Vitamins that may be helpful
L-carnitine is an amino acid needed to transport fats into the
mitochondria (the place in the cell where fats are turned into energy). Adequate energy
production is essential for normal heart function. Several studies using 1 gram of L-carnitine
two to three times per day showed an improvement in heart function and a reduction in symptoms
of angina.5 6 7
Coenzyme Q10 also contributes to the energy-making mechanisms of the heart. Angina
patients given 150 mg of coenzyme Q10 each day have experienced greater ability to exercise
without experiencing chest pain.8 This has been confirmed in independent
Low levels of antioxidant vitamins in the
blood, particularly vitamin E, are associated
with greater rates of angina.10 This is true even when smoking and other risk
factors for angina are taken into account. Early short-term studies using 300 IU
(International Units) per day of vitamin E could not find a beneficial action on
angina.11 A later study supplementing small amounts of vitamin E (50 IU per day)
for longer periods of time showed a minor benefit in people suffering angina.12
Those affected by variant angina have been found to have the greatest deficiency of vitamin E
compared with other angina patients.13
Nitroglycerin and similar drugs cause
dilation of arteries by interacting with nitric oxide, a potent stimulus for dilation. Nitric
oxide is made from arginine, a common amino
acid. Blood cells in people with angina are known to make insufficient nitric
oxide,14 which may in part be due to abnormalities of arginine metabolism. Taking 2
grams of arginine three times per day for as little as three days has improved the ability of
angina sufferers to exercise.15 Seven of ten people with severe angina improved
dramatically after taking 9 grams of arginine per day for three months in an uncontrolled
study.16 Detailed studies have investigated the mechanism of arginine and have
proven it operates by stimulating blood vessel dilation.17
N-acetyl cysteine (NAC) may improve the
effects of nitroglycerin in people with angina.18 People with unstable angina who
took 600 mg of NAC three times daily in combination with a nitroglycerin transdermal (skin)
patch for four months had significantly lower rates of subsequent heart attacks than did
people who used either therapy alone or placebo.19
Magnesium deficiency may be a contributing
factor for spasms that occur in coronary arteries, particularly in variant
angina.20 21 While studies have used injected magnesium to stop such
attacks effectively,22 23 it is unclear whether oral magnesium would be
effective in preventing or treating blood vessel spasms. One double-blind study of patients
with exercise-induced angina, however, showed that oral magnesium supplementation (365 mg
twice a day) for 6 months significantly reduced the incidence of exercise-induced chest pain,
compared with a placebo.24
In a controlled study, men with severe coronary heart disease were given an exercise test,
after which they took either 15 grams of
ribose or a placebo four times daily for three days. Compared with the initial test, men
taking ribose were able to exercise significantly longer before experiencing chest pain and
before abnormalities appeared on their electrocardiogram (ECG), but only the ECG changes were
significantly improved compared with those in the placebo group.25 Sports
supplement manufacturers recommend 1 to 10 grams per day of ribose, while heart disease
patients and people with rare enzyme deficiencies have been given up to 60 grams per day.
Bromelain has been reported in a
preliminary study to relieve angina. In that study, 600 people with cancer were receiving bromelain (400 to 1,000 mg per
day). Fourteen of those individuals had been suffering from angina. In all 14 cases, the
angina disappeared within 4 to 90 days after starting bromelain.26 However, as
there was no control group in the study, the possibility of a placebo effect cannot be ruled
out. Bromelain is known to prevent excessive stickiness of blood platelets,27 which
is believed to be one of the triggering factors for angina.
Fish oil, which contains the fatty acids
known as EPA and DHA, has been studied in the
treatment of angina. In some studies, enough fish oil to provide a total of about 3 grams of
EPA and 2 grams of DHA has reduced chest pain as well as the need for
nitroglycerin;28 other investigators could not confirm these findings.29
People who take fish oil may also need to take
vitamin E to protect the oil from undergoing potentially damaging oxidation in the
body.30 It is not known how much vitamin E is needed to prevent such oxidation; the
amount required would presumably depend on the amount of fish oil used. In one study, 300 IU
of vitamin E per day prevented oxidation damage in individuals taking 6 grams of fish oil per
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
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