Dietary Supplements in Adults Taking Cardiovascular Drugs [Internet]
Bibliographic record
Abstract
Background A substantial proportion of patients with cardiovascular diseases use dietary supplements in anticipation of benefit. This also poses risks of adverse events from supplement-drug interactions and nonadherence associated with polypharmacy. Objectives For supplements commonly used by patients with cardiovascular disease, we examined benefits, harms, and effects on cardiovascular drug pharmacokinetics of coadministration of dietary supplements with cardiovascular drugs. We also sought evidence regarding variability among subgroups, and of statistical interactions between supplements and drugs. Data Sources We searched MEDLINE®, Embase, the Cochrane Library, International Bibliographic Information on Dietary Supplements (IBIDS), and Allied and Complementary Medicine Database (AMED), as well as gray literature, from inception to September 2011. Study Selection Following a predefined protocol, two reviewers included experimental and observational studies comparing a supplement plus cardiovascular drug versus drug alone published in English or German; other languages were excluded due to concerns with study quality and applicability. Data Extraction One reviewer extracted data into a standardized electronic form, assessed study risk of bias, graded the strength of the body of evidence, and reported its applicability. Study risk of bias and strength of evidence regarding gradable outcomes were independently verified, as was a random 10 percent subset of all data. Data Synthesis Sixty-seven randomized controlled trials, two controlled clinical trials, and one observational study contributed evidence of limited validity in highly selected populations. Evidence was insufficient for all gradable clinical efficacy and harms outcomes (e.g., mortality, thrombotic events, serious adverse events) because there were few, small studies per supplement. One pragmatic trial in women showed no benefit from coadministering vitamin E with aspirin on a composite cardiovascular outcome. Evidence for most intermediate outcomes of efficacy was insufficient or of low strength and suggested no effect. Notable findings were incremental improvement of triglyceridemia with omega-3 fatty acid supplementation, stabilization of international normalized ratio with vitamin K added to warfarin therapy, and improved high-density lipoprotein cholesterol (HDL-C) with added garlic. Clinically nonsignificant or otherwise inconclusive changes were noted for pharmacokinetic outcomes. Limitations The evidence base principally consisted of underpowered short-term studies in selected populations, generally with moderate risk of bias. Conclusions Limitations of the evidence base precluded meaningful conclusions across most supplement-drug combinations. Low-strength evidence indicates benefits of omega-3 fatty acids, vitamin K, and garlic coadministration on specific intermediate outcomes. Evidence regarding harms was inconclusive. Care providers and researchers should query supplement use to improve care and to facilitate research regarding drug-supplement interactions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.018 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.010 | 0.011 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.040 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".