Micronutrient Supplementation to Reduce Cardiovascular Risk

Micronutrients and cardiovascular risk

There are many nutrients that affect human health, and this study stresses their interactive synergy by encouraging a diverse plant-forward diet such as the Mediterranean diet and the DASH (Dietary Approach to Stop Hypertension) diet.

This extensive review of the literature helps us to understand which nutrients have the best evidence to date. This is heavily weighted on what has been studied. It is also important to remember that the beneficial value of the interactions of eating foods with these micronutrients is likely much greater than taking an isolated nutrient as a supplement.

The micronutrients with the strongest evidence for cardiovascular (CV) disease prevention were coenzyme Q10, omega-3 fatty acids, and folic acid. Micronutrients that had the greatest effect on multiple CV risk factors included genistein, zinc, anthocyanin, curcumin, flavonol, L-arginine, magnesium, and alpha-lipoic acid.

Coenzyme Q10 had the greatest benefit on all-cause cardiac mortality, with a relative risk of 0.68. A recent study published in Circulation also found coenzyme Q10 to be one of the most effective dietary supplements for congestive heart failure.

A surprise from this paper was the discussion of the multiple benefits associated with genistein. Genistein is a polyphenol that is found in high concentrations in beans. It is also a phytoestrogen (plant estrogen) that binds to estrogen receptors, preventing the more potent estrogens from stimulating tissue growth. This helps explain why populations of Asian countries who eat more of these foods (soybeans) have a lower incidence of breast and prostate cancer.

Many commonly prescribed medications inhibit these key nutrients. Some examples to remember are listed below.

• Angiotensin-converting enzyme (ACE) inhibitors and zinc: ACE inhibitors are associated with low zinc. Consider checking zinc levels in elderly patients on ACE inhibitors who get recurring infections.
• Metformin and vitamin B12: The package insert for metformin suggests checking B12 levels every 3 years.
• Statins and coenzyme Q10: Statin medications inhibit HMG coenzyme reductase, which is needed for coenzyme Q10 to make ATP in muscles. We want the heart muscle to have plenty of this nutrient for optimal function.
• Acetaminophen and glutathione: Glutathione is one of the body’s strongest antioxidants made in the liver. N-acetyl cysteine is given to people with acetaminophen overdose to increase glutathione and protect the liver from injury.
• Proton pump inhibitors (PPIs) and multiple micronutrients: Acid is needed for nutrient absorption, and suppressing acid with PPIs inhibits the absorption of iron, magnesium, B vitamins, folate, and calcium. This class of medicines also inhibits enzymes DDAH and ADMA, which convert nitrites to nitric oxide. Root vegetables (beets, onions, garlic, etc) help lower blood pressure by being rich in nitrates from the soil in which they grow. The nitrates get converted to nitrites and then nitric oxide, resulting in vasodilation. Being on a PPI may negate the beneficial effects of eating these CV superfoods. It is estimated that two-thirds of chronic PPI takers do not need the medication.