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Heart disease remains the leading cause of death for both women and men in the U.S.  Some supplements may help keep your heart healthy, but others may potentially contribute to heart disease.

Supplements That May Help

There is strong evidence that sterol esters (like the phytosterol beta-sitosterol) and stanol esters, available in supplements and in some "heart healthy" margarines and spreads, can significantly lower LDL cholesterol. (There is also some evidence that taking curcumin may increase the cholesterol-lowering effects of phytosterols.) You can get more information about this, plus our tests and reviews of products in the Cholesterol-Lowering Supplements Review.

Garlic has been shown to reduce total cholesterol and triglycerides, and may slow the development of atherosclerosis. One brand of garlic supplement in particular has been shown to lower triglycerides more than others. You can get more information about these, including our tests and reviews of products in the Garlic Supplements Review.

Red yeast rice can significantly lower cholesterol, but products vary widely in their amounts of natural, active statin compounds.  You can get more information and our tests and comparisons of products in the Red Yeast Rice Supplements Review.

High-dose niacin has been shown to lower LDL cholesterol. However, it should not be taken with statin-containing supplements (red yeast rice), or with statin drugs, which could increase the risk of serious events like stroke. You can get more information about niacin, including our tests and reviews of products in the B Vitamin Supplements Review.

Some, but not all studies suggest that pantethine (which is not a B vitamin but is often included as an ingredient in B vitamin supplements) may help to lower LDL cholesterol.

CoQ10 has been shown to significantly reduce the risk of adverse cardiovascular events by 50% in people with moderate to severe heart failure, and may be helpful in reducing some of the side-effects of cholesterol-lowering statin drugs. You can get more information about CoQ10 (and ubiquinol, a related compound), including our tests and reviews of products, in the CoQ10 and Ubiquinol Supplements Review.

Vitamin D may lower the risk of cardiovascular disease in those with low blood levels of vitamin D but not be of benefit for people who do not have a vitamin D deficiency. You can get more information about vitamin D, including our tests and reviews of products in the Vitamin D Supplements Review.

Similarly, improving magnesium to adequate levels can slightly reduce blood pressure, and magnesium blood levels in the mid to high normal range have been associated with a lower risk of death from cardiovascular disease, as noted in the Magnesium Supplements Review.

Berberine may help to reduce blood pressure, triglycerides and total and LDL cholesterol (as well as blood sugar) in people with type 2 diabetes; however, be aware that it may interact with several cholesterol-lowering medications, potentially increasing blood levels (and the risk of side effects) of these drugs.

Some, but not all studies suggest that extracts of citrus bergamot (Citrus bergamia) fruit may help to lower cholesterol levels in people with high cholesterol. It has been proposed that certain flavonoids in bergamot, including neoeriocitrin, naringin and neohesperidin, may, like statin medications, act on an enzyme involved in cholesterol synthesis (HMG-CoA reductase), or may influence an enzyme that plays a role in the metabolism of energy in cells (AMP-activated protein kinase or AMPK), although this remains to be proven (Nauman, Integr Food Nutr Metab 2019). In several small clinical trials, bergamot extract taken in daily dosages ranging from 150 mg to 1,500 mg daily (most studies used between 500 mg and 1000 mg of extract), alone or along with statin medication for one to six months, was generally well-tolerated and decreased total cholesterol levels by about 12 % to 31% , "bad" LDL cholesterol by 7% to 40% and triglycerides by about 11% to 39% in people with high cholesterol, metabolic syndrome or coronary artery disease compared to baseline or a control group (Lamiquiz-Moneo, Crit Rev Food Sci Nutr 2020).

Although the exact composition of the extracts used was not always provided, one trial that found modest reductions in total and LDL cholesterol compared to baseline in adults with high cholesterol levels used a branded extract (Bergavit) at a daily dosage of 150 mg of flavonoids standardized to contain 16% neoeriocitrin, 47% neohesperidin, and 37% naringin (Toth, Front Pharmacol 2015). However, not all studies have found a benefit, and, due to the limited size of these trials and wide variations in formulations, more research is needed. Few side effects other than heartburn have been reported in clinical trials, although longer-term studies are needed. Due to a potential blood-sugar lowering effect of bergamot extract (Mollace, Fitoterapia 2011), caution should be used in people taking blood-sugar lowering medications. Also be aware that bergapten, a compound in bergamot, may block potassium from entering nerve cells. This could cause hyperexcitability of nerve cells, resulting in involuntary muscle contractions and cramps if bergamot is consumed in large quantities. This was reported in a 44-year-old man who consumed approximately 4 quarts of Early Grey tea daily (which is traditionally flavored with bergamot) for three weeks. His symptoms resolved after reducing consumption of the tea (Finsterer, Lancet 2002).

Artichoke leaf extract may modestly lower total and, possibly, LDL cholesterol levels in people with high cholesterol, according to small-short-term studies, although larger, long-term studies are needed to confirm this. It does not appear to improve HDL cholesterol or triglyceride levels. Sign in for details about the dosage of artichoke leaf extract that has shown benefit.

Supplements That May Not Help

Calcium -- Although getting sufficient calcium may decrease your risk of dying from cardiovascular disease, too much may be harmful. A study found that calcium (800 mg) given once daily to postmenopausal women with high cholesterol caused a significant increase in serum cholesterol (up by about 50 mg/dL) and an increase in the thickness of lining of the carotid artery - changes associated with heart disease. Only if you don't get enough calcium should you consider a supplement, and it generally recommended that calcium supplementation not exceed 500 mg per dose, or more than 900 mg per day. You can get more information about these supplements, including our tests and reviews of products, in the Calcium Supplements Review.

Fish Oil -- Despite the fact that omega-3 fatty acids that have been linked to some heart healthy effects, it seems that the benefits come from consumption of fish, and not supplements. Only if you don't eat fish might fish oil supplements provide some heart benefit. Also, because fish oil supplements can have a blood-thinning effect, they should be used with caution in people taking other blood-thinning supplements or medications. You can get more information about these supplements, including our tests and reviews of products, in the Fish/Marine Oil Supplements Review.

Multivitamins have not been found to reduce (nor increase) the risk of heart attack, stroke or death from cardiovascular disease. You can get more information about these supplements, including our tests and reviews of products, in the Multivitamin and Multimineral Supplements Review.

Policosanol -- Although there is some evidence from several studies from Cuba suggesting a cholesterol-lowering effect, other studies have failed to find this effect, as noted in our Cholesterol-Lowering Supplements Review.

Certain probiotics may modestly lower systolic and diastolic blood pressure, and "bad" LDL cholesterol — although they do not appear to increase "good" HDL cholesterol. There is mixed evidence as to whether probiotics reduce triglyceride levels. More information, plus our tests of popular products, is found in the Probiotic Supplements and Kefirs Review.

Diatomaceous earth -- This silica-rich powder (from fossilized remains of microorganisms or "diatoms") has been promoted to lower cholesterol, although there is only weak evidence to support this use. A single, preliminary study among 19 men and women (ages 35 to 67) with moderately high cholesterol found that 250 mg of diatomaceous earth taken three times daily for two months modestly decreased average blood levels of total cholesterol (from 285 mg/dL to 248 mg/dL) as well as "bad" LDL cholesterol and triglycerides, compared to baseline (Wachter, Eur J Med Res 1998). However, placebo-controlled trials are needed to prove a benefit. The side effects and long-term safety diatomaceous earth supplementation is unknown and inhalation can causing coughing and shortness of breath. Chronic exposure to large amounts of inhaled diatomaceous earth through industrial use has been linked with lung cancer. Topical exposure can cause skin dryness, irritation and rash (Akhoundi, J Insect Sci 2013).

Supplements That May Be Harmful

Vitamin E supplements, once touted for heart health, have not been found to provide a benefit for people with cardiovascular disease, and could actually be harmful for some heart disease patients, since they could reduce the effectiveness of cholesterol-lowering agents.

There is reason to believe that L-carnitine and lecithin could actually contribute to atherosclerosis in certain people, and it may be wise to avoid long-term supplementation with either one.

Unlike artichoke leaf extract, drinking artichoke juice does not appear to be beneficial and may actually worsen triglyceride levels.

Foods

Cocoa powders and dark chocolate rich in flavanols can improve vascular function and blood pressure, and even raise levels of HDL ("good") cholesterol. You can get more information about these, as well as our tests and reviews of products in the Cocoa Powders, Extracts, Nibs, Supplements, and Chocolates Review.

Replacing some saturated fat in the diet with olive oil may help lower risk factors for heart disease, such as high blood pressure and high cholesterol. You can get more information about extra virgin olive oil and see our Top Picks among products in the Extra Virgin Olive Oil Review.

Oats and oat-based cereals can be a good source of soluble fiber, which can help to lower cholesterol reduce the risk of heart disease. See our Oat Cereals Review for the clinical evidence, including how much you need to consume in order to significantly reduce cholesterol.

There mixed evidence for whether soy can lower cholesterol. Although the FDA currently allows companies to make the claim that "25 grams of soy protein daily, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease," the agency has proposed revoking this health claim due to inconsistent findings (a final decision has not yet been made). In addition, a specific protein peptide isolated from soy, called lunasin, is sometimes promoted to lower cholesterol, but it was not shown to be beneficial in a clinical trial.

Eating walnuts every day may help lower "bad" cholesterol in older people, although it doesn't seem to improve "good" cholesterol or triglyceride levels. Sign in for details about the amount of walnuts eaten and whether any specific diet had to be followed.

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