Should we take supplements to prevent cardiovascular disease?
Intake of vitamin and mineral supplements is quite common, despite the lack of evidence to support its effectiveness in preventing cardiovascular disease. 52% of the population takes supplements, multivitamins being adopted by 31% of the population, vitamin D by 19%, calcium by 14% and vitamin C by 12%, and from the latest statistics we found that every year Americans spend more than $30 billion on food supplements.
If we refer to the European area, the data from EPIC (European Prospective Investigation on Cancer and Nutrition) gathered from 36,034 men and women in 2009 indicated a wide range of supplements, with a strong north-south gradient, which was the most high in the north (eg Denmark) and lowest in the south. However, there is no general agreement on whether individual vitamins and minerals or combinations thereof should be taken as supplements for the prevention or treatment of CVD.
The Canadian Cancer Society recommends a single supplement: 1,000 IU of vitamin D, which should be given in the fall and winter and only if the patient’s doctor agrees. What is generally recommended internationally is the consumption of a balanced diet as part of a healthy lifestyle. For example, the 2015 Report of the US Advisory Committee on Dietary Guidelines, which also covers the reduction of CVD risk, did not recommend supplements, but recommended 3 dietary models:
- The healthy American diet, low in saturated fat, trans fat and red meat, rich in fruits and vegetables.
- The Mediterranean diet.
- The vegetarian diet.
Health Canada followed suit with its food guide, which points out that nutrients should be obtained through healthy eating patterns that focus on plant-based foods, and especially vegetable proteins, but they had no recommendations for the use of supplements. This type of advice is now offered by other organizations around the world.
These diets, with their accompanying recommendations, will continue the movement towards more plant-based diets, relatively rich in vitamins and minerals, which liberally meet the requirements (reference dietary intakes). Thus, for the general public, the emphasis was on meeting the requirements through diet, rather than supplements. Therefore, we present an update of the previous systematic review and the 2018 meta-analysis of the impact of vitamin and mineral supplements on the outcomes of cardiovascular disease and mortality from all causes.
This updated review shows similar results to the previous report in terms of the preventive benefits of both folic acid and B vitamins for stroke and was rated with moderate quality. No effect was observed for commonly used multivitamins, vitamin D, calcium and vitamin C, and even an increased risk of all-cause mortality from niacin (with statin) was observed. No conclusive evidence has been found on the benefits of supplements from different dietary environments when nutrients are sufficient.
Reducing excess calories and improving dietary composition can prevent many primary and secondary cardiovascular events. Current guidelines recommend diets:
- rich in fruits, vegetables, whole grains, nuts and legumes;
- moderate in dairy and low-fat seafood;
- poor in processed meat, sugary drinks, refined grains and sodium.
Supplementation may be helpful for some people, but it cannot replace a good diet. Factors that influence individuals to consume a low quality diet are innumerable and include a lack of knowledge, lack of availability, high cost, lack of time, social and cultural norms, poor quality and taste. Governments should focus on cardiovascular disease as a global threat and adopt policies that reach all levels of society and create a food environment in which healthy foods are accessible and desirable.
Healthcare professionals should be proficient in basic nutritional knowledge to promote a sustainable model of healthy eating for the prevention of cardiovascular disease, both for healthy people and those at higher risk. Consumption of plant-based foods is a safe approach to increase the intake of micronutrients, and from this perspective the Dahna application has a generous number of vegetarian menus that we invite you to discover.