and green tea are good sources of a type of antioxidant known as polyphenols. Green tea tends to have more of these antioxidants because of the way that it's processed. It also has less caffeine than black tea.

Research has found a number of ways that tea might help your heart. There's some evidence that tea can improve your cholesterol profile. Other studies have suggested that it can lower your risk for heart disease, high blood pressure, and even diabetes.

Most people can drink up to 8 cups of green tea daily without safety issues. But some people choose to take supplements made from green tea extract. The research on these supplements is limited, and there's a potential for side effects, including liver toxicity. Green tea supplements may contain caffeine, so if you're dealing with insomnia or anxiety, it may be best to avoid them.

What supplements probably won't improve your heart health?

These supplements are often claimed to improve heart health but don't have strong evidence supporting their use.

1. Flaxseed oil

Like fish oil, flaxseed oil is an omega-3 fatty acid. It's plant-based, so its chemical structure is different from the omega-3 you get from fish. For your body to be able to use flaxseed oil in the same way, it needs to be changed into the oil that you get from fish. After that process, you end up with only about 10% of the active ingredient.

We don't know if flaxseed oil has the same potential for harm (risk of atrial fibrillation) as fish oil. And there could be other benefits that are still being studied. But for now, there's no strong evidence to support the use of flaxseed oil supplements.

2. Daily multivitamin

Multivitamins will not lower your risk of heart disease. Research looking at hundreds of thousands of people has also found no benefit for cancer prevention or stroke. Most of the time, if you eat a balanced diet, then it's not necessary to take a daily multivitamin. And if you consume too many vitamins, they can be stored in the body and do more harm than good.

3. Plant stanols and sterols

Plant stanols and sterols are naturally found in foods like nuts and vegetable oils. Supplements or foods fortified with these ingredients can help to lower cholesterol by about 10%. But some research has linked these substances to a higher risk of heart disease. For now, it's best to avoid these supplements until more is known about their effect on heart health.

4. Vitamin D

Your body makes vitamin D when your skin gets exposed to sunlight. You also get it from fish, mushrooms, and fortified dairy products. People with low levels of vitamin D may have an increased risk of heart attack, stroke, and hypertension. But supplements don't seem to lower that risk. An analysis of 21 studies that included over 80,000 people found no evidence that supplements improve heart health.

There may be other reasons to take vitamin D, including for bone health. If you're at risk for having low vitamin D, a healthcare professional can run a blood test to tell you whether your levels are low.

5. Niacin

Niacin used to be prescribed to improve cholesterol for some people. But even though it might make your numbers look better, it turns out that high doses of niacin may actually be harmful to your heart. High doses of niacin (1,000 mg or more) can cause other side effects, including flushing and high blood sugar, among others.

6. L-arginine

L-arginine is a supplement that's often marketed for heart health. But a randomized controlled study looking at people who were recovering from a heart attack found a higher risk of death in those taking the supplement. This caused the study to end early.

This supplement may lower your blood pressure. The problem is that the effect isn't always predictable. L-arginine can interact with blood pressure medications and meds for erectile dysfunction. In these situations, your blood pressure may get dangerously low.

7. Vitamin K2

Vitamin K2 (menaquinone) comes from fermented food like cheese, kefir (a yogurt-like drink), sauerkraut, and natto, a type of fermented soybean. You can also get this vitamin from egg yolk, beef liver, and chicken. It's different from vitamin K1, which is found in green leafy vegetables and berries.

There's some evidence that foods high in vitamin K2 may be protective for the heart. But overall, studies of supplements haven't shown a clear advantage. One study that looked at aortic stenosis found no benefit of supplements in people who already had this condition.

Vitamin K2 is important for normal blood clotting. But it hasn't been found to increase the risk of blood clots in people who are not on blood thinners. If you are on a blood thinner, it's important to check with a healthcare professional before starting this supplement.

What are the risks of taking supplements?

As mentioned, sometimes supplements can do more harm than good. The risks usually depend on the product, but generally speaking, they can include:

• Interaction with medications

• Incorrect labeling

• Toxicity to liver, kidneys, or other organs

• False sense of security

It's worth mentioning again that since these products are not regulated by the FDA, you don't have a way to know exactly what, or how much, you're getting.

So, what will help my heart health?

Now you know supplements won't do much to improve your heart health. But there are steps you can take to do so naturally and effectively.

Limiting salt for heart health

Lowering sodium intake is a great way to reduce the risk of high blood pressure and heart disease. You can lower sodium in your diet by:

• Limiting your intake of ultra-processed foods, frozen meals, and fast food.

• Using herbs, spices, and different types of vinegar when cooking can enhance the flavor of your meals and minimize how much salt you need.

• Instead of eating pre-prepared sauces and dressings, you can make your own with olive oil, herbs, and spices of your choice.

Other diet changes for heart health

The Mediterranean diet and the DASH diet are consistently linked with better heart health. But any eating pattern that focuses on plant-based foods, whole grains, healthy fats, and lean protein can help promote better heart and overall health.

Limiting added sugars, animal products, and alcohol is also important for lowering inflammation. Chronic inflammation is linked to many health conditions, including heart disease.

Lifestyle changes for heart health

Other lifestyle changes you can make to improve heart health include:

• Exercising regularly

• Avoiding smoking

• Maintaining a balanced and comfortable weight

Besides these lifestyle changes, it's important to go to a healthcare professional for regular checkups. Doing so can help your healthcare team monitor your risks and come up with a treatment plan if needed. This is especially important if you have a personal or family history of heart disease.

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