Comparative Efficacy of Nutraceuticals on Endothelial Function: A Systematic Review and Network Meta-Analysis
Clinical Snapshot
PICO Framework
| P — Population | Individuals with cardiovascular diseases (CVDs) and hypertension |
| I — Intervention | Dietary interventions/nutraceuticals (magnesium, vitamin D3, flaxseed, barberry, folic acid, omega-3) |
| C — Comparator | Placebo or control interventions (network comparison) |
| O — Outcomes | Flow-mediated dilation (FMD) as a measure of endothelial function |
Bottom Line
This network meta-analysis suggests magnesium and vitamin D3 supplementation may provide clinically meaningful improvements in endothelial function (FMD) in patients with cardiovascular disease or hypertension, with high certainty evidence. However, the analysis relies on surrogate endpoints rather than hard clinical outcomes. While these findings support the potential role of targeted nutraceutical interventions as adjunct therapy for vascular health, the mixed certainty of evidence across different supplements and lack of long-term clinical outcome data limit immediate practice recommendations. Clinicians should consider these interventions within established cardiovascular risk management frameworks, particularly for patients with documented endothelial dysfunction, while awaiting trials with clinical endpoints.
Key Findings
P Value: Not reported
Effect Size: Magnesium: MD 8.17; Vitamin D3: MD 7.84; Flaxseed: MD 7.39
Primary Outcome: Flow-mediated dilation (FMD) improvement
Nnt Or Sensitivity: Certainty of evidence: High (magnesium, vitamin D3), Moderate (barberry), Low (flaxseed, folic acid), Very low (omega-3)
Confidence Interval: Not reported in abstract
Clinical Application
High feasibility as interventions are readily available nutraceuticals, though optimal dosing and duration unclear Relevant to Australian practice; magnesium and vitamin D3 available on PBS for specific indications; aligns with RACGP cardiovascular risk management guidelines emphasising lifestyle interventions Adults with established cardiovascular disease or hypertension requiring adjunct vascular protection strategies
Abstract
PURPOSE OF REVIEW: This network meta-analysis (NMA) compares the efficacy of dietary interventions in improving flow mediated dilation (FMD) as a measure of endothelial function among individuals with cardiovascular diseases (CVDs) and hypertension. This work can be a basis for the design of future clinical trials and for the development of evidence-based nutritional guidelines to improve cardiovascular outcomes. RECENT FINDINGS: The most substantial improvements in FMD were observed with magnesium (MD: 8.17; CoE: High), vitamin D3 (MD: 7.84; CoE: High), flaxseed (MD: 7.39; CoE: Low), barberry (MD: 6.64; CoE: Moderate), folic acid (MD: 3.36; CoE: Low), and omega-3 (MD: 1.83; CoE: Very low). Sensitivity analyses confirmed the robustness of these findings. Several dietary interventions, particularly magnesium and vitamin D₃, have been shown to improve endothelial function in individuals with CVDs and hypertension. These findings highlight the potential role of nutritional strategies as adjunct therapies for preserving vascular health. TRIAL REGISTRATION: Systematic review registered with PROSPERO, registration number CRD420251041093.
References
- 1.Norouzzadeh, M., Rashedi, M. H., Mahdavi-Mazdeh, G., Kosari, A., & Shahinfar, H. (2026). Comparative efficacy of nutraceuticals on endothelial function: A systematic review and network meta-analysis. Current Atherosclerosis Reports. https://doi.org/10.1007/s12603-013-0043-6
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