Cardiovascular Disease

Cardiovascular disease covers coronary artery disease, stroke, heart failure and peripheral arterial disease, most of it driven by atherosclerosis developing over decades. The risk factors that matter are well established and quantified: blood pressure, LDL cholesterol, smoking, diabetes, physical inactivity, obesity and diet quality. Against that backdrop, supplements occupy a small and often misrepresented space. Fish oil at around 1 g/day did not reduce events in the large VITAL and ASCEND trials, and higher doses carry a dose-related increase in atrial fibrillation. High-dose icosapent ethyl showed benefit in people with raised triglycerides already on statins, but that is a prescription drug, not an over-the-counter fish oil. CoQ10 is reasonable to trial for statin-associated muscle symptoms, though evidence is mixed and it interacts with warfarin. Supplemental calcium above roughly 1000 mg/day has been linked in some analyses to a modest increase in cardiovascular events, unlike dietary calcium. Red yeast rice contains a natural statin with unpredictable potency and the same safety profile without dose control. High-dose vitamin E and beta-carotene in smokers have both shown harm. The honest summary is that supplements are a marginal lever, and time and money are better spent on blood pressure, lipids, smoking cessation, activity and glycaemic control.