Heart disease is a leading killer in the United States, Europe, and Asia. Unfortunately, as more countries adopt the Western lifestyle in place of their ancestral diets, heart disease will continue to progress. In the United States, alone, deaths due to heart and vascular disease unnecessarily kill almost 1 million people every year. High blood pressure is one of the leading risk factors for heart disease—more than 1 billion of the world’s 7.6 billion people have high blood pressure.

Chest pain is a primary reason a person visits the emergency room. After graduating from medical school, I was frequently asked why I went into Primary Care, Family Medicine to be specific.  The main reason was my interest in preventive medicine. I would always say, “I would rather help patients prevent a heart attack than trying to treat one after it already happened”. I am confident that I am on the right path.

Consuming a heart-healthy diet, not smoking, and participating in routine exercise are the three of the most important things one can do to prevent heart disease. These three things are more important than any doctor-prescribed medication ever made.

Risk Factors for heart disease

  • High blood pressure – makes the heart work harder than it's designed to
  • Smoking – causes blood vessel damage and promotes clogged arteries
  • Diabetes – causes blood vessel oxidative damage
  • Obesity – places extra stress on the heart
  • Elevated homocysteine – causes oxidative damage to blood vessels
  • Elevated C-reactive protein, a marker of inflammation (Learn more about inflammation)
  • Family history of heart disease  – healthy living can reduce this risk
  • High cholesterol – contributes to clogged arteries
  • Elevated LDL (bad cholesterol) – contributes to clogged arteries
  • Elevated triglycerides – contributes to clogged arteries
  • Elevated Lp(a) in blood – genetic risk factor
  • Diet low in fruits and vegetables – person lacks antioxidants needed for protection
  • Diet high in animal-based foods – hormones and chemicals in animal products increase risk
  • Sleep apnea/lack of sleep – puts stress on the heart
  • Chronic stress – elevates cortisol levels, which promotes heart disease and hardening of the arteries
  • Depression/anxiety –  elevates cortisol levels, which promotes heart disease
  • Unresolved conflict – elevates cortisol levels, which promotes heart disease
  • Feelings of guilt  – elevates cortisol levels, which promotes heart disease
  • Diagonal earlobe crease – genetic risk factor
  • Male pattern baldness –  genetic risk factor

The more risk factors a person has, the higher one’s risk. The presence of a few risk factors does not mean a person will definitely have a heart attack or stroke. Therefore, reducing as many risk factors as possible is very important to reduce risk of heart disease, heart attack, stroke and ultimately, death.

Medications can help reduce risk factors

Modern medicine has a few tools in the “doctor toolbox,” which can be helpful in reducing risk factors. In those who are at risk, medicine can play a very important role, especially when diet, lifestyle, and supplements are not sufficient. Unfortunately, daily medication use is the only measure many will commit to. This is a dangerous strategy, however. Doctors use blood pressure-lowering medications and cholesterol-lowering medications to try and reduce risk, but living a healthier lifestyle should also be part of the equation.

Foods for a healthy heart

Choosing the right food to consume is one of the most important ways to prevent heart disease and lower inflammation in the arteries and heart. The heart health benefits of a Mediterranean diet have been proven by multiple studies. A 2013 study in the New England Journal of Medicine, for instance, concluded, “Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events.”. 

A diet rich in fruits, vegetables, and beans is key, but a variety of other foods can help:

  • Nuts – unsalted brazil nuts, pine nuts, almonds, cashews and walnuts.  Nuts are rich in linoleic acid, a unique, healthy anti-inflammatory omega-6 fatty acid
  • Seeds – unsalted pumpkin, chia, and sunflower seeds
  • Fruits – organic fresh fruits. 4 servings per day, minimum
  • Dietary lignans – found in flaxseedgreen tea and strawberries
  • Leafy greens – collard greens, spinach and kale, to name a few. 6 servings/day
  • Soy products – organic tofu, edamame, miso, tempeh
  • Fish – eat wild (not farm-raised) fish, but no more than once per week due to possible mercury contamination (low-mercury fish options include trout, whitefish, salmon, anchovies, and many more).
  • Red meat and poultry – eat only grass-fed and hormone-free meat and free-range poultry
  • Extra rich olive oil – high in oleic acid, an omega-9 fatty acid. Only cook with olive oil at low and medium temperatures
  • Coconut oil – ideal for cooking at high temperatures and healthier than canola oil
  • Light sesame oil – acceptable for cooking at high temperatures, has various health benefits
  • Green tea – good for the heart.
  • Purified water – avoid sugary drinks

Supplements for heart health

Taking supplements is a part of a regimen that many follow to help improve cardiovascular health.

Vitamin C

Vitamin C, or ascorbic acid, is a crucial vitamin, and it plays a significant role in collagen, the main component of arteries. According to a 2009 study in The American Journal of Clinical Nutrition, which studied people from the United States, more than 7 percent of people six years of age and older were vitamin C deficient based on blood tests. More than half surveyed consumed suboptimal amounts in their diet. Vitamin C levels are also lower in those who smoke tobacco. Studies show a diet high in foods containing vitamin C is good for the heart. A 2017 study in the Journal of Nutritional Biochemistry demonstrated that rose hips, which are rich in vitamin C, helped prevent atherosclerosis, the precursor to heart disease.

Vitamin D

Vitamin D deficiency is a risk factor for heart disease according to a 2013 study in Nutrients.  A Harvard University study showed that people with higher levels of vitamin D in their blood had 80 percent less risk of heart attacks when compared to those with the lowest levels. A study from Germany showed those with lower vitamin D blood levels were five times more likely to die from sudden cardiac death when compared to those with higher vitamin D blood levels.   

Additionally, a 2017 study concluded, “… the levels of blood vitamin D were significantly lower in heart attack patients, especially in America and Asia, and sufficient blood vitamin D levels might protect against the occurrence of heart attacks.” Suggested Dose: Vitamin D 2,000-5,000 IU daily, for life.

Omega-3 Fish Oil

Omega-3 essential fatty acids consist primarily of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). A 2014 study in Nutrition Journal showed that the majority of Americans do not consume enough omega-3 essential oils. They can be found in a variety of food sources, including fish (mackerel, cod and salmon are among the richest), walnutschia seedsflax seedshemp seeds, and natto.

A 2017 study in Future Science showed omega-3 oils can reduce the inflammation leading to heart disease. A 2017 study in Atherosclerosis  showed that higher levels of omega-3 in the blood could reduce death from heart disease by 30 percent.

Drug companies manufacture and sell patients a pharmaceutical grade fish oil, which has been shown to lower triglyceride levels by 50 percent. However, non-pharmaceutical prescriptions do the same at a fraction of the cost. Suggested dose: Omega-3 fish oil 1,200 mg daily or 3,600 mg daily.

Krill oil

Krill oil is taken by many as an alternative to omega-3 fish oil. Krill oil can help reduce risk factors for heart disease. Krill oil can lower Triglycerides, a type of fat that circulates in the blood.

Krill oil also lowers LDL (bad) cholesterol, a leading risk factor for heart disease. A 2017 study of 662 patients in Nutrition Reviews showed LDL could be reduced in those who consumed krill oil. Other studies have shown consistent findings. Suggested dose: Krill oil 500 mg to 2,000 mg daily (an alternative to fish oil)

Coenzyme Q10

Coenzyme Q10 (CoQ10) plays an important role in the health of mitochondria, the powerhouses of our cells. Since the heart is the most active of all organs, it produces and requires the most CoQ10 in order to meet its metabolic demands. However, in those with cardiac disease, higher levels of CoQ10 are required.

A 2017 study, which reviewed 14 other studies, showed an important benefit of CoQ10—the results showed those who took CoQ10 were 31 percent less likely to die from complications of congestive heart failure.  

A 2014 study in Medical Science Monitor showed that 50 mg of Coenzyme Q10, when taken twice per day, could be beneficial in reducing muscle aches caused by prescription statin drugs.  Other studies have been conflicting. Coenzyme Q10 may also reduce bad (LDL) cholesterol, triglycerides, and LP(a) blood levels. Suggested dose:  CoQ10 100 mg three times per day or 300 mg once daily.

Red Yeast Rice (RYR)

A 2008 study showed that RYR, when combined with lifestyle changes and omega-3 fish oil supplements, LDL (bad) cholesterol could be lowered by up to 42 percent—a result similar to drugs like atorvastatin (Lipitor).

Another 2008 study from China reported in the American Journal of Cardiology, included nearly 5,000 people who all took Red Yeast Rice for almost 5 years. The researchers concluded that longer-term therapy with RYR significantly reduce recurrence of heart attacks, prevented new heart attacks, and lowered the risk of dying by 33%. The researchers stated that RYR was safe and well tolerated.

A 2015 study showed similar findings, leading researchers to conclude “…RYR might be a safe and effective treatment option for dyslipidemia (high cholesterol) and cardiovascular risk reduction in statin-intolerant patients”.  In other words, they concluded that RYR is a good alternative in patients who could not tolerate cholesterol-lowering statin drugs.


Spirulina, a potent antioxidant, provides another weapon in the cholesterol-lowering arsenal.  A 2008 study of the Mexican population showed spirulina could lower cholesterol values and blood pressure in test subjects.

A more recent study from 2014 showed that 1 gram of spirulina taken daily could lower total cholesterol by 16 percent when taken for 12 weeks.  It also lowered triglycerides and LDL (bad) cholesterol.  A 2015 study confirmed spirulina’s cholesterol-lowering benefits. Taking spirulina in addition to prescription lowering medications is acceptable.

Spirulina can be used as a supplement, and many manufacturers sell it in a pill or powder form. The powder formulation is best when adding to foods.  If using spirulina powder, I recommend adding it to a smoothie.

Other Heart-Healthy Supplements

  • Magnesium chelate – helps the heart and arteries to relax
  • L-carnitine – helps optimize mitochondrial function, important in those with congestive heart disease
  • L-Arginine – an amino acid which is helpful for angina and congestive heart
  • Folic Acid or methyl-folate- helps lower homocysteine, a risk for heart disease
  • D-ribose – theoretically helpful in those with heart failure
  • Niacin –  helps increase good cholesterol (HDL). Facial flushing is a common side effect
  • Vitamin B12 or methylcobalamin – helps lower homocysteine, a risk for heart disease
  • Essential oils – chamomile, wintergreen, peppermint, and lavender. Can be diffused in the air or taken internally. Helps reduce stress, which can negatively affect the heart.

Live a heart-healthy lifestyle

Heart disease is a leading killer of people all over the world. Tobacco cessation, a healthy diet high in fruits and vegetables and routine exercise can prevent premature death from heart disease in those who choose healthier lifestyle options.  Walking at least 10,000 steps per day is a good goal for most.  A good night sleep also plays an important role in preventing heart disease. Frequently,  people chose vitamins and supplements to help further control risk factors and improve outcomes, especially when dietary and lifestyle changes are not sufficient.


  1. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Ramón Estruch, M.D., Ph.D., Emilio Ros, M.D., Ph.D., et. Al N Engl J Med 2013; 368:1279-1290April 4, 2013DOI: 10.1056/NEJMoa1200303
  2. Journal of The American College of Nutrition 2017, Vol 36. Mp 6. 434-441  Association between Urinary Phytoestrogens and CRP in the Continuous National Health and Nutrition Examination Survey
  3. Am J Clin Nutr. 2009 Nov;90(5):1252-63. doi: 10.3945/ajcn.2008.27016. Epub 2009 Aug 12.
  4. Heart Advis. 2015 Oct;18(10):10.
  5. J Nutr Biochem. 2017 Jun;44:52-59. doi: 10.1016/j.jnutbio.2017.02.017. Epub 2017 Mar 21.
  6. Kienreich K, Tomaschitz A, Verheyen N, et al. Vitamin D and Cardiovascular Disease. Nutrients. 2013;5(8):3005-3021. doi:10.3390/nu5083005.
  7. Papanikolaou Y, Brooks J, Reider C, Fulgoni VL. U.S. adults are not meeting recommended levels for fish and omega-3 fatty acid intake: results of an analysis using observational data from NHANES 2003–2008. Nutrition Journal. 2014;13:31. doi:10.1186/1475-2891-13-31.
  8. Bäck M. Omega-3 fatty acids in atherosclerosis and coronary artery disease. Future Science OA. 2017;3(4):FSO236. doi:10.4155/fsoa-2017-0067.
  9. Atherosclerosis. 2017 Jul;262:51-54. doi: 10.1016/j.atherosclerosis.2017.05.007. Epub 2017 May 6.
  10. Sorin Ursoniu, Amirhossein Sahebkar, et. al.  for the Lipid and Blood Pressure Meta-analysis Collaboration Group; Lipid-modifying effects of krill oil in humans: systematic review and meta-analysis of randomized controlled trials, Nutrition Reviews, Volume 75, Issue 5, 1 May 2017, Pages 361–373, https://doi.org/10.1093/nutrit/nuw063
  11. Lei L, Liu Y. Efficacy of coenzyme Q10 in patients with cardiac failure: a meta-analysis of clinical trials. BMC Cardiovascular Disorders. 2017;17:196. doi:10.1186/s12872-017-0628-9.
  12. Skarlovnik A, Janić M, Lunder M, Turk M, Šabovič M. Coenzyme Q10 Supplementation Decreases Statin-Related Mild-to-Moderate Muscle Symptoms: A Randomized Clinical Study. Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 2014;20:2183-2188. doi:10.12659/MSM.890777.
  13. Suksomboon, N., Poolsup, N. and Juanak, N. (2015), Effects of coenzyme Q supplementation on metabolic profile in diabetes: a systematic review and meta-analysis. J Clin Pharm Ther, 40: 413–418. doi:10.1111/jcpt.12280
  14. Amirhossein Sahebkar, Luis E. Simental-Mendía, Claudia Stefanutti, Matteo Pirro, Supplementation with coenzyme Q10 reduces plasma lipoprotein(a) concentrations but not other lipid indices: A systematic review and meta-analysis, Pharmacological Research, 2016, 105, 198
  15. Simvastatin vs Therapeutic Lifestyle Changes and Supplements: Randomized Primary Prevention Trial Becker, David J. et al.  Mayo Clinic Proceedings , Volume 83 , Issue 7 , 758 - 764
  16. Lipids Health Dis. 2007 Nov 26;6:33.
  17. Sci Food Agric. 2014 Feb;94(3):432-7. doi: 10.1002/jsfa.6261. Epub 2013 Jul 10.
  18. Biomed Res Int. 2015;2015:486120. doi: 10.1155/2015/486120. Epub 2015 Jan 22.