Table DEvidence for the gradable intermediate efficacy outcomes—Key Question 2

Outcome MeasureDietary Supplement + CV Drug (s)Conclusion, Effect EstimateApplicability
Low strength of evidence
Lipid profileCo-Q10 (200 mg/day) + FenofibratesNo difference for HDL-C (1 study)
MD,1.55 mg/dL (95% CI, −6.78 to 3.68)
Mean age: 53 years
Mixed gender
High CHD risk
12 weeks treatment
Lipid profileGarlic (4 g/day) + NitratesIn favor of combination for HDL-C (1 study)
MD, 8.40 mg/dL (95% CI, 1.91 to 14.89)
Unknown age, gender
High CHD risk
12 weeks treatment
Lipid profileGarlic (4 g/day) + WarfarinIn favor of combination for HDL-C (1 study) MD, 4.50 mg/dL (95% CI, 0.19 to 8.81)Mean age: 56 years
Mixed gender
High CHD risk
12 weeks treatment
Lipid profileOmega-3 fatty acids (3.6 g/day omega-3 to 9.2 g/day fish oil) + StatinsIn favor of combination:
TG (2 studies pooled)
MD, −74.95 mg/dL (95% CI, −95.80 to −54.10)
No difference for:
HDL-C (7 studies pooled)
MD, 1.70 mg/dL (95% CI, −1.52 to 4.92)
LDL-C (6 studies pooled)
MD, −1.06 mg/dL (95% CI, −5.28 to 3.16)
Achieving LDL-C and HDL-C targets (1 study)
RR, 0.93 (95% CI, 0.84 to 1.03) and 1.00 (95% CI, 0.90 to 1.10), respectively
Mean age: 45–63 years
Mixed or unclear CHD risk
Mixed gender
Up to 25 weeks treatment
Lipid profileOmega-3 fatty acids (1.8 g/day) + Calcium channel blockers + AspirinIn favor of combination for TG (2 studies not pooled)
−81.00 mg/dL (95% CI, −125.30 to −36.70) and −54.00 mg/dL (95% CI, −94.1 to −13.90)
Mean age: 57 years
85% males
High CHD risk
4–6 weeks treatment
Lipid profileOmega-3 fatty acids (3.2 g/day) + Calcium channel blockers + Aspirin + DipyridamoleIn favor of CV drug alone for LDL-C (1 study)
21.00 mg/dL (95% CI, 3.30 to 38.70)
In favor of combination for TG (1 study)
−81.0 mg/dL (95% CI, −125.30 to −36.70)
Mean age: 56 years
100% males
High CHD risk
Up to 12 weeks treatment
Lipid profileVitamin E (900 mg/day) + NifedipineIn favor of combination for LDL-C (1 study)
MD, −39.83 mg/dL (95% CI, −71.29 to −8.37)
In favor of combination for TG (1 study)
MD, −23.91 mg/dL (95% CI, −35.89 to −11.93)
Elderly
Mixed gender
High CHD risk
12 weeks treatment
Blood pressureOmega-3 fatty acids (2 g/day) + StatinsIn favor of combination for SBP (1 study)
MD, −8.50 mmHg (95% CI, −16.33 to −0.66)
No difference for DBP (1 study)
MD, 0.20 mmHg (95% CI, −4.76 to 5.16)
Mean age among groups: 44–53 years
Mixed gender
Mixed CHD risk
5 weeks treatment
Blood pressureOmega-3 fatty acids (4 g/day fish oil) + StatinsMedian reductions from baseline in SBP (1 study) (−5.00 vs. 0.30 mmHg, p = 0.008) and DBP (−3.30 vs. −1.80 mmHg, p = 0.045)Mean age: 58 years
Mixed gender
Unclear CHD risk
6 weeks treatment
Blood pressureOmega-3 fatty acids (3–5 g/day) + ACE inhibitorsNo difference between groups for SBP (2 studies pooled):
MD, −0.51 mm/Hg (95% CI, −10.59 to 9.57) or for
DBP: MD, −1.75 mm/Hg (95% CI, −5.98 to 2.48)
Mean age: 40–55 years
Mixed gender
Unclear CHD risk
6–25 weeks treatment
INRVitamin K (150 μg/day) + Anticoagulants
In favor of combination (1 study)
RR for % of time in therapeutic range, 9.0% (95% CI, 1.42 to 16.57)
RR for n achieving stable INR, 2.56 (95% CI, 1.24 to 5.28)
Elderly (age range 58–85 years)
Mixed gender
Unclear CHD risk
25 weeks treatment
Insufficient strength of evidence
Conclusion: Inconclusive (type II error or inconsistent direction of estimates)
Lipid profileAll lipid(s):
Coenzyme Q10 (100 mg/day) + Statins; Coenzyme Q10 (200 mg/day) + Fenofibrate;
Garlic (4 g/day) + Warfarin; Garlic (4 mL/day) + Statins/Aspirin
Gingko biloba (120 mg/day) + Antiplatelets
Magnesium (365 mg/day) + Hydrochlorothiazide
Omega-3 fatty acids (4 g/day) + Fenofibrate; Omega-3 fatty acids (3 g/day) + Calcium channel blockers; Omega-3 fatty acids (4 g/day) + Niacin/Aspirin; Omega-3 fatty acids (10 g/day) + Aspirin; Omega-3 fatty acids + Statins
Vitamin E (0.6g/day) + Gemfibrozil; Vitamin E (100 mg/day, 100 IU/day) + Statins
Only specific lipid(s):
TG: Niacin (250 mg/day) + Propranolol
Garlic (4 g/day) + Nitrates
Omega-3 fatty acids + ACE inhibitors
Magnesium (4.5 g/day) + Hydrochlorothiazide
Vitamin E (900 mg/day) + Antiplatelet agents
LDL-C: Omega-3 fatty acids (1.8 g/day) + Calcium channel blockers + Aspirin
HDL-C: Vitamin E (900 mg/day) + Nifedipine
Omega-3 fatty acids (1.8 g/day) + Calcium channel blockers + Aspirin; Omega-3 fatty acids (3.2 g/day) + Calcium channel blockers + Aspirin + Dipyridamole
Blood pressureCoenzyme Q10 (200 mg/day) + Fenofibrates (systolic blood pressure)
Echinacea (5 g/day) + Warfarin
Garlic (4 g/day) + Warfarin
Gingko biloba (120 mg/day) + Aspirin; G. biloba (300 mg/day) + Antiplatelet thienopyridines; G. biloba (120 mg/day) + Cilostazol
Magnesium (4.5 g/day) + Hydrochlorothiazide; Magnesium (3.65 g/day) + Beta-adrenergic antagonists
Omega-3 fatty acids (10 g/day) + Aspirin; Omega-3 fatty acids (4 g/day) + Beta-blockers
Vitamin E (600 mg/day) + Furosemide; Vitamin E (900 mg/day) + Nifedipine; Vitamin E (600 mg/d) + Gemfibrozil
INREchinacea (5 g/day) + Warfarin
Garlic (4 g/day) + Warfarin
Ginger (3.6 g/day) + Warfarin
Gingko biloba (2 g/day) + Warfarin
Ginseng (1.5–2 g/day) + Warfarin
Omega-3 fatty acids (4 g/day) + Warfarin
QT prolongationVitamin E (400 IU/day) + Statins

Note: CHD = coronary heart disease; CI = confidence interval; CV = cardiovascular; DBP = diastolic blood pressure; HDL–C = high-density lipoprotein-cholesterol; INR = international normalized ratio; LDL-C = low-density lipoprotein-cholesterol; MD = mean difference; RR = relative risk; SBP = systolic blood pressure; TG = triglycerides.

From: Executive Summary

Cover of Dietary Supplements in Adults Taking Cardiovascular Drugs
Dietary Supplements in Adults Taking Cardiovascular Drugs [Internet].
Comparative Effectiveness Reviews, No. 51.
Seely D, Kanji S, Yazdi F, et al.

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