Micronutrients, encompassing vitamins and minerals found in our diets, play a crucial role in preventing cardiovascular disease. Several studies have shown the importance of diet in cardiovascular disease risk. This has led to the recommendations by the American Heart Association that we consume diets containing generous amounts of fruits and vegetables and that are low in saturated fats, sugar, and salt.
However, except for a few studies, not much evidence has emerged to support daily multivitamin supplementation to prevent heart disease. What are plausible explanations for this? We know that heart disease is very likely caused by oxidative stress placed on the body, probably because of chronic inflammation from diseases such as obesity. Chronic inflammation can deplete the antioxidant molecules naturally found in the body, leading to damage to the cells lining the walls of the arteries by ROS (reactive oxygen species). The ultimate result is atherosclerosis or hardening of the arteries. This, in turn, contributes to the development of high blood pressure, heart attacks, and strokes.
Evidence has been found that omega-3 fatty acids are effective in preventing cardiovascular disease. In keeping with that finding, the AHA has recommended the consumption of fatty fish, such as trout, tuna, and salmon, at least twice weekly. And in the COSMOS study, it was shown that flavanol-enriched cocoa extract was effective in preventing cardiovascular disease. Whereas it is now generally accepted that consuming a diet containing generous amount of fruits and vegetables is important for preventing heart disease, the jury is still out regarding the individual supplementation of anti-oxidant vitamins such as vitamins C and E. On the other hand, folic acid supplementation was shown to reduce the incidence of strokes. But if we assume the benefit of these plant foods is derived from the antioxidant vitamins and minerals they contain, why have we not had success with the traditional antioxidant vitamins like vitamins C and E?
The answer to this may be that these micronutrients work synergistically. They work together, and not individually. Another possibility may be that whole foods contain these micronutrients in pre-determined ratios that are important for their efficacy. For example, some studies have reported on the importance of the ratio of EPA (eicosapentaenoic acid) to DHA (docosahexaenoic acid) in omega-3 fatty acid supplementation for the prevention of heart disease. Other researchers have even gone as far as recommending the supplementation of EPA alone for greatest cardiovascular efficacy.
No discussion of micronutrients in cardiovascular disease would be complete without noting that over-supplementation of micronutrients can have the opposite effect and actually promote heart disease. This was found to be the case with vitamin A and selenium.
What we are faced with is the complex interaction of multiple vitamins, minerals, and trace elements, acting like a cohesive grand orchestra, from which we can never hope to reproduce the stellar performance of the whole, by singling out one particular instrument to play the harmony of different sounds producing the final composition.
Keeping this metaphor in mind, we can see how taking a supplement by itself, either as a multivitamin or as a single vitamin, could never provide the benefits produced by a balanced diet. Supplements should be taken in conjunction with a balanced diet if the need arises and with the guidance of a medical provider or trained dietitian. Today, the Mediterranean and DASH diets are the diets of choice for the greatest impact on cardiovascular health.
In summary, while micronutrients play a pivotal role in preventing cardiovascular disease, their efficacy hinges on a holistic dietary approach, emphasizing the importance of balanced nutrition and professional guidance.
For more information:
COSMOS l and Multivitamin Outcomes Study
COSMOS STUDY FINDINGS:yhttps://cosmostrial.org/results/
Antioxidant Supplementation in Cardiovascular Prevention: https://www.sciencedirect.com/science/article/pii/S0735109722071066?via%3Dihub