Cardiovascular prevention through supplements
The idea that vitamins and minerals reduce myocardial infarction, stroke and cardiovascular death. Large RCTs (VITAL, HOPE, HOPE-2, HPS, JPHC) for vitamin D, E, folate+B12+B6 and antioxidants showed no clinically meaningful event reduction in non-deficient people. ESC/EAS and SEA do not recommend vitamin-mineral complexes for primary or secondary cardiac prevention in patients without confirmed deficiency.
5 drugs
Also known as: Cardiovascular supplements, Vitamins for vessels
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- CKrill oilNot recommended · Phospholipid-bound omega-3 (EPA and DHA) with astaxanthin from Antarctic krill Euphausia superba, supplementKrill oil is an OTC supplement with claimed EPA/DHA load in fewer capsules than standard fish oil. EFSA in 2010 approved an EPA+DHA claim at 250 mg/day for normal heart function – the wording is source-agnostic (fish oil, krill oil, algal omega-3). No RCT has shown a krill-oil effect on hard cardiovascular outcomes (MI, stroke, CV death). Statins and non-pharmacological measures – blood-pressure and glucose control, smoking cessation, 150 min/week activity, Mediterranean diet – have orders-of-magnitude stronger evidence (ESC 2021, SEC 2022). If krill oil was bought to replace a prescribed statin, discuss with a cardiologist; stopping a statin in confirmed coronary disease multiplies infarction risk. EPA/DHA supplementation may be considered as an add-on in severe hypertriglyceridaemia above 5 mmol/L in agreement with the treating doctor.
- DOmega-6 polyunsaturated fatty acids (linoleic acid and GLA)Not recommended · Essential polyunsaturated fatty acidsOmega-6 is sold as part of "omega 3-6-9" complexes on the idea of "balanced fats for the heart." The reality is different: nearly everyone gets linoleic acid in excess from sunflower, corn, and soybean oil, and adults on a standard diet do not develop deficiency. The AHA 2017 Presidential Advisory and the EFSA 2010 Opinion both recommend meeting linoleic acid needs through food, not capsules. If the goal is cardiovascular protection, omega-3 (EPA+DHA) and the Mediterranean diet do the work – not omega-3-6-9 combinations. Buying these supplements means less EPA+DHA per capsule at a higher price than pure omega-3. If a clinician proposes such a supplement for cardiovascular prevention, consider seeking a second opinion.
- DOmega-9 monounsaturated fatty acid (oleic acid)Not recommended · Monounsaturated fatty acidsOmega-9 capsules are sold as a cardioprotective supplement, leaning on evidence about olive oil within the Mediterranean diet. The diet-to-capsule extrapolation has not been made: no large RCT has shown a cardiovascular benefit from isolated oleic-acid supplementation. Oleic acid is non-essential – the body synthesises it from stearic acid. If omega-9 capsules were proposed for cardiovascular prevention, consider seeking a second opinion: prevention is built on the Mediterranean diet, smoking cessation, blood-pressure and lipid control, and physical activity.
- DTocotrienolsNot recommended · Natural vitamin E forms (4 isomers α, β, γ, δ)Tocotrienols are a form of vitamin E sold as supplements and promoted to protect the heart and blood vessels and to lower the risk of heart attack and stroke. For cardiovascular prevention, studies have not shown convincing benefit from vitamin E supplements, including tocotrienols: they do not reduce heart attacks, strokes, or mortality. What does help is controlling blood pressure and cholesterol, quitting smoking, regular physical activity, a Mediterranean-style diet, and proven medications when a doctor prescribes them (for example, statins where indicated). The substance is harmless in this role, but it is not something to rely on for protecting your vessels.
- FCholecalciferol + menaquinone-7 (D3+K2 combo)Not recommended · Combined supplement: fat-soluble vitamins D3 and K2D3+K2 combo is heavily marketed on the biohacker argument: «K2 directs calcium into bone and removes it from vessels, preventing atherosclerosis and cardiovascular events». The large VITAL 2019 RCT (25 871 participants, mean 5.3 years) found vitamin D without K2 did not reduce cardiovascular events or cancer vs placebo. Cochrane 2014 on vitamin D and all-cause mortality confirmed: vitamin D does not reduce mortality in non-deficient people. No large cardiovascular outcome RCTs exist for K2. ESC 2021 does not recommend any vitamin-mineral complex for primary or secondary cardiac prevention in non-deficient people. If the combo was recommended «for heart and vessels», consider seeking a second opinion. Important: vitamin K reduces the effect of warfarin and other vitamin K antagonists; patients on these anticoagulants, including those with a mechanical heart valve, must not take vitamin K supplements without medical agreement.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit