Evidence-Based Complementary and Alternative Medicine / 2011 / Article / Tab 2

Review Article

Prevalence of Dietary Supplement Use in Patients with Proven or Suspected Cardiovascular Disease

Table 2

Comparison of results in studies of dietary supplement use in cardiac patients.

StudySettingClinical characteristics of sampleMean age of sample (SD; range)% femaleEthnic compositionPrevalence of supplement useAssociations between cardiovascular health, medication and supplement useReasons for usePhysician awareness

Ackman et al. (1999) [7]Hospital clinicDiagnosed congestive heart failure69 (−)37%Vitamins/minerals 59%
Nutritional supplements 17%
Health food/herbal products 38%
Use unrelated to CHF severity

Ai and Bolling (2002) [8]Cardiac clinicAdmitted for non-emergency/non-transplant surgery62.4 (36–84)44%Megavitamins 13%
Herbs and folk remedies 12%
Homeopathy 4%

Albert et al. (2009) [9]Hospitals and cardiology practicesDiagnosed heart failure69.6 (±13.1; 31–98)37%81% CaucasianMultivitamins/minerals 36%
Herbal therapy 12%
60% users take with prescription medication
Users more likely than nonusers to be under cardiologist care, have high cholesterol, diabetes but not significantly different ejection fractionPromote or maintain good health 45%–47%
Overall wellbeing 30%–42%
Energy/decrease fatigue 13%–25%

Amira and Okubadejo (2007) [10]Hypertension clinicDiagnosed hypertension55.1 (±12.4)60%Dietary supplements and herbs 97%Users had higher BMI (29 versus 27) but no different on blood pressure readings or duration of hypertension. Users no different on medication compliance and blood pressure control

Artz et al. (2006) [11]CommunityTaking nonprescription medication for cardiac reason69%Vitamin/mineral supplement 38%
Nonvitamin/mineral supplement 21%
36% vitamin/mineral supplement users and 16% other supplement users also take prescription cardiac medication

Barraco et al. (2005) [12]Hospital cardiology unitSuspected acute coronary syndrome66.2 (±13.4)39%79% Caucasian, 13% African-AmericanHerbals 5%
Anti-oxidants 4%
Minerals 3%

Buettner et al. (2007) [13] CommunitySelf-reported CAD/stroke or hypertension/high cholesterolCAD/stroke 66 (−)
hypertension/high cholesterol 58 (−)
46%/57%80%/78% White, 10%/10% Black, 3%/4% Mexican-AmericanMultivitamin 36%–40%
Minerals 9%–11%
Herbs 7%–10%
Other supplements 6%-7%
Of cardiac medication users:
Multivitamin 36%–40%
Minerals 25%–30%
Herbs 6%–9%
Other supplements 6%-7%
Of those taking medication for cardiovascular disease, 63% of those with previous CAD/stroke and 64% of those with hypertension/high cholesterol also used a supplement
CAD/stroke group more likely to use vitamin E, B vitamins and less likely to use fish oil; hypertension/high cholesterol group more likely to use garlic and ginseng

Chagan et al. (2005) [14]Hospital clinicDiagnosed cardiovascular diseaseusers 61.4 (±16.7)
nonusers 58.7 (±16.3)
40%50% White, 23% African-American, 15% Hispanic, 12% other“Biological-based therapy”: ever used 48%, used in last 12 months 42%No difference in users and nonusers in number of cardiovascular diseases. Average of 2 supplements and 7 prescription medications used per patient.
42 potential interactions identified, most commonly aspirin and vitamin E in 16 patients
18 of 42 supplements taken for a cardiac reason
75% users perceive safe, 70% effective, 45% believe cause fewer side effects than prescription medication
40% physicians unaware
67% of users were not asked by physicians about use

Dal Corso et al. (2007) [15]Outpatient heart failure clinicClinic patients65.7 (±10)11%Vitamins/minerals 21%
Herbal medicine 9%
Only 1 patient from 153 reduced and interrupted heart failure tablets39% did not report herbal use to doctors
44% did not report vitamin/mineral use

Gohar et al. (2008) [16]Outpatient hypertension clinicClinic patients57.3 (±16)46%64% White European, 25% South Asian, 11% Afro-CaribbeanAny biological-based therapy 29%
Vitamin supplements 20%
Dietary supplements 11%
Herbal medicine 7%

Krasuski et al. (2006) [17]Outpatient cardiology clinicReturning clinic patients66.2 (±11.6)32%Multivitamins 68%No difference between users and nonusers on use of aspirin, betablockers, ACE-inhibitors, statins or CoumadinGreater benefit than prescription 15%, safer than prescription 45%, no interactions 47%50% did not inform cardiologists

Liu et al. (2000) [18]Cardiothoracic surgery clinicPatients attending clinic41% aged 40–65,
51% aged over 65
28%76% White, 7% African American, 6% Hispanic, 6% Native AmericanVitamins 54%
Herbs 10%
Homeopathy 3%

Pharand et al. (2003) [19]Hospital ward, outpatient clinic and emergency roomDiagnosed with CHF or CAD for at least 6 months66 (40% over 70)41%Multivitamin/mineral 23%
vitamin/mineral 38%
Herbal product 17%

Shafiq et al. (2003) [20]Hospital hypertension clinicPatients attending clinic71% aged over 50,
26% aged 36–50,
3% aged 18–25
26%Ayurveda 57%
Herbal medicine 14%
Homeopathy 8%
Adverse reactions of conventional therapy 59%
Recommended by family/friends 62%
5% informed
doctors about CAM

Stys et al. (2004) [21]Preventive cardiology clinicPatients attending clinic61 (±14)28%Vitamins 53%
Herbs 21%
1 or more supplements 57% Average of 3 supplements per user
Users more likely to have established CAD, family history of premature CAD, higher total cholesterol, higher HDL and use statins
Users and nonusers have similar blood pressure and HbA1c levels

Wong et al. (2003) [22]Warfarin clinicPatients attending clinicUsers 56.5 (±12.4)
Nonusers 56.4 (±11.7)
59%Herbal medicine 26%INR for users lower than for nonusers
No difference between herbal users and nonusers in indication for Warfarin, duration of Warfarin therapy or Warfarin dosage

Wood et al. (2003) [23]Registry of patients with cardiovascular diseasePreviously hospitalised with ischaemic heart disease, CHF or AF64.3 (±11.9)35%Megadose vitamins 35%
Herbal supplements 32%
Non-herbal supplements 22%
Of 24 patients taking warfarin, amiodarone, sotalol, or digoxin, 50% also used vitamin, 36% herbal, 36% non-herbal supplementPotential improvement in condition 57%, proven benefit 28%, dissatisfied with conventional treatment 17%

Yeh et al. (2006) [6]CommunitySelf-reported cardiovascular disease35% aged 65 and over; 31% aged 50–6453%82% White, 13% Black, 5% otherHigh-dose vitamins 3%
Herbal therapies 18%
Similar rates of vitamin and herbal use in those with and without cardiovascular disease80% herbal users perceived herbs to be helpful56% did not disclose herbal use

Yilmaz et al. (2007) [24]Outpatient cardiology clinicAdmitted to clinicmales 54.7 (±13.3),
females 56.2 (±14.7)
46%Herbals 39%
Of users: 55% used daily with average duration of 39 months (±70 months)
Users and nonusers were similar on diabetes, smoking, prior MI and prior PCI19% used for hypertension, 23% for high cholesterol92% did not inform physicians

Zick et al. (2005) [25]Heart failure clinicDiagnosed congestive heart failure57 (±10)33%Any supplement 33%82% used supplement for cardiac problem: 62% for CHF, 13% angina, 6% for hypertension

Note: —: not reported, NA: not applicable, Study examined CAD/stroke and hypertension/hypercholesterolaemia groups separately and 2 figures are presented, one for each group.