Angina (Chest Pain)
Supplements studied for angina (chest pain).
Overview
Six supplements are indexed for angina across 21 studies.
N-Acetyl Cysteine (NAC) and L-Carnitine carry the strongest ratings (WA 68, medium). NAC with nitroglycerin may reduce nitrate tolerance and improve unstable angina symptoms, though results vary and the combination can cause headaches and low blood pressure. L-Carnitine may improve exercise capacity and delay chest pain onset in chronic stable angina.
Vitamin E (WA 52; low effect size, high evidence, medium trust) does not improve angina symptoms despite possible vascular effects. Fish Oil (WA 32; very low effect size, low evidence, medium trust) does not improve heart outcomes and may increase cardiac death risk in some men with angina, though this needs confirmation. See the heatmap and evidence reviews below.
Effect graph
Relevant supplements
Relevant supplements sorted by DEX Score.
| N-Acetyl Cysteine (NAC) | ★★★★★ | Medium |
| L-Carnitine | ★★★★★ | Medium |
| Vitamin E | ★★★★★ | Low |
| Astragalus | ★★★★★ | Low |
| Hawthorn | ★★★★★ | Very Low / None |
| Fish Oil | ★★★★★ | Very Low / None |
Studies
Find individual evidence reviews for supplements sorted by DEX Score.
6 supplements for , and rated at least stars. All purchase bands. No minimum star filter.
L-CarnitineView supplement →
Consider purchase·★★★★★
How we scored this▸
- Some small studies in people with chronic stable angina or cardiac syndrome X show that L-carnitine, taken by mouth or given intravenously, may help improve exercise capacity and delay the start of chest pain.
- Oral doses studied have ranged from 900 mg to 2 grams per day for 2 weeks up to 6 months.
Browse 5 studies
RCTL-carnitine moderately improves the exercise tolerance in chronic stable angina2000n=28
In 28 chronic stable angina patients, oral L-carnitine 2 g/day for 3 months improved exercise tolerance on treadmill testing versus baseline with good safety.
- Effect
- Benefit
- Duration
- 3 months
- Dose
- 2 g/day
- Population
- Patients with depressive disorders
- Participants
- 28
- Avg age
- ~56
RCTEffects of L- and DL-carnitine on patients with impaired exercise tolerance1995n=10
In 10 patients with exercise intolerance, oral L- or DL-carnitine 900 mg/day for 2 weeks did not significantly improve exercise capacity versus baseline.
- Effect
- No Benefit
- Duration
- 2 weeks
- Dose
- 900 mg/day
- Population
- Patients with cardiac disease
- Participants
- 10
RCTThe therapeutic effect of L-carnitine in patients with exercise-induced stable angina: a controlled study1991
In 200 angina patients across three centers, L-carnitine 2 g/day for 6 months improved exercise tolerance and reduced angina episodes versus baseline.
- Effect
- Benefit
- Duration
- 6 months
- Dose
- 2 g/day
- Population
- Heart failure patients
- Ages
- 40–65
RCTEffects of L-carnitine on exercise tolerance in chronic stable angina: a multicenter, double-blind, randomized, placebo controlled crossover study1985n=44
In 44 men with chronic stable angina, L-carnitine 1 g twice daily for 4 weeks increased exercise duration and reduced ST-segment depression versus placebo in a crossover trial.
- Effect
- Benefit
- Duration
- 4 weeks
- Dose
- 1 g 2×/day
- Population
- Patients with depressive disorders
- Participants
- 44
Controlled trialEffects of L-carnitine on exercise tolerance in patients with stable angina pectoris1984n=12
In 12 stable angina patients, L-carnitine 900 mg/day for 12 weeks increased exercise tolerance and reduced angina frequency versus baseline in a controlled study.
- Effect
- Benefit
- Duration
- 12 weeks
- Dose
- 900 mg/day
- Population
- Patients with depressive disorders
- Participants
- 12
N-Acetyl Cysteine (NAC)View supplement →
Consider purchase·★★★★★
How we scored this▸
- Taking N-acetylcysteine by mouth or vein along with nitroglycerin may help prevent tolerance to nitroglycerin and improve symptoms in unstable angina.
- However, some studies show it may not always work, and the combination can cause severe headaches and low blood pressure.
Browse 6 studies
RCTNitroglycerine/N-acetylcysteine in the management of unstable angina pectoris1998n=46
An RCT of 46 unstable angina patients found combined nitroglycerin and NAC reduced angina episodes more than nitroglycerin alone.
- Effect
- Benefit
- Dose
- 5 g/day
- Population
- Unstable angina patients
- Participants
- 46
RCTEffect of transdermal nitroglycerin or N-acetylcysteine, or both, in the long-term treatment of unstable angina pectoris1997n=200
A 4-month RCT of 200 angina patients found transdermal nitroglycerin plus NAC improved exercise tolerance and reduced nitrate tolerance versus nitroglycerin alone.
- Effect
- Benefit
- Duration
- 4 months
- Population
- Unstable angina patients
- Participants
- 200
Clinical trialDifferent susceptibility to the development of nitroglycerin tolerance in the arterial and venous circulation in humans. Effects of N-acetylcysteine administration1992n=20
A study of 20 angina patients found arterial and venous beds differed in susceptibility to nitroglycerin tolerance during combined NAC therapy.
- Population
- ALL patients
- Participants
- 20
RCTPreventive administration of intravenous N-acetylcysteine and development of tolerance to isosorbide dinitrate in patients with angina pectoris1992n=10
An RCT of 10 patients found preventive IV NAC (5 mg/kg) delayed development of nitrate tolerance during continuous nitroglycerin infusion.
- Effect
- Benefit
- Duration
- 30 hours
- Dose
- 5 mg/kg
- Population
- Angina patients
- Participants
- 10
RCTChronic administration of N-acetylcysteine fails to prevent nitrate tolerance in patients with stable angina pectoris1990
An RCT found chronic NAC (10 mg/day) failed to prevent nitrate tolerance during long-term nitroglycerin therapy.
- Effect
- No Benefit
- Duration
- 4 days
- Dose
- 10 mg/day
- Population
- Stable angina patients
RCTN-acetylcysteine fails to attenuate haemodynamic tolerance to glyceryl trinitrate in healthy volunteers1989
An RCT found NAC (200 mg three times daily) did not attenuate hemodynamic tolerance to glyceryl trinitrate in angina patients.
- Effect
- No Benefit
- Duration
- 4 days
- Dose
- 200 mg 3×/day
- Population
- Healthy adults
Vitamin EView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- Taking vitamin E by mouth does not improve angina (chest pain) symptoms.
- Some studies suggest it might help blood vessel function but does not reduce chest pain in smokers or nonsmokers.
Browse 6 studies
ObservationalCholesterol standardized plasma vitamin E levels are reduced in patients with severe angina pectoris2000n=64
A study in 128 angina patients found cholesterol-standardized plasma vitamin E levels reduced in severe angina (grade III–IV) versus mild-moderate angina.
- Dose
- 0.40 mg/day
- Population
- Hypertensive patients
- Participants
- 64
- Avg age
- 58±1
RCTEffects of vitamin E on chronic and acute endothelial dysfunction in smokers2000n=11
A study in 22 smokers found vitamin E 600 IU/day for 8 weeks restored flow-mediated vasodilation impaired by acute and chronic smoking versus baseline.
- Effect
- Benefit
- Duration
- 8 weeks
- Dose
- 600 IU/day
- Population
- Smokers
- Participants
- 11
- Avg age
- ~28
RCTVitamin E supplementation and cardiovascular events in high-risk patients2000n=4,761
The HOPE trial in 9,541 high-risk patients found vitamin E 400 IU/day did not reduce cardiovascular death, MI, or stroke over ~4.5 years versus placebo.
- Effect
- No Benefit
- Dose
- 400 IU/day
- Population
- Heart failure patients
- Participants
- 4,761
- Ages
- 55+
ObservationalVitamin E and coronary artery disease1999
A review found mixed evidence on vitamin E (up to 800 IU/day) for coronary artery disease prevention, with observational data more promising than trial results.
- Effect
- Benefit
- Dose
- 800 IU/day
- Population
- Patients
RCTEffects of alpha tocopherol and beta carotene supplements on symptoms, progression, and prognosis of angina pectoris1998n=1,795
The ATBC study in 1,795 Finnish male smokers with angina found neither alpha-tocopherol 50 mg/day nor beta carotene reduced angina recurrence or major coronary events.
- Effect
- No Benefit
- Dose
- 50 mg/day
- Population
- Cancer patients
- Participants
- 1,795
- Ages
- 50–69
RCTVitamin E administration improves impairment of endothelium-dependent vasodilation in patients with coronary spastic angina1998n=60
A study in 60 patients with coronary spastic angina found oral vitamin E 300 mg/day improved impaired endothelium-dependent vasodilation versus baseline.
- Effect
- Benefit
- Dose
- 300 mg/day
- Population
- Patients
- Participants
- 60
AstragalusView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- A small study found taking astragalus three times a day may improve heart pumping in people with angina, but it did not improve all aspects of heart function.
- Laboratory and animal studies support astragalus’s heart benefits, but more human studies are needed.
Browse 1 study
Clinical trialAction of Astragalus membranaceus on left ventricular function of angina pectoris1994n=20
In 20 angina patients over 2 weeks, astragalus increased cardiac output 5.1 to 5.95 L/min/m² but did not improve left ventricular diastolic function.
- Effect
- Benefit
- Duration
- 2 weeks
- Population
- Angina patients
- Participants
- 20
Fish OilView supplement →
Do not purchase·★★★★★
How we scored this▸
- Taking fish oil supplements does not seem to improve heart-related outcomes or survival in people with angina.
- Some studies suggest that fish oil or eating more oily fish might increase the risk of heart-related death and sudden cardiac death in men with angina, but more research is needed to confirm this.
Browse 2 studies
RCTLack of benefit of dietary advice to men with angina: results of a controlled trial2003n=3,114
A study of 3114 men with angina (< 70 years old) advised to take up to 3 g/day found that fish oil supplementation may increase the risk of cardiac death and sudden cardiac death compared to those advised to eat more fruit, vegetables or oily fish alone. [10583]
- Effect
- No Benefit
- Dose
- 3 g/day
- Population
- Men with angina
- Participants
- 3,114
- Ages
- <70
Controlled trialFish oil in angina pectoris1987n=36
A 12-wk study of 36 patients with stable angina pectoris given fish oil found no significant effects on frequency of angina compared to placebo. Neither treatment affected blood pressure. [10584]
- Effect
- No Benefit
- Duration
- 12 weeks
- Population
- Angina patients
- Participants
- 36
HawthornView supplement →
Do not purchase·★★★★★
How we scored this▸
- Early clinical studies show that taking hawthorn extract three times a day for four weeks can help improve chest pain symptoms and heart test results in patients with angina who are already on standard heart medications.
- Another study using hawthorn with additional herbs did not reduce the number of chest pain episodes but helped improve some symptoms and quality of life.
Browse 1 study
RCTTreating unstable angina with detoxifying and blood-activating formulae: A randomized controlled trial2021n=144
In 144 patients with unstable angina over 4 weeks, a detoxifying formula containing 15 g Polygonum cuspidatum and 10 g hawthorn improved angina symptoms versus control.
- Effect
- No Benefit
- Duration
- 4 weeks
- Dose
- 10 g/day
- Participants
- 144
Evidence visualised
Same ratings as above, aggregated so you can see coverage and imbalance.
| Supplement | DEX | Studies | Meta-analyses | Share |
|---|---|---|---|---|
| N-Acetyl Cysteine (NAC) | ★★★★★68% | 6 | 0 | 29% |
| Vitamin E | ★★★★★52% | 6 | 0 | 29% |
| L-Carnitine | ★★★★★68% | 5 | 0 | 24% |
| Fish Oil | ★★★★★32% | 2 | 0 | 10% |
| Astragalus | ★★★★★40% | 1 | 0 | 5% |
| Hawthorn | ★★★★★32% | 1 | 0 | 5% |