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SINGAPORE - I have observed that many of my friends and patients would not hesitate to pop supplement pills in the belief that they are getting many health benefits.
My personal opinion is that we should recommend only the supplements which have been shown to be useful, in properly done research studies.
There is always a logical argument why certain substances can prevent or cure heart diseases based on a very mechanistic view from various basic science data.
However, the proof usually comes from properly conducted clinical trials to show whether these supplements actually make a difference in people.
Even many pharmaceutical drugs have failed at the final hurdle.
I am taking this opportunity to look at the evidence supporting the use of several popular supplements for heart disease.
OMEGA-3 FATTY ACIDS
Derived from marine fish, the important components are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).
These fatty acids are thought to be important components of the cell membrane and will help to prevent the development of potentially fatal abnormal heart rhythms.
Other beneficial effects of omega-3 fatty acids include the ability to thin out the blood and prevent blood clots and heart attacks and the lowering of the triglyceride or fatty acid levels in the blood.
It was observed that men who ate at least two servings of fish per week were less likely to die of heart disease compared with those who did not eat fish.
One study looked at more than 11,000 patients who had already suffered a heart attack. Taking omega-3 fatty acids lowered their risk of dying by 20 per cent.
Another study looked at 7,000 patients with mild to severe chronic heart failure and found that it reduced the risk of dying by 9 per cent.
However, in a recently published study this year, Italian researchers looked at 12,000 patients who had multiple risk factors for heart disease and did not find any benefit in taking omega-3 fish oils as compared with olive oil.
Hence, it is recommended that those who have had heart attacks and those who have heart failure take about 1g of EPA and DHA, combined, a day.
This works out to be about two to three ounces of fatty fish per day.
For those who do not yet have heart disease, the evidence is not clear. For this group of patients, I would avoid recommending popping the omega-3 pills or eating much more fish.
COENZYME Q-10
This is part of an enzyme complex in each cell and is involved in the generation of energy.
It is also a powerful antioxidant.
It can be depleted with age and in those with various diseases.
The best data in terms of a controlled trial appeared this year in a study where patients with heart failure were given Q-10 or a placebo and they found a 50 per cent reduction in deaths for those who took Q-10.
This is the first good evidence that Q-10 may be useful in treating patients with heart failure.
Also, Q-10 has been shown to be useful in helping patients who are suffering the side effect of taking statins, which is muscle weakness or aches. This is believed to be due to the depletion of Q-10 from the muscle cells.
Q-10 in the form of ubiquinol is better absorbed from the gut and Q-10 in a soluble gel preparation may also be better absorbed.
It is usually taken twice a day to improve absorption and taking it with a fatty meal may help as well.
The dose ranges from 100mg to 200mg daily.
ANTIOXIDANTS
These help to prevent damage to cells caused by free radicals.
Free radicals can come from environmental pollution or from one's own body processes.
Free radicals can cause the oxidation of bad cholesterol particles which are then taken up by scavenger cells and turned into foam cells.
Such cells then enter the blood vessel walls and deposit the cholesterol within.
Antioxidants help to mop up free radicals before they can cause any damage.
The most well-studied of the antioxidants is vitamin E. Initially, a study from Cambridge in the 1990s showed that there was a 40 per cent reduction in heart events with vitamin E. That study involved about 2,000 patients.
However, subsequent controlled studies involving both patients with established heart disease or diabetes and healthy people taking vitamin E or C did not show any benefit in terms of reducing heart events or deaths.
In fact, patients who took vitamin E had a higher risk of a haemorrhagic stroke.
It is, therefore, my recommendation that we should not take antioxidant supplements in the form of vitamin E or C for the sake of preventing heart disease.
RED YEAST RICE
Red yeast rice has been used for centuries by Chinese medicine practitioners to improve blood circulation and to reduce digestive problems.
It contains a naturally occurring cholesterol lowering substance called lovastatin.
This statin will block the liver from producing bad cholesterol.
It is very similar to cholesterol-lowering drugs and has the possibility of the same side effects.
Compared with the latest cholesterol-lowering drugs, such as rosuvastatin, the cholesterol-lowering effect of red yeast rice is milder.
Red yeast rice has been shown to reduce bad cholesterol levels by 22 per cent and raise good cholesterol levels by up to 20 per cent.
In a study of 5,000 Chinese patients who had suffered a heart attack, taking red yeast rice reduced the incidence of a recurrent heart attack or death by 45 per cent.
It also reduced the risk of dying by 33 per cent.
Currently, red yeast rice can be considered an alternative for patients who have high bad cholesterol but are unable to tolerate the traditional cholesterol-lowering medications.
The dose of red yeast rice is recommended to be 2,400mg twice daily.
REMAIN OPEN-MINDED
As we move into the new millennium, there is much more interest in traditional therapies for maintaining good health as well as to treat diseases.
Many Western medical practitioners are also very keen to find out whether these traditional remedies will work in the modern era and are carrying out more controlled studies to get more information.
This will be good for patients in the future when there will be more therapeutic options available besides modern medications.
We will also be able to debunk some age-old myths and remedies in the process. But we should not throw out the baby with the bathwater and always keep an open mind.
kennethng@novenaheartcentre.com.sg
Dr Kenneth Ng is a consultant cardiologist at the Novena Heart Centre. He specialises in treating heart failure. He was the director of the heart failure programme of the National Healthcare Group from 2003 to 2007.
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