- Heart disease is the leading cause of death in the United States.
- Cardiovascular disease incidence has risen dramatically since 1900.
- The " Big 4" nutrients for heart health are:
- CoQ10 (Coenzyme Q10)
- K2 as MK-7
- Omega 3 Fats (EPA and DHA)
America's Heart Disease Epidemic
Heart disease is now the leading cause of death in the United States; however, it is a relatively new disease in the grand scheme of things. Rarely seen in earlier days, the incidence of cardiovascular disease has risen dramatically since 1900 and is now clearly linked to our modern lifestyle.
Mozaffarian et al. 2015 (1)
Diet, Exercise, & Stress Reduction Can Help + The "Big 4"
Just as we’ve created a high incidence of heart disease, we can reverse course and create healthier hearts. In addition to consuming an anti-inflammatory diet, getting regular exercise, and reducing stress, nutritional support can help you regain and maintain heart health. Here we review our “Big 4” favorite nutrients documented to enhance heart health.
1. Coenzyme Q10 (CoQ10)
Coenzyme Q10 is a naturally occurring, powerful antioxidant produced in the human body. It is present in the mitochondria (energy producing organelles) of every cell and is central to energy production. Because of this role, higher amounts of CoQ10 are present in tissues that require a lot of energy, such as the heart, kidney, and liver.
An interesting irony is that statins, a common medication prescribed to those at risk of heart disease, actually deplete CoQ10. (2) Because of this, it is recommended that those taking statins supplement with CoQ10.
CoQ10 Supplementation Can Improve Heart Health
- Heart failure patients who supplemented with 100 mg of CoQ10 three times a day (a total of 300 mg) in combination with standard therapies saw lower rates of cardiovascular-related death, decreased all-cause mortality, and lowered incidence of hospital stays compared with the placebo group. (3)
- 3 out of 4 heart disease patients have low levels of CoQ10. (4)
- In heart failure patients awaiting transplants, CoQ10 supplementation improved functional status, clinical symptoms, and quality of life! (5)
- Supplementation with CoQ10 in subjects with elevated blood pressure (systolic BP >140 mmHg or diastolic BP >90 mmHg) resulted in mean decreases in systolic blood pressure of 11 mmHg and diastolic blood pressure of 7 mmHg, as reported in a Cochrane systematic review. (6)
- In congestive-heart-failure patients, treatment with 2 mg/kg of body weight of CoQ10 each day for one year significantly decreased hospitalization and complications, compared to a placebo group. (7)
Suggested daily intake of CoQ10 for optimum health (from diet and supplement)
- 100 mg to 600 mg
2. Vitamin K
There are two types of vitamin K in our diet. The first is vitamin K1, which is produced by green leafy vegetables. The second is vitamin K2, which is produced by bacteria, and so is only found in certain fermented or aged foods. Vitamin K2 is found in several different forms (MK-4, MK-7, etc.).
Vitamin K2 is more biologically active than K1, yet harder to obtain in the traditional Western diet, which does not include many fermented foods. Vitamin K2 in the form of MK-7 has been well documented to support heart health. In fact, healthy arteries have been shown to contain 100x more K2 than unhealthy ones. (8)
Vitamin K2 Reduces Risk of Heart Disease, Arterial Calcification, and Heart Attack
A form of vitamin K2, known as MK-7, helps to maintain normal calcium metabolism in the arteries, and supports vascular elasticity, helping to prevent arterial stiffness and calcification. However, these vast benefits were not shown when vitamin K1 was consumed in isolation. We need K2 as MK-7 to optimize heart health.
- The Rotterdam study found that consuming at least 32 mcg/day of vitamin K2 in the MK-7 form reduces cardiovascular risk by 50%, arterial calcification by 50%, and all-cause mortality by 25% (9)
- In the EPIC cohort, researchers found that women aged 49 to 70 saw a 9% decreased risk of coronary heart disease for every 10 mg increase in MK-7 consumption. (10)
- Those with the highest intake of MK-7 had a 29% lower risk of peripheral arterial disease, compared to those with the lowest MK-7 intake. (11)
- Also, MK-7 intake was associated with reduced coronary calcification. (12)
How to Get MK-7
MK-7 is hard to obtain from diet, as there are only a few known food sources—natto (fermented soybean) and aged cheeses are the main ones.
Image from Evangel (13)
A Note on Vitamin K Supplements: Vitamin K supplements should not be used if you are on blood thinners (i.e., Coumadin®), except under a doctor’s supervision. Talk with your doctor before increasing your vitamin K intake if you fall under this category.
Suggested daily intake of vitamin K as MK-7 for optimum health (from diet and supplement)
- 180 mcg to 200 mcg
3. Omega-3 Fats
Omega 3s are essential fats that we must obtain from food or supplements each day. The most bioavailable forms of Omega 3s are EPA and DHA, which are mainly found in fatty fish. The less bioavailable form, ALA, can be obtained from plant-based foods like flaxseeds, chia seeds, soybean oil, and canola oil. However, only a small fraction of ALA can be converted to EPA and DHA, and some folks convert very little at all.
How Omega-3 Fats Improve Heart Health
- They improve blood pressure.
- They lower triglyceride levels.
- They reduce inflammation.
- They decrease atherosclerosis.
- They prevent blood clotting. (14)
Research Shows Omega-3 Fats Decrease Your Risk of Death from Heart Disease
- In a randomized controlled trial, participants supplemented with just 840 mg per day of omega 3s (in the form of EPA and DHA) and saw a 28% lower risk of heart attack in the 5-year follow up period, compared with those who did not supplement. (15)
- Compared to consuming no fish, studies show that people who consume fatty fish a few times per week have almost HALF the risk of death from coronary heart disease and almost ONE THIRD the risk of death from a heart attack. (16)
- A meta-analysis including 127,477 participants reported that omega‐3 supplements lowered risk for heart attack and death from heart disease by 8%, on average. Risk-reduction was linearly associated with the omega-3 dosage. Higher doses provided more significant risk reductions than lower ones. (17)
Suggested daily intake of EPA/DHA for optimum health (from diet and supplement)
- 3,000 mg, but any amount is helpful.
Magnesium is essential for more than 600 biochemical reactions within the body. One of these is muscle relaxation. A delicate balance of calcium and magnesium is used to contract and relax the heart muscle—which happens thousands of times per day. Without enough magnesium, these contractions can become altered, causing arrythmias. In fact, circulating magnesium levels in the blood are inversely associated with heart disease risk. (18)
On Average, We Aren’t Getting Enough Magnesium
Insufficient magnesium intake is the rule rather than the exception. A 2012 study reported that two-thirds of people in developed countries received less than their minimum daily magnesium requirement. (19)
Magnesium Decreases Risk of Cardiovascular Disease, Stroke, and Heart Failure
- Participants with a low serum magnesium level (<0.76 mmol/L) had a 30 to 50% higher risk of atrial fibrillation in two large scale studies (Atherosclerosis Risk in Communities and the Framingham Offspring Study). (20, 21)
- Low serum magnesium (<0.70 mmol/L) was associated with a 70% higher risk of incident heart failure in the Atherosclerosis Risk in Communities (ARIC) study. (22)
- The large Nurse’s Health Study reported that those with the highest magnesium intake had a 13% lower risk of stroke than those with the lowest magnesium intake (those in the highest vs lowest quintile).
- Magnesium supplementation can lower blood pressure (23) by:
As you can see, magnesium is SUPER important for supporting heart health. Pay special attention to your magnesium intake, and supplement when necessary, as most people do not get enough on a regular basis. Actually, low magnesium status is now recognized officially as “chronic, latent magnesium deficiency," (26, 27) a phenomenon which unfortunately occurs all around the world.
Suggested daily intake of magnesium for optimum health (from diet and supplement)
- 500 mg to 1,000 mg
- Mozaffarian, D., et al. 2015. Heart disease and stroke statistics – 2015 update. Circulation 131(4):e29-e322.
- Lopez-Jimenez, F. Can coenzyme Q10 prevent statin side effects? Mayo Clinic Website Q&As, uploaded Jan. 14, 2020.
- Mortensen, S. A., et al. 2014. The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: Results from Q-SYMBIO: A randomized double-blind trial. JACC Heart Failure 2(6):641-649.
- Zozina, V. I., et al. 2018. Coenzyme Q10 in cardiovascular and metabolic diseases: Current state of the problem. Current Cardiology Reviews 14(3):164-174.
- Berman, M., et al. 2004. Coenzyme Q10 in patients with end-stage heart failure awaiting cardiac transplantation: A randomized, placebo-controlled study. Clinical Cardiology 27(5):295-299.
- Ho, M.J. et al. 2016. Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension. Cochrane Database of Systematic Reviews 3, article no. CD007435. John Wiley & Sons, Ltd.
- Morisco, C., et al. 1993. Effect of coenzyme Q10 therapy in patients with congestive heart failure: A long-term multicenter randomized study. The Clinical Investigator 71(8 Suppl):S134-136.
- Knapen, M. H., et al. 2015. Menaquinone-7 supplementation improves arterial stiffness in healthy post menopausal women: A double-blind randomized clinical trial. Thrombosis and Haemostasis 113(5):1135-1144.
- Geleijnse, J. M., et al. 2004. Dietary intake of menaquinone is associated with a reduced risk of coronary heart disease: The Rotterdam study. Journal of Nutrition 134(11):3100-3105.
- Gast, G. C. M., et al. 2009. A high menaquinone intake reduces the incidence of coronary heart disease. Nutrition, Metabolism, and Cardiovascular Diseases 19(7):504-510.
- Vissers, L. E. T., et al. 2016. The relationship between vitamin K and peripheral arterial disease. Atherosclerosis 252:15-20.
- Beulens, J. W., et al. 2009. High dietary menaquinone intake is associated with reduced coronary calcification. Atherosclerosis 203(2):489-493.
- Evangel, M. S. K2 & Longevity. Patch Website. Accessed January 20, 2021.
- Chaddha, A. 2015. Omega-3 fatty acids and heart health. Circulation 132(22):e350-e352.
- Manson, J. E., et al. 2019. Marine n-3 fatty acids and prevention of cardiovascular disease and cancer. New England Journal of Medicine 380(1):23-32.
- Stone, N. J. 1996. Fish consumption, fish oil, lipids, and coronary heart disease. Circulation 94(9):2337-2340.
- Hu, Y., et al. 2019. Marine omega-3 supplementation and cardiovascular disease: An updated meta-analysis of 13 randomized controlled trials involving 127 477 participants. Journal of the American Heart Association 8(19):e013543.
- Del Gobbo, L. C., et al. 2013. Circulating and dietary magnesium and risk of cardiovascular disease: A systematic review and meta-analysis of prospective studies. American Journal of Clinical Nutrition 98(1):160-173.
- Rosanoff, A., et al. 2012. Suboptimal magnesium status in the United States: Are the health consequences underestimated? Nutrition Reviews 70(3):153-164.
- Misialek, J. R., et al. 2013. Serum and dietary magnesium and incidence of atrial fibrillation in whites and in African Americans – Atherosclerosis Risk in Communities (ARIC) study. Circulation Journal 77(2):323-329.
- Khan, A. M., et al. 2013. Low serum magnesium and the development of atrial fibrillation in the community: The Framingham Heart Study. Circulation 127(1):33-38.
- Peacock, J. M., et al. 1999. Relationship of serum and dietary magnesium to incident hypertension: The Atherosclerosis Risk in Communities (ARIC) study. Annals of Epidemiology 9(3):159-165.
- Banjanin, N. and G. Belojevic. 2018. Changes of blood pressure and hemodynamic parameters after oral magnesium supplementation in patients with essential hypertension – An intervention study. Nutrients 10(5):581.
- Touyz, R. M., and G. Yao. 2003. Inhibitors of Na+/Mg2+ exchange activity attenuate the development of hypertension in angiotensin II-induced hypertensive rats. Journal of Hypertension 21(2):337-344.
- Blache, D., et al. 2006. Long-term moderate magnesium-deficient diet shows relationships between blood pressure, inflammation and oxidant stress defense in aging rats. Free Radical Biology & Medicine 41(2):277-284.
- DiNicolantonio, J. J., et al. 2018. Subclinical magnesium deficiency: A principal driver of cardiovascular disease and a public health crisis. Open Heart 5:e000668.
- Elin, R. J. 2011. Re-evaluation of the concept of chronic, latent, magnesium deficiency. Magnesium Research 24(4):225-227.