Micronutrient Deficiencies, Inflammatory Diets, and Cardiovascular Health

Heart health is well known to be impacted by diet, including Mediterranean-style diets, which prioritize the consumption of plant-based foods. Studies suggest that the heart health benefits of such diets include improving high-density lipoprotein quality,¹ inflammation profiles in some populations,² and survival rates in individuals with a history of cardiovascular disease (CVD).³ While a colorful, plant-based food approach is optimal, supplementation may also be appropriate for a targeted and personalized intervention to improve cardiovascular function. What is the role of specific dietary nutrients in the prevention and treatment of cardiovascular disease and metabolic dysfunction?

Nutrients for the Heart

The American Heart Association encourages individuals to include fruits and vegetables at every meal in order to consume a range of heart-healthy nutrients, including magnesium, potassium, B vitamins, vitamin D, omega-3 fatty acids, and selenium, as well as other antioxidants and soluble fiber. A 2020 meta-analysis of 117 prospective cohort studies that included over four million individuals emphasizes the established conclusion that higher intakes of fruits and vegetables result in lower risk of coronary heart disease, stroke, and overall incidence of cardiovascular diseases.⁴ In addition, a recent meta-analysis of 16 studies, including 12 randomized controlled trials (RCTs) and four randomized cross-over studies (n=1,161) found that diets high in fruits, vegetables, and plant oils significantly reduced measurements of the inflammatory biomarker C-reactive protein (CRP) in healthy populations as well as in those with cardiovascular and metabolic dysfunctions.⁵

A diet that prioritizes colorful, plant-based foods reflects a more robust intake of antioxidant and anti-inflammatory micronutrients and phytonutrients that support cardiovascular and metabolic pathways. At the same time, research studies continue to investigate specific nutrients and their value as supplements in heart health. For example:

• A 2020 meta-analysis of 43 RCTs found that a selenium/antioxidant mixture decreased CVD mortality risk by 23% among individuals of differing risk factors for chronic disease.⁶ The noted mixtures primarily consisted of vitamin C (120 mg to 1,000 mg), vitamin E (15 to 30 mg or 200 to 800 IU), zinc (20 to 30 mg), beta-carotene (6 to 25 mg), and selenium (50 to 200 mcg) given in capsule or pill form.
• A 2021 meta-analysis of 25 prospective cohort studies (approximately two million participants) evaluated the association between the consumption of marine omega-3 fatty acids, fish, and CVD mortality risk and found both dietary intakes to be inversely associated with the outcome.⁷ Investigators further detailed a nonlinear dose response relationship suggesting an increase of 20 grams of fish or 80 milligrams of omega-3 fatty acid intake per day reduced CVD mortality risk by 4%.⁷
• An older but still relevant Cochrane review and meta-analysis of double-blinded RCTs supported the use of the hawthorn berry and its extract as an adjunctive treatment option for patients with congestive heart failure.⁸ Significant benefits were found for physiologic outcomes, exercise tolerance, and symptom control (e.g., improvement of symptoms such as shortness of breath and fatigue).⁸

INFLAMMATORY DIETS & CVD RISK

How do habitual pro-inflammatory diets impact chronic disease risk? A large US-based cohort study contributes new data to the diet, inflammation, and disease connection with an investigation into the link between pro-inflammatory diets and the risk of developing heart diseases.⁹

In November 2020, the Journal of the American College of Cardiology published the results of a large prospective study (n=210,145) that used an empirically developed, food-based dietary index to evaluate levels of inflammation induced by a person’s diet.⁴ The evidence indicated that a dietary pattern with higher inflammatory potential was associated with an increased incidence of total CVD, coronary heart disease (CHD), and stroke in US women and men.⁹ According to the investigators, the study is among the first to link a food-based dietary inflammatory index with CVD incidence.⁹

Results of the study indicated that:⁹

• A higher dietary inflammatory potential, reflected by a higher EDIP score, was significantly associated with an increased risk of CVD across all three cohorts and between sexes.
• Compared to those consuming anti-inflammatory diets, participants consuming pro-inflammatory diets had a 38% greater relative risk of developing CVD. Similar association trends were observed between EDIP scores and risk of CHD and stroke.
• Also compared with anti-inflammatory diets, participants consuming pro-inflammatory diets reported higher body mass index (BMI) and lower physical activity, were less likely to take a multivitamin, reported less intake of fruits, vegetables, and whole grains, and were more likely to have a family history of CHD.

Researchers continue to study the relationships between nutritional habits and the risk of CVD and other chronic disease development, to detail involved inflammatory mechanisms, and to replicate and validate findings across populations.

MICRONUTRIENT INSUFFICIENCIES & CVD RISK

Deficiencies in one or more micronutrients are commonly reported worldwide¹⁰ and can lead to a range of health issues, including chronic illnesses such as CVD. In addition, only an approximate one in ten adults in the United States eats the recommended amounts of fruits and vegetables,¹¹ despite the heart health benefits of phytonutrients. A recent editorial in the Journal of the American Heart Association stated that insufficient intake of dietary micronutrients such as vitamin A, magnesium, selenium, and vitamin D is common in adults with heart failure.¹²

Observational studies continue to report a higher risk of cardiovascular diseases as well as cardiovascular and all-cause mortality associated with lower vitamin D levels,¹³ as well as an inverse association between circulating magnesium levels and incidence of coronary heart disease, hypertension, and type 2 diabetes.¹⁴ Nutrients work in the body as cofactors to ensure healthy cardiovascular and metabolic pathways, as well as the health of other body systems; therefore, it is important to consume enough of each of them. An approach to eating that incorporates a variety of foods and adequate amounts of nutrients from plant-based foods helps to ensure a balanced intake of nutrients that support both heart and whole-body health.

Along with diet, supplementation may also be indicated to address nutrient deficiencies, and studies continue to investigate the impact and benefits of this intervention specific to heart health. A 2021 systematic review of 49 clinical trials exploring magnesium supplementation for blood pressure impact found beneficial yet conflicting results.¹⁵ Participants with untreated hypertension showed a blood pressure decrease when treatments were more than 600 mg of magnesium/day; half of the included studies (120 to 486 mg of magnesium/day) showed systolic or diastolic blood pressure decreases, but not both, while others at the same dosage reported no change in blood pressure; in 10 studies with participants concurrently taking antihypertensive medications, all magnesium doses (240 to 607 mg/day) led to a decrease in blood pressure measurements.¹⁵

CoQ10, READ YEAST RICE, & STATINS

Statins are a standard pharmacological treatment to help lower cholesterol and protect against heart attack and stroke for high-risk patients; however, side effects such as muscle pain and weakness are common. Studies suggest that certain nutrients used in conjunction with statins may reduce adverse effects such as muscle-related symptoms and may help patients maintain a prescribed statin intervention. Coenzyme Q10 (CoQ10) is an antioxidant found in many foods, including fruits and vegetables, and research suggests that this nutrient supports optimal cardiovascular performance in patients with heart conditions¹⁶ and may help to counteract some statin-related side-effects.¹⁷

Red yeast rice (RYR) is a fermented food well-known in traditional Chinese medicine for its beneficial effects in cardiovascular disease.¹⁸ The fermented rice naturally contains monacolins, including monacolin K, which is identical to the pharmaceutical drug lovastatin, and research suggests that RYR may be comparable to statin therapy, helping to lower lipid levels in patients with high cholesterol.^18,19 A 2020 meta-analysis of RCTs (n=10,699 patients with myocardial infarction and borderline hypercholesterolemia) found that RYR extract as an adjunctive treatment improved cardiovascular outcomes and lipid profiles.²⁰ Six out of seven of the included studies were double-blinded RCTs, and studies administered 1,200 mg of RYR extract orally per day with a treatment course and follow-up from four weeks to four and a half years.²⁰

Many foods and their nutrients help to support heart function through impacting levels of cholesterol. Oatmeal and its soluble fiber are just one common example. For optimal heart health and overall wellness, a functional medicine approach prioritizes nutrient-dense diets rich in antioxidants and anti-inflammatory agents, along with targeted supplementation when indicated. For the latest research on cardiovascular and metabolic health, dietary approaches, and personalized, effective, and sustainable treatment strategies, learn more from functional medicine experts at IFM’s Cardiometabolic Advanced Practice Module (APM).