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Micronutrient Supplementation to Reduce Cardiovascular Risk
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
Healthy dietary patterns are rich in micronutrients, but their influence on cardiovascular disease (CVD) risks has not been systematically quantified.
OBJECTIVES
The goal of this study was to provide a comprehensive and most up-to-date evidence-based map that systematically quantifies the impact of micronutrients on CVD outcomes.
METHODS
This study comprised a systematic review and meta-analysis of randomized controlled intervention trials of micronutrients on CVD risk factors and clinical events.
RESULTS
A total of 884 randomized controlled intervention trials evaluating 27 types of micronutrients among 883,627 participants (4,895,544 person-years) were identified. Supplementation with n-3 fatty acid, n-6 fatty acid, l-arginine, l-citrulline, folic acid, vitamin D, magnesium, zinc, α-lipoic acid, coenzyme Q10, melatonin, catechin, curcumin, flavanol, genistein, and quercetin showed moderate- to high-quality evidence for reducing CVD risk factors. Specifically, n-3 fatty acid supplementation decreased CVD mortality (relative risk [RR]: 0.93; 95% CI: 0.88-0.97), myocardial infarction (RR: 0.85; 95% CI: 0.78-0.92), and coronary heart disease events (RR: 0.86; 95% CI: 0.80-0.93). Folic acid supplementation decreased stroke risk (RR: 0.84; 95% CI: 0.72-0.97), and coenzyme Q10 supplementation decreased all-cause mortality events (RR: 0.68; 95% CI: 0.49-0.94). Vitamin C, vitamin D, vitamin E, and selenium showed no effect on CVD or type 2 diabetes risk. β-carotene supplementation increased all-cause mortality (RR: 1.10; 95% CI: 1.05-1.15), CVD mortality events (RR: 1.12; 95% CI: 1.06-1.18), and stroke risk (RR: 1.09; 95% CI: 1.01-1.17).
CONCLUSIONS
Supplementation of some but not all micronutrients may benefit cardiometabolic health. This study highlights the importance of micronutrient diversity and the balance of benefits and risks to promote and maintain cardiovascular health in diverse populations. (Antioxidant Supplementation in the Prevention and Treatment of Cardiovascular Diseases; CRD42022315165).
Additional Info
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Micronutrient Supplementation to Reduce Cardiovascular Risk
J Am Coll Cardiol 2022 Dec 13;80(24)2269-2285, P An, S Wan, Y Luo, J Luo, X Zhang, S Zhou, T Xu, J He, JI Mechanick, WC Wu, F Ren, S LiuFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
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.