With those as young as 30 now getting heart attacks, the belief that heart disease is a problem associated with old age can no longer be sustained. When it comes to dietary factors, the role of the food we eat, or the supplements we take, can have a significant impact on heart health by regulating blood pressure, influencing homocysteine, cholesterol and triglyceride levels, managing antioxidant status and even manipulating the production of anti-inflammatory products that can help protect the heart from free radical damage.
The adult heart beats approximately 70 times per minute, sending 2,000 gallons of blood through 60,000 miles of blood vessels to nourish the organs and tissues on a daily basis. Any damage to the heart, its vessels or its valves can reduce the efficiency by which it works, thereby increasing the risk of cardiovascular health issues. Low physical activity, smoking, high alcohol consumption, stress, poor diet and being overweight are key diet and lifestyle examples that can increase the risk of heart disease. Making key lifestyle changes, such as quitting smoking and improving physical and emotional wellbeing, can not only help improve heart health directly but also improve overall general wellbeing.
Eicosapentaenoic acid (EPA)
Many of the health benefits associated with fish and marine food consumption are now widely recognised to be due to their high content of the long-chain omega-3 fatty acids EPA and DHA. Whilst oily fish is a great source of both EPA and DHA, concentrated fish oil is the best way to get adequate doses and application of pure EPA required for therapeutic outcomes. For example, although both EPA and DHA lower triglyceride levels, they exert very different effects on cholesterol levels. Products that contain both DHA and EPA reduce triglycerides but increase LDL-C levels, whereas EPA-only oils reduce both.  In addition, EPA has anti-atherosclerotic effects and reduces brachial-ankle pulse wave velocity (baPWV), a marker for arterial stiffness and is the precursor to biologically active substances that exert anti-hypertensive, anti-arrhythmic, anti-thrombotic and anti-inflammatory effects, directly opposing those of the highly inflammatory omega-6 fatty acid, arachidonic acid (AA). Indeed, the ratio of AA to EPA is being hailed as “a new risk marker” for cardiovascular disease and the use of pure EPA (1 – 4g daily) can be used to optimise the AA to EPA ratio, thereby offering cardiovascular health benefits that are clinically superior to DHA-containing oils or pure DHA oils. 
Up to a quarter of people in the UK have low levels of vitamin D in their blood, which means they are at risk of the clinical consequences of vitamin D deficiency. Adequate vitamin D status is not only important for bone health, but is also important for optimal function of many organs and tissues throughout the body, including the cardiovascular system. Low vitamin D levels (<50 nmol/L) cause an increase in parathyroid hormone, which increases insulin resistance and is associated with diabetes, metabolic syndrome, hypertension, inflammation and increased cardiovascular risk.  Supplementation with 20-50 mg/d (800-2000 IU/d) oral vitamin D3 is sufficient to raise serum 25-hydroxyvitamin D concentrations to acceptable levels of >50 nmol/L. [5, 6]
Statins, alongside antidepressants, are among the most commonly prescribed drugs and are used to lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase. The Coenzyme Q10-lowering effect of statins can however have potential adverse consequences with as many as 15% of statin users experiencing muscle side effects (including myalgia and rhabdomyolysis). As such, increasing pressure is being placed on GPs to be made aware of the possible consequences of Coenzyme Q10 (CoQ10) depletion and to highlight the need for supplementation to reduce potential side effects. CoQ10 is itself beneficial for cardiovascular health and studies show benefits for cardiovascular disease outcomes including congestive heart failure, ischaemic heart disease and hypertensive heart disease.  Taking ubiquinol (the reduced, bioactive form of CoQ10 that is converted from ubiquinone within the body – often poorly) supplements can correct the deficiency caused by such medications without affecting the medication’s positive effects on cholesterol levels, and can improve statin-induced myopathy.  CoQ10 is, however, highly lipophilic and therefore poorly absorbed. Over the past several years, extensive efforts have been made to improve oral bioavailability and formulation strategies aimed at improving the absorption of CoQ10 include colloidal delivery systems like the patented VESIsorb® delivery designed to mimic natural absorption processes. VESIsorb® delivered CoQ10 at a single dose of 120 mg has been shown to raise blood plasma levels to 6.89 mg/mL compared to 2.44 mg/mL shown with 120 mg oil-based CoQ10.  Given that higher blood levels (> 3.5 mg/mL) appear to enhance both the magnitude and rate of clinical improvement and that ubiquinol, the supplement with the reduced form of CoQ10 lowers LDL cholesterol, combining ubiquinol with VESIsorb® is likely to offer significant benefits over standard CoQ10 of lower bioavailability (ubiquinone).
Red yeast rice
Red yeast rice is an ancient Chinese food product with cholesterol-lowering effects. The cardiovascular benefits of red yeast rice are due to the monacolin K content, which has statin-like characteristics and lipid lowering properties. Several studies have found red yeast rice to be moderately effective at improving cholesterol and particularly for lowering LDL cholesterol levels, with one large randomised controlled study from China reporting significantly improved risk of major adverse cardiovascular events and overall survival in patients taking red yeast rice following a heart attack.  Consumers should, however, be aware that there is considerable variation in monacolin K content between supplement brands and that preparations providing a daily dose of at least 10 mg daily are required for therapeutic effects.
Plant sterol-enriched foods possess well-documented LDL cholesterol-lowering effects and work by inhibiting cholesterol absorption in the small intestinal through an absorption inhibition pathway. The efficacy of sterols as dietary supplements has recently been reviewed and findings suggest that supplements delivering doses of between 1.0 to 3.0 g/day show clinically significant reductions in LDL-cholesterol levels. 
Vitamin B3 – also called niacin or nicotinic acid – is another example of a safe, effective lipid management tool. Niacin has been clinically shown to improve levels of LDL, HDL and triglycerides.  The dose required for cholesterol management is relatively high (1-2 g two to three times daily) and approximately 70% of individuals receiving niacin experience flushing, a side effect of treatment caused by vasodilation of the dermal blood vessels which can lower adherence but may be reduced by pre-treatment with aspirin.
Vitamin B6, B12 and folate
Homocysteine is an intermediate sulphur-containing amino acid produced during the metabolism of methionine. High concentrations of homocysteine are toxic to vascular endothelial cells and are associated with an increased risk for cardiovascular disease. To remove homocysteine, the body either reconverts it into methionine through remethylation or converts it into the amino acid cysteine through transsulfuration. Both pathways involve a number of enzymes in conjunction with several B-vitamin cofactors. Supplementation with folic acid, vitamin B6 and vitamin B12 has been clinically shown to significantly reduce homocysteine. [13, 14] Whilst these nutrients are found in over-the-counter multivitamins, many of these supplements do not offer therapeutic potential because they only contain vitamins in relatively low amounts. As such, specialised combinations of the three can be formulated to specifically target homocysteine control. A product delivering at least 0.9 mg folic acid, 24 mg B6 and 0.9 mg B12 may be a safe and effective treatment, satisfying the recommended daily allowance (RDA) but not exceeding the tolerable upper limit (UL) supplying levels.
Whether it is for general heart heath or management of specific areas of cardiovascular health, there is certainly a good selection of products from which the consumer can choose. Many of the natural supplements with proven cardiovascular health benefits focus on cholesterol and triglyceride management, with many offering additional health benefits such as immune and inflammatory pathway support.
Ensuring good cardiovascular health may also require dietary and lifestyle changes. Adopting a good diet coupled with an active lifestyle to help reduce stress will help to keep the heart healthy for long-term complete body wellbeing.
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