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Dietary Supplements in Adults Taking Cardiovascular Drugs [Internet]

Dietary Supplements in Adults Taking Cardiovascular Drugs [Internet]

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US)

Version: April 2012


Vascular disease is a preventable condition that is the leading contributor to mortality in the United States, and second place in Canada after cancer. Vascular disease includes peripheral vascular disease evident in hypertension; cardiovascular disease such as angina pectoris, myocardial infarction and heart failure; and cerebrovascular disease such as transient ischemic attack (TIA) and stroke.

Executive Summary

The American Heart Association estimates that more than 81 million American adults (one-third of all adults) have at least one form of cardiovascular disease (CVD). CVD is broadly defined to include all the disorders of the arterial system, including the heart and coronary arteries, the arterial supply to the brain, and the peripheral arterial system. CVD manifests typically as hypertension, angina, myocardial infarction (MI), heart failure, stroke and transient ischemic attacks (TIAs), and intermittent claudication or blockage. While there has been progress in the control of CVD, it demands huge investments from the health care system, and represents great burdens and lost opportunities for individuals, families, and society overall.


Overall, 33,224 records were identified by searches of databases after removing all duplicates. The PRISMA diagram in Figure 2 depicts the flow of retrieved records through the phases of screening and inclusion.


Billions of dollars are spent annually in the United States on complementary and alternative medicine (CAM), and a large portion of this expenditure is spent directly on dietary supplements. Given the high prevalence of cardiovascular disease and frequency of polypharmacy in this population, the risk of drug-supplement interactions deserves serious consideration primarily to avoid potential harm; either as a result of decreasing clinical effect of drugs, or increased toxicity. There is also a real possibility of drug interactions leading to synergistic effects and positive clinical outcomes. A more thorough understanding and knowledge of potential drug-supplement interactions is important to provide specific evidence-based recommendations that do not call for universal avoidance of all dietary supplements in conjunction with pharmaceutical treatments to treat or to prevent cardiovascular disease. Without such precision, recommendations may result in the avoidance of potentially beneficial supplements or more importantly might be more readily ignored, leading to greater likelihood for harm through negative interaction.

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