Table 8.
Level of evidence and classes of recommendations for nutritional supplements.
| Supplement | Recommendations | Strength | Level of evidence |
|---|---|---|---|
| Sodium | It is recommended to limit salt intake to 2.3 g sodium (6 g/day salt). It is recommended to substitute salt with other spices and herbs. It is recommended to use food labels for information of sodium content in foods. | I | B |
| It is recommended to reduce as much as possible the use of industrial pre-prepared food, as well as salted snacks and vegetables. | I | B | |
| Efforts should be put into reducing sodium content in industrial foods through legislation. | I | B | |
| Omega-3 | |||
| General population (primary prevention) | Eat a variety of fish, preferably fat, at least twice a week. Each fish portion (55–85 g) should supply at least 500–1000 mg EPA + DHA. | II a | A |
| It is recommended not to exceed 200 g daily of fish that contain a high level of mercury (such as mackerel, sword fish or shark) or 400 g of other fish. Removing the skin off the fish before preparation can reduce the amount of contaminants. | I | B | |
| For children and pregnant women it is recommended to avoid eating fish with potentially high levels of contaminants. | III | B | |
| Omega-3 supplements containing 1 g of EPA + DHA. | II b | B | |
| People with proven CVD | Individuals who do not regularly consume fish might consider ingesting omega-3 supplements containing 1 g of EPA + DHA. | II b | A |
| Hypertriglyceridemia | 2–6 g of omega 3 daily can reduce serum TG levels. However, no long-term studies have been conducted to evaluate the clinical outcome in these individuals | II b | B |
| Phytosterols | Plant phytosterols can be considered for the reduction of LDL cholesterol in mildly hypercholesterolemic individuals at intermediate to high risk who do not wish to use, or cannot tolerate, other cholesterol-lowering medications. | II a | A |
| Plant phytosterols can be used in combination with statins for additional reduction of LDL cholesterol. | II b | A | |
| Antioxidant-vitamin supplementation | Based on data from intervention controlled trials, it is not recommended to use antioxidant vitamins supplementation to prevent or treat CVD. | III | A |
| Vitamin D | At this point there is no recommendation for screening blood vitamin D levels for CVD prevention. | III | C |
| Correction of low vitamin D levels may reduce CVD morbidity and mortality. | II b | B | |
| It is not recommended to use vitamin D supplements in order to prevent CVD in people with normal vitamin D levels. | III | C | |
| CoQ10 | The long term effect of CoQ10 supplementation on Patients with CHF and/or treated with statins is yet to be proven. Therefore it is not recommended to use CoQ10 supplementation in these patients. | III | B |
| In the short term Co Q10 supplementation results in mild blood pressure reduction and mild increase in ejection fraction in CHF patients. | II b | B | |
| Magnesium (Mg) | At this point there is no recommendation for screening blood magnesium levels for CVD prevention in general population. | III | C |
| Correction of low magnesium levels may reduce CVD morbidity and mortality, particularly after myocardial infarction. | II a | A | |
| It is not recommended to use magnesium supplements in order to prevent CVD in people with normal magnesium levels. | III | A | |
| Folate, vitamin B6, vitamin B12 | Low serum folate and/or vitamin B12 concentrations should be corrected to prevent neurologic and hematologic diseases. Women of childbearing age should consume 400 µg/day of folic acid supplementation for the prevention of neural tube defects of the fetus. |
I | A |
| Folic acid and vitamin B supplements are not effective for primary, nor for secondary prevention of CVD and stroke. | III | A |