Omega-3 and Vitamin D May Reduce Heart Failure Complications

Data from a study1 published in April 2022 in JACC: Heart Failure reveals that people with Type 2 diabetes who used omega-3 supplements had a lower incidence of hospitalization with heart failure. Heart failure is a form of heart disease in which the heart experiences ventricular dysfunction.

The heart is separated into four chambers. The bottom two chambers called the ventricles, pump blood to the lungs or the body.2 When there is left ventricular failure, a person experiences fatigue and shortness of breath. With right ventricular failure a person may experience abdominal and peripheral fluid buildup.

Heart failure can affect one or both sides of the heart. Experts believe there are more than 15 million new diagnoses of heart failure globally each year.3 In the U.S., more than 600,000 new cases are diagnosed each year. Additionally, it's estimated that 10 times that number of Americans currently have heart failure.

Despite advances in drug therapy, the prognosis continues to remain poor. Individuals with severe heart failure have a mortality rate of up to 60% over one year and up to 30% mortality rate in mild to moderate failure.4 Heart failure develops as the ventricles become inefficient. This can happen from a variety of different factors that place excessive demand on the heart.

One factor that can lead to heart failure is long-term, uncontrolled high blood pressure or hormonal disorders such as hyperthyroidism. But, the primary cause of heart failure is coronary artery disease, which reduces the delivery of oxygen and nutrients to the heart muscle. Over time, this leads to impaired function.

There's also a relationship between chronic high blood pressure and coronary artery disease,5 which means that high blood pressure may have an effect on the development of heart failure through at least two pathways. The primary focus of the featured study was to evaluate whether an omega-3 supplement could reduce the risk of hospitalization for heart failure in participants with or without Type 2 diabetes.

Omega-3 Supplements Lower Risk of Heart Failure Admission

The data were gathered from the vitamin D and omega-3 trial (VITAL)6 that started in 2010. VITAL, the parent trial for this study, engaged 25,871 men and women to evaluate their dietary supplementation of vitamin D3 or omega-3 fatty acids and the impact it had on developing heart disease, stroke or cancer in people who did not have a history of these health conditions.

Participants took the supplements for a five-year intervention phase and researchers have continued with ongoing follow-up. The ancillary study began in 2014, in which the researchers assessed the role that race and Type 2 diabetes had on supplementation with omega-3 fatty acids.

There were four arms to the study.7 The first group received 2,000 international units (IU) per day of vitamin D3 and 1 gram per day of fish oil. The researchers compared results against three other groups who received either two placebos, or a placebo for vitamin D or fish oil. The primary outcome measure was new heart failure with hospitalization and the secondary outcome measure was recurrent hospitalization.

When the researchers evaluated the results8 they found that omega-3 supplements could reduce hospitalization rate for the first heart failure by 0.69 in participants who had Type 2 diabetes when compared to taking a placebo. They also found that omega-3 effectively reduced recurrent hospitalization in black participants. The results did not show a benefit for individuals who did not have Type 2 diabetes.

However, the researchers did not measure the omega-3 index for these individuals, thus it is difficult to determine if omega-3 levels were low in those who experienced the greatest benefit. There is evidence to suggest from past studies that individuals with Type 2 diabetes have significantly lower omega-3 indices than those who do not have Type 2 diabetes,9 suggesting increasing dietary intake may help prevent the condition.

Data10 also suggests that omega-3 supplementation may help lower inflammatory levels in people with diabetes, which also contributes to better heart health.11

Vitamin D Significant Factor in Heart Failure Outcomes

One arm of the study included participants who took only vitamin D and a placebo to replace omega-3 fatty acids. In this cohort, the researchers did not find that only vitamin D could help reduce hospitalization rates in people with heart failure. However, there is evidence from multiple past studies that vitamin D has a significant effect on protecting heart health.

Data from one study showed an anti-inflammatory effect from vitamin D in patients with congestive heart failure (CHF) suggesting it may serve as “a new anti-inflammatory agent for the future treatment of the disease. Our data provide evidence for the involvement of an impaired vitamin D–parathyroid hormone axis in the progression of CHF.”12

Evidence also suggests that vitamin D has an impact on mineral metabolism and myocardial dysfunction in patients with CHF. Researchers wrote in the American Journal of Cardiology that deficiency may be “a contributing factor in the pathogenesis of CHF.”13

Epidemiological studies have also provided strong support that vitamin D has cardioprotective effects14 and data also show that most patients with CHF have insufficient vitamin D levels, lower than 20 ng/mL.15 Researchers hypothesize that this may be related to the sedentary lifestyle of people with CHF and that insufficient levels contribute to the etiology of the disease.

More data indicated that low concentrations of vitamin D3 contribute to a poor prognosis in patients with heart failure, which may be related to inflammation.16 Furthermore, deficiency is highly prevalent, including in patients with heart failure and is “a significant predictor of reduced survival.”17

Researchers found that supplementing with vitamin D was independently associated with a reduction in mortality and that lower vitamin D levels were associated with high body mass index, diabetes, decreased calcium and hemoglobin levels and female gender.18

Sulfur and Magnesium: Two Crucial Nutrients for Heart Health

Sulfur has been a “forgotten” nutrient and you don't hear it mentioned very often. Yet it's very important for optimal body function and health. You get most of your sulfur from certain proteins in your diet, specifically, those that contain the amino acids methionine, cysteine, cystine, homocysteine, homocystine and taurine.19 Of these, the two most important are methionine and cysteine.

Neither of these is stored in the body, although glutathione is a key storage form of sulfur.20 Glutathione keeps many other antioxidants performing at peak levels and cysteine availability is thought to be a rate-limiting factor for glutathione synthesis.21 According to Stephanie Seneff, Ph.D., who has written several papers on sulfur,22,23,24 deficiency appears to play a role in a wide range of health problems and diseases, including heart disease.

In 2011, during an interview with Seneff,25 we discussed the influence that sulfur has on health and disease. She talked about the crucial connections between sulfur, cholesterol and vitamin D, suggesting that sensible sun exposure plays an important role in heart and cardiovascular health as it regulates not only vitamin D3 but also cholesterol sulfate in circulation.

Magnesium also plays a crucial role in high blood pressure and cardiovascular disease. Because serum magnesium is not a reflection of the total amount your body has available, experts believe that most cases of deficiency go undiagnosed.26 Additionally, because of a decrease of magnesium in the soil, medications and the number of processed foods eaten by the majority of people, many are at risk for deficiency.

Low levels of magnesium have been associated with Type 2 diabetes, high blood pressure, atherosclerotic vascular disease and sudden cardiac death.27 Some estimates are that nearly half the U.S. population eats less than the required amount of magnesium-rich food and that the prevalence and incidence of Type 2 diabetes rose while consumption of magnesium declined.

Magnesium is a natural calcium channel blocker that also increases nitric oxide production to relax the arteries and improve endothelial dysfunction.28 These functions reduce the risk of high blood pressure.29

Researchers have been studying the effect of magnesium on blood pressure for many years, but not always with the same results. One literature review of 44 human trials proposes that the dissimilar results are a function of study designs that are not uniformly matched between studies.30 When a uniform subset of the 44 studies was combined, the scientists found a strong effect of magnesium against high blood pressure.