Interactions of commonly used dietary supplements with cardiovascular drugs: a systematic review

Abstract

BackgroundThe objective of this systematic review was to examine the benefits, harms and pharmacokinetic interactions arising from the co-administration of commonly used dietary supplements with cardiovascular drugs. Many patients on cardiovascular drugs take dietary supplements for presumed benefits and may be at risk for adverse supplement-drug interactions.MethodsThe Allied and Complementary Medicine Database, the Cochrane Library, EMBASE, International Bibliographic Information on Dietary Supplements and MEDLINE were searched from the inception of the review to October 2011. Grey literature was also reviewed.Two reviewers independently screened records to identify studies comparing a supplement plus cardiovascular drug(s) with the drug(s) alone. Reviewers extracted data using standardized forms, assessed the study risk of bias, graded the strength of evidence and reported applicability.ResultsEvidence was obtained from 65 randomized clinical trials, 2 controlled clinical trials and 1 observational study. With only a few small studies available per supplement, evidence was insufficient for all predefined gradable clinical efficacy and harms outcomes, such as mortality and serious adverse events. One long-term pragmatic trial showed no benefit from co-administering vitamin E with aspirin on a composite cardiovascular outcome. Evidence for most intermediate outcomes was insufficient or of low strength, suggesting no effect. Incremental benefits were noted for triglyceridemia with omega-3 fatty acid added to statins; and there was an improvement in levels of high-density lipoprotein cholesterol with garlic supplementation when people also consumed nitratesConclusionsEvidence of low-strength indicates benefits of omega-3 fatty acids (plus statin, or calcium channel blockers and antiplatelets) and garlic (plus nitrates or warfarin) on triglycerides and HDL-C, respectively. Safety concerns, however, persist.

Concurrent Use of Low‐Dose Aspirin and Omega‐3 Fatty Acids and Risk of Upper Gastrointestinal Complications: A Cohort Study with Nested Case–Control Analysis

“…Such synergistic effect is likely to be related to the capability of OM3 to reduce thromboxane A2 synthesis and block thromboxane A2 and prostaglandin H2 receptors in human platelets, so increasing the therapeutic effect of aspirin . As such, OM3 fatty acids are currently considered able to enhance the antiplatelet activity of aspirin without creating a potential risk of gastrointestinal bleedings , although the available clinical evidence in this regard remains scarce .…”

“…Nevertheless, to the best of our knowledge, no real‐world evidence from large observational studies is available with respect to the risk of UGIC associated with the concurrent use of LDA with OM3. In fact, although the available information on this topic indicates a good safety profile for this combination, it is limited to adverse events reported from clinical trials .…”

CoQ10 Function and Role in Heart Failure and Ischemic Heart Disease

“…At 1,200 mg CoQ 10 per day, adverse events are minimal, and even doses of 3,000 mg CoQ 10 per day have been administered to humans for eight months with no adverse effects noted (50). Earlier concerns that CoQ 10 supplements may interfere with the effects of warfarin, also listed on the National Center for Complementary and Integrative Health website (128), have not been substantiated (81,111). Extensive attempts have been made in the commercial production of CoQ 10 .…”

Complementary and Alternative Medicine

“…In addition, numerous supplements may increase bleeding risk or other complications during surgical or other invasive procedures. Finally, supplements may interact with immunosuppressive drugs and other medications 40 – 43 …”

“…The potential for interactions between dietary/herbal supplements and medications is substantial 40 – 43 , 51 . Immunosuppressive medications are critical drugs and essential for preventing organ rejection in transplant recipients.…”