Myocardial Infarction
Supplements studied for myocardial infarction.
Overview
Several supplements show medium-strength evidence for myocardial infarction. Black Tea (WA 68; medium effect size, high evidence, high trust) is linked in observational research to lower heart attack risk and better survival with regular daily intake. N-Acetyl Cysteine (NAC) (WA 64; medium effect size, medium evidence, high trust) may limit heart muscle damage when given early during certain heart attacks, though trials are small. Red Yeast Rice (WA 72; medium effect size, high evidence, very high trust) may reduce repeat non-fatal heart attacks in people with prior events in Chinese research, with unclear generalizability. Coenzyme Q10 (WA 56; medium effect size, low evidence, medium trust) showed reduced further cardiac events in one small post-MI study.
L-Carnitine (WA 56; low effect size, very high evidence, medium trust) has mixed results across ten studies—some report fewer abnormal heartbeats and improved survival, others find no clear benefit. See the heatmap and evidence reviews below for supplement-by-supplement detail.
Effect graph
Relevant supplements
Relevant supplements sorted by DEX Score.
| Red Yeast Rice | ★★★★★ | Medium |
| Black Tea | ★★★★★ | Medium |
| N-Acetyl Cysteine (NAC) | ★★★★★ | Medium |
| L-Carnitine | ★★★★★ | Low |
| Coenzyme Q10 | ★★★★★ | Medium |
| Green Tea | ★★★★★ | Low |
| Melatonin | ★★★★★ | Low |
| Multivitamin | ★★★★★ | Very Low / None |
| Calcium | ★★★★★ | Very Low / None |
Studies
Find individual evidence reviews for supplements sorted by DEX Score.
9 supplements for and rated at least stars. All purchase bands. No minimum star filter.
Red Yeast RiceView supplement →
Consider purchase·★★★★★
How we scored this▸
- In some people who have had a previous heart attack, taking red yeast rice—1.2 grams daily for 4 to 4.5 years—may help lower the chances of having another non-fatal heart attack by about 58%.
- It also appears to reduce the need for further heart procedures and sudden death from heart problems.
- However, this research was only done in China, and it's unclear if the same benefits apply elsewhere.
- There was no evidence that red yeast rice reduces the risk of death from heart attacks.
Browse 4 studies·1 meta-analysis
MetaEfficacy of red yeast rice extract on myocardial infarction patients with borderline hypercholesterolemia: A meta-analysis of randomized controlled trials2020
A meta-analysis of 7 trials (10,699 post-MI patients) found red yeast rice at 1,200 mg/day reduced nonfatal MI, revascularization, sudden death, and improved lipid profiles.
- Effect
- Benefit
- Duration
- 4 weeks–4.5 years
- Dose
- 200 mg/day
- Population
- Surgical patients
RCTBeneficial impact of Xuezhikang on cardiovascular events and mortality in elderly hypertensive patients with previous myocardial infarction from the China Coronary Secondary Prevention Study (CCSPS)2009n=772
In 772 elderly hypertensive post-MI patients over 4.5 years, Xuezhikang reduced coronary events by 38% and coronary death by 29% versus placebo.
- Effect
- Benefit
- Population
- Older adults
- Participants
- 772
RCTEffect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction2008
In ~5000 post-MI Chinese patients over 4.5 years, Xuezhikang cut major coronary events from 10.4% to 5.7%, reduced CV and total mortality ~30%, and improved lipids.
- Effect
- Benefit
- Population
- Surgical patients
RCTXuezhikang, an extract of cholestin, reduces cardiovascular events in type 2 diabetes patients with coronary heart disease: subgroup analysis of patients with type 2 diabetes from China coronary secondary prevention study (CCSPS)2007n=306
In 591 type 2 diabetics with coronary heart disease followed ~4 years, Xuezhikang reduced coronary events from 18.6% to 9.2% versus placebo.
- Effect
- Benefit
- Population
- Diabetic patients
- Participants
- 306
Black TeaView supplement →
Consider purchase·★★★★★
How we scored this▸
- Drinking black tea daily may lower the risk of having a heart attack (myocardial infarction).
- People who drink one or more cups of black tea every day have been found to have about a 28% to 44% lower chance of heart attack and better survival afterward compared to those who do not drink tea.
- The natural antioxidants and caffeine in black tea help improve heart and blood vessel health by reducing harmful inflammation and oxidative stress.
- Drinking black tea regularly over many months or years seems especially helpful.
- However, very high amounts might not be better, so moderation is key.
- Overall, black tea is a healthy beverage choice that can help protect the heart.
Browse 4 studies·1 meta-analysis
ObservationalInverse association of tea and flavonoid intakes with incident myocardial infarction: the Rotterdam Study2002n=4,807
In 4,807 Rotterdam Study participants followed 5.6 years, tea drinkers consuming >375 mL/day had 43% lower incident MI risk (RR 0.57) than nondrinkers; flavonoid intake was inversely associated with fatal MI.
- Effect
- Benefit
- Population
- Adults
- Participants
- 4,807
- Ages
- ≥55
ObservationalTea consumption and mortality after acute myocardial infarction2002n=1,900
In 1,900 post-MI patients followed 3.8 years, moderate (OR-derived HR 0.69) and heavy (HR 0.61) tea drinkers had lower mortality than nondrinkers after adjusting for confounders.
- Effect
- Benefit
- Population
- Patients after acute myocardial infarction
- Participants
- 1,900
MetaDoes tea affect cardiovascular disease? A meta-analysis2001
A meta-analysis found each 3 cups/day increase in tea associated with 11% lower myocardial infarction risk, but geographic heterogeneity was substantial and publication bias could not be excluded.
- Effect
- Benefit
ObservationalCoffee and tea intake and the risk of myocardial infarction1999
In a case-control study, tea intake >1 cup/day was associated with 44% lower MI risk (OR 0.56) versus nondrinkers; coffee showed no significant association.
- Effect
- Benefit
N-Acetyl Cysteine (NAC)View supplement →
Consider purchase·★★★★★
How we scored this▸
- Giving N-acetylcysteine (NAC) early during a heart attack, sometimes together with other heart medications, may help limit heart muscle damage and improve heart function.
- One trial found that NAC plus nitrate therapy reduced the amount of damaged heart tissue in people having a certain type of heart attack (STEMI) treated with angioplasty.
- Other studies suggest NAC may reduce oxidative stress and support heart function after a heart attack.
- The evidence so far comes from small or early studies, so more research is needed.
Browse 4 studies
RCTEarly Use of N-acetylcysteine With Nitrate Therapy in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction Reduces Myocardial Infarct Size (the NACIAM Trial [N-acetylcysteine in Acute Myocardial Infarction])2017
The NACIAM trial found early IV NAC (29 g over 2 days) plus low-dose nitroglycerin significantly reduced MRI-assessed infarct size in STEMI patients undergoing PCI.
- Effect
- Benefit
- Duration
- 2 days
- Dose
- 29 g/day
- Population
- ALL patients
Clinical trialEffect of N-acetylcysteine on oxidative stress and ventricular function in patients with myocardial infarction2006n=15
A trial of 30 acute MI patients found 15 g NAC over 24 hours reduced malondialdehyde and improved left ventricular ejection fraction versus streptokinase alone.
- Effect
- Benefit
- Duration
- 24 hours
- Dose
- 15 g/day
- Population
- Patients with myocardial infarction
- Participants
- 15
RCTInfarct Size Limitation: acute N-acetylcysteine defense (ISLAND trial): preliminary analysis and report after the first 30 patients1996n=10
Preliminary ISLAND trial data in 30 anterior MI patients suggested NAC (100 mg/kg) after streptokinase may limit infarct size, but the study was underpowered.
- Effect
- Benefit
- Dose
- 100 mg/kg/day
- Population
- Patients with myocardial infarction
- Participants
- 10
RCTN-acetylcysteine in combination with nitroglycerin and streptokinase for the treatment of evolving acute myocardial infarction. Safety and biochemical effects1995n=20
An RCT of 27 evolving MI patients found NAC plus nitroglycerin and streptokinase reduced oxidative stress (MDA) and trended toward faster reperfusion versus control.
- Effect
- Benefit
- Dose
- 15 g/day
- Population
- Patients with acute myocardial infarction
- Participants
- 20
Coenzyme Q10View supplement →
Reconsider purchase·★★★★★
How we scored this▸
- Taking coenzyme Q10 by mouth may help people who have had a heart attack.
- One small study found that starting 60 mg twice a day within three days of the heart attack reduced the risk of further heart problems, including another heart attack or death, by about half after one month and one year.
Browse 1 study
RCTEffect of coenzyme Q10 on risk of atherosclerosis in patients with recent myocardial infarction2003n=73
A 12-month study found that 120 mg/day coenzyme Q10 (n = 73) significantly reduced total cardiac events (24.6% vs. 45.0%, p <0.02), non-fatal infarction risk (13.7% vs 25.3%, p <0.05) and cardiac deaths compared to patients taking vitamin B (n = 71). Patients taking coenzyme Q10 had reduced fatigue (40.8% to 6.8%) and increased levels of high density lipoprotein cholesterol (1.26 +/- 0.43 vs. 1.12 +/- 0.32 mmol/L). Both groups experienced reductions in total and LDL cholesterol. Roughly half of all patients in each group (n = 36 vs. 31) were receiving 10 mg/day Lovastatin.
- Effect
- Benefit
- Duration
- 12 months
- Dose
- 120 mg/day
- Population
- Heart failure patients
- Participants
- 73
L-CarnitineView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- Some research shows that taking L-carnitine by mouth or through a vein after a heart attack can reduce abnormal heartbeats, improve heart muscle health and function, and lower the risk of death.
- Typical doses include 2 to 4 grams daily by mouth for up to a year, or intravenous doses started soon after the heart attack.
- However, other studies found no clear benefits in heart function or survival.
- Differences in study methods and treatment plans might explain these mixed results.
Browse 10 studies·2 meta-analyses
MetaEffective dosing of L-carnitine in the secondary prevention of cardiovascular disease: a systematic review and meta-analysis2014n=3,108
A meta-analysis of 5 RCTs (3,108 patients) found L-carnitine after acute MI reduced all-cause mortality, with no significant dose differences between 2, 3, 4, and 6 g/day for mortality, heart failure, or reinfarction.
- Effect
- Benefit
- Dose
- 3 g/day
- Participants
- 3,108
MetaL-carnitine in the secondary prevention of cardiovascular disease: systematic review and meta-analysis2013n=3,629
A meta-analysis of 13 controlled trials (3,629 patients) found L-carnitine after acute MI reduced all-cause mortality by 27%, ventricular arrhythmias by 65%, and angina by 40% versus placebo.
- Effect
- Benefit
- Population
- Adults
- Participants
- 3,629
RCTMetabolic treatment with L-carnitine in acute anterior ST segment elevation myocardial infarction. A randomized controlled trial2006n=4,000
In the CEDIM 2 trial of 2,330 patients with anterior STEMI, L-carnitine reduced 5-day mortality (HR 0.61) but did not significantly reduce the 6-month composite of death and heart failure.
- Effect
- No Benefit
- Population
- Heart failure patients
- Participants
- 4,000
RCTDoes left ventricular function improve with L-carnitine after acute myocardial infarction?1999n=60
In 60 patients with acute anterior MI, 6 g/day IV L-carnitine for 7 days then 3 g/day oral for 3 months did not significantly improve left ventricular ejection fraction or end-systolic/diastolic volumes versus placebo.
- Effect
- No Benefit
- Duration
- 3 months
- Dose
- 6 g/day
- Population
- Adults
- Participants
- 60
- Avg age
- ~56
RCTA randomised, double-blind, placebo-controlled trial of L-carnitine in suspected acute myocardial infarction1996n=101
In 101 patients with suspected acute MI, oral L-carnitine 2 g/day for 28 days reduced infarct size, angina (17.6% vs 36.0%), heart failure (23.4% vs 36.0%), and total cardiac events (15.6% vs 26.0%) versus placebo.
- Effect
- Benefit
- Duration
- 28 days
- Dose
- 2 g/day
- Population
- Heart failure patients
- Participants
- 101
RCTControlled study on L-carnitine therapeutic efficacy in post-infarction1996n=160
In 160 post-MI patients, oral L-carnitine 4 g/day for 12 months reduced angina, improved lipid profile, and lowered mortality to 1.2% versus 12.5% in controls.
- Effect
- Benefit
- Duration
- 12 months
- Dose
- 4 g/day
- Population
- Adults
- Participants
- 160
- Ages
- 39–86
The effect of L-carnitine in the infarct size in one-month post-myocardial infarction cases.1996
A clinical study in post-MI patients reported that L-carnitine supplementation reduced infarct size and improved recovery one month after myocardial infarction.
- Effect
- Benefit
RCTEffects of L-carnitine administration on left ventricular remodeling after acute anterior myocardial infarction: the L-Carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) Trial1995n=472
In the CEDIM trial of 472 post-MI patients, L-carnitine 9 g/day IV then 6 g/day oral for 12 months significantly attenuated left ventricular dilation; death plus heart failure was 6% vs 9.6% with placebo.
- Effect
- Benefit
- Duration
- 12 months
- Dose
- 9 g/day
- Population
- Heart failure patients
- Participants
- 472
RCT[Anti-arrhythmia treatment using L-carnitine in acute myocardial infarct]1992n=12
In 20 acute MI patients, high-dose IV L-carnitine reduced high-grade ventricular premature beats on day 2 (4/12 vs 7/8 with placebo; p = 0.028), though 24-hour Holter differences were not significant.
- Effect
- Benefit
- Dose
- 3 g/day
- Population
- Athletes
- Participants
- 12
RCTHigh doses of L-carnitine in acute myocardial infarction: metabolic and antiarrhythmic effects1989n=56
In 56 acute MI patients, high-dose IV L-carnitine (100 mg/kg every 12 h) was studied for effects on urinary acylcarnitine excretion and early ventricular arrhythmias during the first 48 hours post-infarction.
- Dose
- 100 mg/day
- Population
- Athletes
- Participants
- 56
Green TeaView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- Some research shows that drinking green tea may be linked to a lower chance of having a heart attack, especially in people at high risk for heart disease.
- People who drink more than three cups of green tea a day had about half the odds of having had a heart attack compared to those who drink less than one cup daily, but this was mostly true for people who also eat fruits and vegetables regularly.
- Drinking 1 to 4 or more cups daily was associated with a 19% to 32% lower chance of heart attack compared to those drinking less than one cup.
- More studies are needed to confirm if green tea helps prevent heart attacks or lowers death risk after a heart attack.
Browse 3 studies·1 meta-analysis
ObservationalGreen Tea and Coffee Consumption and All-Cause Mortality Among Persons With and Without Stroke or Myocardial Infarction2021n=213
In the Japan Collaborative Cohort Study, green tea consumption was associated with lower all-cause mortality in stroke survivors but not clearly in MI survivors.
- Effect
- Benefit
- Participants
- 213
- Ages
- 40–79
ObservationalAssociations between Green Tea Consumption and Coffee Consumption and the Prevalence of Coronary Artery Disease2020n=166
In a cross-sectional study of 612 Japanese cardiac catheterization patients, higher green tea consumption was associated with lower coronary artery disease prevalence.
- Effect
- Benefit
- Population
- Adults
- Participants
- 166
MetaGreen tea consumption and risk of cardiovascular and ischemic related diseases: A meta-analysis2016n=259,267
A meta-analysis of observational studies (259,267 participants) linked higher green tea intake to lower risk of cardiovascular and ischemic disease.
- Effect
- Benefit
- Population
- Adults
- Participants
- 259,267
MelatoninView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- It is not clear whether taking melatonin by mouth or by injection right after a heart attack provides any benefit.
- A review of several small studies found that melatonin given with standard treatment may slightly reduce heart damage markers and modestly improve heart pumping function.
- However, one study in people with a type of heart attack called STEMI found that melatonin given through the vein and directly into the heart artery did not reduce heart muscle damage.
- Some findings suggest that the timing of melatonin use after symptoms begin may affect how well it works.
Browse 2 studies·1 meta-analysis
Systematic reviewMelatonin and Cardioprotection in Humans: A Systematic Review and Meta-Analysis of Randomized Controlled Trials2021
A meta-analysis found melatonin reduced markers of myocardial ischemia-reperfusion injury in human cardiac surgery and PCI studies versus placebo.
- Effect
- Benefit
- Population
- Patients undergoing myocardial revascularization
RCTUsefulness of Early Treatment With Melatonin to Reduce Infarct Size in Patients With ST-Segment Elevation Myocardial Infarction Receiving Percutaneous Coronary Intervention (Melatonin Adjunct in the Acute Myocardial Infarction Treated With Angioplasty Trial)2017n=146
In STEMI patients, earlier melatonin administration before primary PCI was associated with smaller infarct size in post hoc analysis of the Melatonin Adjunct trial.
- Effect
- Benefit
- Population
- STEMI patients
- Participants
- 146
CalciumView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- Taking calcium supplements does not prevent heart attacks.
- Some studies show that taking calcium without vitamin D might increase the chance of having a heart attack.
- Research looking at people’s diets found that eating more calcium from food is linked to a lower chance of heart attack.
- But taking calcium supplements at doses of 500 mg or more each day may increase heart attack risk by about 30 percent in people over 40.
- In fact, for every 69 people who take calcium supplements for five years, one more person may have a heart attack.
Browse 5 studies·4 meta-analyses
MetaAssociation of Vitamin D or Calcium Supplementation with Cardiovascular Outcomes and Mortality: A Meta-Analysis with Trial Sequential Analysis2021n=89,251
A meta-analysis of 23 trials (89,251 adults) found vitamin D and/or calcium supplementation did not meaningfully affect all-cause mortality, cardiovascular mortality, MI, or composite MACE.
- Effect
- No Benefit
- Population
- Adults
- Participants
- 89,251
- Ages
- 18+
MetaCalcium Supplements and Risk of Cardiovascular Disease: A Meta-Analysis of Clinical Trials2021n=28
A meta-analysis of 13 RCTs found calcium supplements raised CVD risk (RR 1.15) and CHD risk (RR 1.16), particularly in healthy postmenopausal women receiving supplements vs placebo.
- Effect
- No Benefit
- Dose
- 1000 mg/day
- Population
- Postmenopausal women
- Participants
- 28
MetaThe effects of calcium supplementation on verified coronary heart disease hospitalization and death in postmenopausal women: a collaborative meta-analysis of randomized controlled trials2015n=63,563
A meta-analysis of 18 RCTs (63,563 postmenopausal women) found calcium with or without vitamin D did not increase CHD events (RR 1.02) or all-cause mortality (RR 0.96) vs placebo.
- Effect
- No Benefit
- Population
- Postmenopausal women
- Participants
- 63,563
ObservationalAssociations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg)2012
In 23,980 EPIC-Heidelberg adults followed 11 years, moderate dietary/dairy calcium lowered MI risk but calcium supplements were associated with higher MI risk vs non-users.
- Effect
- No Benefit
- Population
- Adults
- Ages
- 35–64
MetaEffect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis2010n=8,151
A patient-level meta-analysis of 5 calcium RCTs (8,151 adults) found calcium supplements associated with 31% higher MI risk (HR 1.31); no increase in stroke or all-cause mortality.
- Effect
- No Benefit
- Dose
- 500 mg/day
- Population
- Adults
- Participants
- 8,151
- Ages
- 18–65
MultivitaminView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- It’s unclear if taking multivitamins helps prevent heart attacks.
- Studies show that taking multivitamins daily for several years does not lower the overall risk of heart attacks or death from heart attacks.
- However, one study found that people who had a previous heart attack and were not taking cholesterol-lowering statin drugs saw a 38% lower risk of more heart problems and death when they took high-dose multivitamins.
- Another large study found that people without heart disease who regularly took multivitamins had an 8% lower risk of heart attack.
- More research is needed to know who might benefit most.
Browse 3 studies
ObservationalMultivitamin/mineral supplementation and the risk of cardiovascular disease: a large prospective study using UK Biobank data2022n=465,278
A longitudinal study of 465,278 adults found multivitamin/mineral supplementation was not associated with lower cardiovascular disease risk.
- Effect
- No Benefit
- Population
- Adults
- Participants
- 465,278
RCTEffect of high-dose oral multivitamins and minerals in participants not treated with statins in the randomized Trial to Assess Chelation Therapy (TACT)2018
An RCT in participants not treated with statins found high-dose oral multivitamins and minerals did not significantly reduce cardiovascular events.
- Effect
- No Benefit
- Population
- Post-MI patients not on statins
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
Evidence visualised
Same ratings as above, aggregated so you can see coverage and imbalance.
| Supplement | DEX | Studies | Meta-analyses | Share |
|---|---|---|---|---|
| L-Carnitine | ★★★★★56% | 10 | 2 | 28% |
| Calcium | ★★★★★40% | 5 | 4 | 14% |
| Black Tea | ★★★★★68% | 4 | 1 | 11% |
| N-Acetyl Cysteine (NAC) | ★★★★★64% | 4 | 0 | 11% |
| Red Yeast Rice | ★★★★★72% | 4 | 1 | 11% |
| Green Tea | ★★★★★52% | 3 | 1 | 8% |
| Multivitamin | ★★★★★40% | 3 | 0 | 8% |
| Melatonin | ★★★★★48% | 2 | 1 | 6% |
| Coenzyme Q10 | ★★★★★56% | 1 | 0 | 3% |