Atherosclerosis
Supplements studied for atherosclerosis.
Overview
Eleven supplements are indexed for atherosclerosis across 37 studies.
Garlic (WA 72; medium effect size, high evidence, very high trust) may slow arterial plaque buildup and reduce vessel stiffening; aged garlic extract reduced coronary calcium progression by nearly 30% over one year in one study. Fish Oil (WA 36; very low effect size, medium evidence, medium trust), Vitamin E (WA 48; low effect size, medium evidence, medium trust), and Vitamin C alone (WA 44) generally do not slow atherosclerosis in most trials, though vitamin C with vitamin E showed possible benefit in some men.
Vitamin B3 (Niacin) (WA 40; very low effect size, high evidence, medium trust) has unclear effects and does not clearly outperform statins or reduce heart attacks. See the heatmap and evidence reviews below for all eleven supplements.
Effect graph
Relevant supplements
Relevant supplements sorted by DEX Score.
| Garlic | ★★★★★ | Medium |
| Vitamin E | ★★★★★ | Low |
| Lycopene | ★★★★★ | Low |
| Flaxseed Oil | ★★★★★ | Low |
| Vitamin C | ★★★★★ | Low |
| Red Yeast Rice | ★★★★★ | Low |
| Vitamin B3 (Niacin) | ★★★★★ | Very Low / None |
| Black Tea | ★★★★★ | Low |
| Alpha-Linolenic Acid | ★★★★★ | Low |
| Acetyl-L-Carnitine | ★★★★★ | Low |
| Fish Oil | ★★★★★ | Very Low / None |
Studies
Find individual evidence reviews for supplements sorted by DEX Score.
11 supplements for , and rated at least stars. All purchase bands. No minimum star filter.
GarlicView supplement →
Consider purchase·★★★★★
How we scored this▸
- Garlic supplements may help slow the buildup of plaque in the arteries (atherosclerosis).
- Several studies suggest that garlic powder or aged garlic extract can reduce age-related stiffening of blood vessels and may help slow the progression of artery thickening and calcium buildup.
- Some research shows that aged garlic extract can reduce the advance of coronary artery calcium by nearly 30% over a year compared with people taking placebo.
- Garlic may also work better when combined with other nutrients.
- For example, aged garlic extract taken with B vitamins and L-arginine has been shown to slow plaque buildup and improve blood vessel function.
- Another study found that aged garlic extract combined with coenzyme Q10 improved blood vessel health in people with high levels of work stress.
Browse 9 studies·1 meta-analysis
MetaEffect of garlic extract on markers of lipid metabolism and inflammation in coronary artery disease (CAD) patients: A systematic review and meta-analysis2023
A meta-analysis in CAD patients found garlic supplementation significantly lowered LDL cholesterol and raised HDL and apolipoprotein-A versus placebo, with mixed effects on other cardiovascular markers.
- Effect
- Benefit
- Population
- CAD patients
RCTThe effect of aged garlic extract on the atherosclerotic process - a randomized double-blind placebo-controlled trial2020n=104
In a 1-year double-blind RCT of 104 adults at cardiovascular risk, 2,400 mg/day aged garlic extract did not significantly slow coronary artery calcification progression versus placebo.
- Effect
- No Benefit
- Duration
- 1 year
- Dose
- 400 mg/day
- Population
- CAD patients
- Participants
- 104
RCTAged garlic extract with supplement is associated with increase in brown adipose, decrease in white adipose tissue and predict lack of progression in coronary atherosclerosis2013n=60
In a 12-month RCT of 60 CAD patients, aged garlic extract with B vitamins and L-arginine reduced coronary calcium progression and white epicardial fat while increasing brown epicardial fat versus placebo.
- Effect
- Benefit
- Duration
- 12 months
- Dose
- 250 mg
- Population
- CAD patients
- Participants
- 60
RCTAnti-atherosclerotic therapy based on botanicals2013
In a 2-year double-blind RCT of 196 asymptomatic men (ages 40–74), time-released garlic drug Allicor slowed carotid atherosclerosis progression measured by B-mode ultrasound versus placebo.
- Effect
- Benefit
- Population
- CAD patients
- Ages
- 40–74
RCTBeneficial effects of aged garlic extract and coenzyme Q10 on vascular elasticity and endothelial function: the FAITH randomized clinical trial2013
In firefighters, 1,200 mg/day aged garlic extract plus 30 mg/day coenzyme Q10 for 1 year improved vascular elasticity measured by pulse-wave velocity and digital thermal monitoring versus placebo.
- Effect
- Benefit
- Duration
- 1 year
- Dose
- 1200 mg/day
- Population
- Firefighters
RCTThe anti-atheroslerotic effect of Allium sativum: statistics re-evaluated2000
A re-evaluation of statistics from a prior garlic atherosclerosis trial concluded that earlier reported anti-atherosclerotic effects were not robustly supported after statistical reassessment.
RCTThe antiatherosclerotic effect of Allium sativum1999n=152
In a 48-month double-blind RCT of 152 adults (ages 50–80), high-dose garlic powder tablets reduced atherosclerotic plaque volume by 5–18% and stabilized plaque growth versus placebo.
- Effect
- Benefit
- Population
- Adults
- Participants
- 152
- Ages
- 50–80
ObservationalProtective effect of chronic garlic intake on elastic properties of aorta in the elderly1997n=101
In a cross-sectional study of 101 adults (ages 50–80) taking ≥300 mg/day standardized garlic powder for ≥2 years, aortic pulse wave velocity and elastic vascular resistance were lower than in matched controls.
- Effect
- Benefit
- Dose
- 300 mg/day
- Population
- Healthy adults
- Participants
- 101
- Ages
- 50–80
RCTGarlic Powder Tablets Reduce Atherogenicity of Low Density Lipoprotein. A Placebo-Controlled Double-Blind Study1996
In a double-blind placebo-controlled study, garlic powder tablets reduced the atherogenicity of low-density lipoprotein compared with placebo in hyperlipidemic subjects.
Flaxseed OilView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- One study of American adults found that eating more linolenic acid, a nutrient in flaxseed oil, was linked to having less calcium buildup in the arteries of the heart.
- But clinical studies have not confirmed this result.
- In one small trial in people with heart disease, taking 5 grams of flaxseed oil mixed into milk lowered triglycerides by 14%, but did not change blood pressure or cholesterol.
Browse 3 studies
RCTA comparison between the effects of flaxseed oil and fish oil supplementation on cardiovascular health in type 2 diabetic patients with coronary heart disease: A randomized, double-blinded, placebo-controlled trial2019n=30
In 90 T2DM patients with CHD over 12 weeks, 2,000 mg/day fish oil or flaxseed oil both reduced insulin and raised total antioxidant capacity versus placebo, with flaxseed also lowering hs-CRP.
- Effect
- Benefit
- Duration
- 12 weeks
- Population
- Diabetic patients
- Participants
- 30
RCTEffect of flaxseed oil supplementation on anthropometric and metabolic indices in patients with coronary artery disease: A double-blinded randomized controlled trial2019n=44
In 44 CAD patients over 10 weeks, 5 g/day flaxseed oil (2.5 g ALA) lowered diastolic blood pressure and triglycerides versus milk placebo, without between-group changes in weight or BMI.
- Effect
- Benefit
- Duration
- 10 weeks
- Dose
- 5 g/day
- Population
- CAD patients
- Participants
- 44
- Ages
- 30–65
ObservationalDietary linolenic acid is inversely associated with calcified atherosclerotic plaque in the coronary arteries: the National Heart, Lung, and Blood Institute Family Heart Study2005n=2,004
Observational study of 2004 adults aged 32-93 found higher dietary linolenic acid intake inversely associated with coronary artery calcification in a dose-response pattern.
- Effect
- Benefit
- Dose
- 0.36 g/day
- Population
- Adults
- Participants
- 2,004
- Ages
- 32–93
LycopeneView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- Some research shows that higher levels of lycopene in the blood are linked to less buildup of artery plaque in the aorta and neck arteries and a lower risk of heart disease and heart attacks for people with artery hardening.
- However, lycopene levels do not seem to affect the risk of ischemic stroke.
Browse 5 studies
Clinical trialLycopene and preclinical carotid atherosclerosis2011n=20
In 120 adults, those with ultrasonic carotid atherosclerosis had significantly lower plasma lycopene concentrations than those without evidence of disease.
- Effect
- Benefit
- Population
- Adults
- Participants
- 20
Inverse association between carotid intima-media thickness and the antioxidant lycopene in atherosclerosis2002n=11
In 33 adults including hypertensive patients with peripheral vascular disease, plasma lycopene was inversely correlated with carotid intima-media thickness (r = 0.42, p = 0.014) independent of LDL and insulin.
- Effect
- Benefit
- Population
- Hypertension patients
- Participants
- 11
ObservationalSerum carotenoids and atherosclerosis. The Rotterdam Study2000n=108
In the Rotterdam Study, higher serum lycopene was inversely associated with aortic atherosclerosis (OR 0.55 top vs bottom quartile), especially in current and former smokers; lutein/zeaxanthin showed no association.
- Effect
- Benefit
- Population
- Older adults
- Participants
- 108
ObservationalRelation of consumption of vitamin E, vitamin C, and carotenoids to risk for stroke among men in the United States1999n=43,738
In 43,738 US men followed 8 years, higher lutein intake showed a nonsignificant inverse association with ischemic stroke; vitamin E, vitamin C, and other carotenoids were not significantly protective.
- Effect
- No Benefit
- Dose
- 411 IU/day
- Population
- Hypertension patients
- Participants
- 43,738
- Ages
- 40–75
ObservationalLycopene and myocardial infarction risk in the EURAMIC Study1997
In the EURAMIC multicenter case-control study, adipose tissue lycopene remained independently protective against myocardial infarction (OR 0.52 for 90th vs 10th percentile) after adjusting for other carotenoids.
- Effect
- Benefit
Vitamin EView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- Taking natural vitamin E by mouth does not seem to slow atherosclerosis (hardening of the arteries) or reduce death risk.
- Some early studies show that taking vitamin E together with vitamin C might help slow artery damage in men, especially smokers and people with heart transplants.
- More research is needed.
Browse 3 studies
RCTEffects of ramipril and vitamin E on atherosclerosis: the SECURE trial2001n=732
The SECURE substudy of 732 patients found ramipril slowed carotid atherosclerosis progression; vitamin E 400 IU/day did not add significant benefit versus ramipril alone.
- Effect
- No Benefit
- Dose
- 400 IU/day
- Population
- Older adults
- Participants
- 732
- Ages
- 55+
RCTAntioxidant Supplementation in Atherosclerosis Prevention (ASAP) study2000n=520
The ASAP trial in 520 adults found combined vitamin E and slow-release vitamin C for 3 years slowed carotid intima-media thickening, especially in men (74% less progression).
- Effect
- Benefit
- Dose
- 136 IU/day
- Population
- Postmenopausal women
- Participants
- 520
- Ages
- 45–69
RCTCambridge Heart Antioxidant Study (CHAOS)1996n=2,002
In the CHAOS trial of 2,002 patients with coronary atherosclerosis, vitamin E (800/400 IU/day) over a median 510 days reduced nonfatal MI (14 vs 41; RR 0.23) but did not lower cardiovascular or all-cause mortality.
- Effect
- Benefit
- Duration
- 510 days
- Dose
- 400 IU/day
- Population
- Patients
- Participants
- 2,002
Red Yeast RiceView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- Taking red yeast rice for 3 to 12 months may help reduce the buildup of plaque in artery walls and improve cholesterol levels.
- Most studies showing these benefits were done in China, and the quality of evidence is mixed.
- Red yeast rice appears to be safe with few side effects reported.
- However, more research is needed to know if it helps in other populations and how well it really works to protect the heart.
Browse 1 study·1 meta-analysis
RCTEffectiveness of red yeast rice on carotid atherosclerosis: A systematic review and meta-analysis2022n=2,217
A meta-analysis of 20 RCTs (2217 patients) found red yeast rice reduced carotid plaque area, plaque score, intima-media thickness, and LDL cholesterol.
- Effect
- Benefit
- Population
- Patients with carotid atherosclerosis
- Participants
- 2,217
Vitamin CView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- Oral vitamin C alone does not slow the development of atherosclerosis.
- One study found that vitamin C with vitamin E may help slow atherosclerosis progression in men, but not in women, after 3 years.
- Vitamin C alone did not help.
Browse 2 studies
RCTSix-year effect of combined vitamin C and E supplementation on atherosclerotic progression: the Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) Study2003
The ASAP trial in 520 hypercholesterolemic adults found combined vitamin E (136 IU) and C (250 mg) twice daily for 6 years slowed carotid atherosclerosis progression 26%.
- Effect
- Benefit
- Duration
- 6 years
- Dose
- 136 IU vitamin E + 250 mg vitamin C, 2×/day
- Population
- Postmenopausal women
- Ages
- 45–69
RCTAntioxidant Supplementation in Atherosclerosis Prevention (ASAP) study: a randomized trial of the effect of vitamins E and C on 3-year progression of carotid atherosclerosis2000n=520
The ASAP trial in 520 adults found combined vitamin E and slow-release vitamin C for 3 years slowed carotid intima-media thickening, especially in men (74% less progression).
- Effect
- Benefit
- Dose
- 136 IU
- Population
- Postmenopausal women
- Participants
- 520
- Ages
- 45–69
Acetyl-L-CarnitineView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- Acetyl-L-carnitine's effect on atherosclerosis is unknown when taken alone.
- One study of a combination supplement containing acetyl-L-carnitine, gamma-linolenic acid, and grape extract found improvement in artery stiffness and blood pressure over a year.
- These results should be viewed cautiously because the study had no comparison group and many participants dropped out.
Browse 1 study
Efficacy of γ-linolenic acid, Vitis vinifera extract, and acetyl-L-carnitine combination therapy for improving arterial stiffness in Korean adults: Real-world evidence2023n=318
A retrospective study in 318 Korean adults with high arterial stiffness found a triple combination of γ-linolenic acid, Vitis vinifera extract, and acetyl-L-carnitine reduced brachial-ankle pulse wave velocity after 1 year.
- Effect
- Benefit
- Population
- Adults
- Participants
- 318
- Ages
- 19+
Alpha-Linolenic AcidView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- Eating more foods rich in alpha-linolenic acid (a type of healthy fat) may lower the risk of hardening and blockages in the heart arteries.
- In one study, each additional gram of this fat in the diet was linked to a 62% lower chance of calcium buildup in heart arteries.
Browse 1 study
ObservationalDietary linolenic acid is inversely associated with calcified atherosclerotic plaque in the coronary arteries: the National Heart, Lung, and Blood Institute Family Heart Study2005n=2,004
Observational study of 2004 adults aged 32-93 found higher dietary linolenic acid intake inversely associated with coronary artery calcification in a dose-response pattern.
- Effect
- Benefit
- Dose
- 0.36 g/day
- Population
- Adults
- Participants
- 2,004
- Ages
- 32–93
Black TeaView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- Drinking 1 to 4 cups of black tea daily may lower the risk of severe aortic atherosclerosis, especially in women.
Browse 1 study
ObservationalTea flavonoids may protect against atherosclerosis: the Rotterdam Study1999n=3,454
In 3,454 Rotterdam Study participants, tea drinkers consuming >500 mL/day had 69% lower odds of severe aortic atherosclerosis versus nondrinkers; associations were stronger in women.
- Effect
- Benefit
- Population
- Adults
- Participants
- 3,454
- Ages
- 2–3
Vitamin B3 (Niacin)View supplement →
Reconsider purchase·★★★★★
How we scored this▸
- It is not clear if taking niacin can slow down atherosclerosis, or the build-up of plaque in the arteries.
- Some early studies show that niacin, combined with another medicine called colestipol, might slightly slow atherosclerosis in men who already have heart disease.
- However, niacin does not seem to work better than statins, and adding niacin to other cholesterol medicines does not further slow artery damage.
- Niacin also does not lower the risk of heart attacks or death.
Browse 8 studies·2 meta-analyses
MetaSupplemental Vitamins and Minerals for CVD Prevention and Treatment2018
A systematic review found moderate evidence for folic acid/B-vitamin cardiovascular benefits but no clear preventive benefit from calcium, vitamin D, multivitamins, or selenium on CVD or all-cause mortality.
- Effect
- No Benefit
MetaNiacin for primary and secondary prevention of cardiovascular events2017n=39,195
A meta-analysis of 39195 participants found that 2 g/day for 33–71 years participants randomised to niacin were more likely to discontinue treatment due to side effects than participants randomised to control group (RR 2.17, 95% CI 1.70 to 2.77; participants = 33,539; studies = 17; I 2 = 77%; moderate-quality evidence).
- Effect
- No Benefit
- Dose
- 2 g/day
- Population
- Adults
- Participants
- 39,195
- Ages
- 33–71
MetaEffect on cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: meta-analysis of randomised controlled trials including 117,411 patients2014n=117,411
A meta-analysis of 117411 participants found that neither niacin, fibrates, nor CETP inhibitors, three highly effective agents for increasing high density lipoprotein levels, reduced all cause mortality, coronary heart disease mortality, myocardial infarction, or stroke in patients treated with statins.
- Effect
- No Benefit
- Participants
- 117,411
RCTExtended-release niacin therapy and risk of ischemic stroke in patients with cardiovascular disease: the Atherothrombosis Intervention in Metabolic Syndrome with low HDL/High Triglycerides: Impact on Global Health Outcome (AIM-HIGH) trial2013n=3,414
A randomized trial of 3414 patients with cardiovascular disease found that 2000 mg/day in the intention-to-treat analysis, there were 50 fatal or nonfatal ischemic strokes: 18 (1.06%) in placebo arm versus 32 (1.86%) in ERN arm (hazard ratio [HR], 1.78 [95% confidence interval {CI}, 1.00-3.17; P=0.050).
- Effect
- No Benefit
- Dose
- 2000 mg/day
- Population
- Patients With Cardiovascular Disease
- Participants
- 3,414
- Avg age
- 64±9
RCTThe Effect of Lipid Modification on Peripheral Artery Disease after Endovascular Intervention Trial (ELIMIT)2013n=102
A randomized trial of 102 found that 40 mg/day non-high-density lipoprotein cholesterol was significantly reduced at 12 months with triple-therapy compared with mono-therapy (p = 0.01).
- Effect
- No Benefit
- Duration
- 24 months
- Dose
- 40 mg/day
- Population
- Peripheral artery disease patients
- Participants
- 102
RCTOne-year reduction and longitudinal analysis of carotid intima-media thickness associated with colestipol/niacin therapy1993n=78
A randomized trial of 78 patients with atherosclerosis found that no significant treatment group differences on carotid IMT were found at 6 months.
- Effect
- Benefit
- Duration
- 4 years
- Population
- Patients With Atherosclerosis
- Participants
- 78
- Ages
- 40–59
RCTRegression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B1990n=52
A randomized trial of 52 men found that 20 mg 2×/day in men with coronary artery disease who were at high risk for cardiovascular events, intensive lipid-lowering therapy reduced the frequency of progression of coronary lesions, increased the frequency of regression, and reduced the incidence of cardiovascular events.
- Effect
- Benefit
- Dose
- 20 mg 2×/day
- Population
- Men
- Participants
- 52
- Ages
- ≤62
RCTBeneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts1987
A randomized trial found that also, the percentage of subjects with new lesions (P less than .04) or any adverse change in bypass grafts (P less than .03) was significantly reduced.
- Effect
- Benefit
- Population
- Men
- Ages
- 40–59
Fish OilView supplement →
Do not purchase·★★★★★
How we scored this▸
- Most research shows that taking fish oil by mouth does not slow down the build-up of plaque in blood vessels (atherosclerosis).
- Fish oil usually does not improve the size of the blood vessel opening or reduce artery wall thickness in people with heart disease.
- One study found that taking fish oil in high doses for over 2 years slightly slowed or reversed plaque build-up in people with heart disease.
Browse 3 studies
RCTEffect of dietary supplementation with omega-3 fatty acids on progression of atherosclerosis in carotid arteries2002n=171
A 2-year study of 171 patients found that 1.65 g/day omega-3 PUFA did not decrease intima-media thickness of the carotid arteries or slow progression of atherosclerosis compared to placebo. [10590]
- Effect
- No Benefit
- Duration
- 2 years
- Dose
- 1.65 g/day
- Population
- CAD patients
- Participants
- 171
RCTThe effect of dietary omega-3 fatty acids on coronary atherosclerosis. A randomized, double-blind, placebo-controlled trial1999n=162
A study of 162 patients with angiographically proven coronary artery disease found that 6 g/day fish oil for 3 months and then 3 g/day for 21 months may modestly slow the progression of coronary atherosclerosis compared to placebo. [10591]
- Effect
- Benefit
- Duration
- 21 months
- Dose
- 6 g/day
- Population
- CAD patients
- Participants
- 162
RCTControlled trial of fish oil for regression of human coronary atherosclerosis. HARP Research Group1995n=31
A study of 59 patients with angiographically proven coronary heart disease and normal plasma lipids were given 6 g/day omega-3 fatty acids for an average of 28 months. Despite increases in EPA adipose tissue concentrations (0.91% vs 0.20%) and reduced triglycerides (-30%), there was no effect on mean minimal diameter of atherosclerotic coronary arteries and percent stenosis compared to placebo. [10592]
- Effect
- No Benefit
- Duration
- 2 years
- Dose
- 6 g/day
- Population
- CAD patients
- Participants
- 31
- Avg age
- ~62
Evidence visualised
Same ratings as above, aggregated so you can see coverage and imbalance.
| Supplement | DEX | Studies | Meta-analyses | Share |
|---|---|---|---|---|
| Garlic | ★★★★★72% | 9 | 1 | 24% |
| Vitamin B3 (Niacin) | ★★★★★40% | 8 | 2 | 22% |
| Lycopene | ★★★★★48% | 5 | 0 | 14% |
| Fish Oil | ★★★★★36% | 3 | 0 | 8% |
| Flaxseed Oil | ★★★★★48% | 3 | 0 | 8% |
| Vitamin E | ★★★★★48% | 3 | 0 | 8% |
| Vitamin C | ★★★★★44% | 2 | 0 | 5% |
| Acetyl-L-Carnitine | ★★★★★40% | 1 | 0 | 3% |
| Alpha-Linolenic Acid | ★★★★★40% | 1 | 0 | 3% |
| Black Tea | ★★★★★40% | 1 | 0 | 3% |
| Red Yeast Rice | ★★★★★44% | 1 | 1 | 3% |