Usual nutrient intake and its association with CVD-related mortality in statin users

The prevalence of statin use among U.S. adults for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) risk is on the rise. Individuals unable to achieve low-density lipoprotein cholesterol (LDL-C) goals with lifestyle changes and medications may turn to functional foods or dietary supplements for perceived health benefits. This dissertation includes two studies. First, we investigated CVD risk factor differences between adults solely using statins and those combining statins with dietary supplements. Analysis of NHANES data (2013–2018) revealed that statin use combined with dietary supplements was associated with a lower prevalence of high total cholesterol (5.1% ± 1.4% vs. 15.6% ± 2.7%, p < 0.001), as well as lower hemoglobin A1c % (6.0% ± 0.1% vs. 6.3% ± 0.1%, p < 0.05) and higher HDL levels (50 ± 1.3 vs. 47 ± 0.8 mg/dL), p < 0.05) compared to statin use alone. Second, we explored associations between the usual intake of select nutrients and CVD-related risk factors and mortality in both statin and non-statin users who participated in the NHANES (1999–2000 to 2017–2018). Findings revealed that moderate to high-level intakes of vitamin D, niacin, and omega-3 fatty acids from all sources, including dietary supplements, had a lower risk of CVD mortality compared to those with the lowest intake levels. Specifically, higher vitamin D intakes in Quartile 3 (HR 0.52 (0.37, 0.73), p < 0.05) and Quartile 4 (HR 0.73 (0.56, 0.96), p < 0.05), when compared to Quartile 1, were associated with reduced risk of CVD mortality. Niacin intake at the highest level was also associated with a reduced CVD mortality risk [Quartile 4, HR 0.42 (0.18, 0.98), p < 0.05]. Moderate omega-3 fatty acid intake was associated with reduced CVD v mortality in statin users [Quartile 3, HR 0.07 (0.01, 0.51), p < 0.05;]. These studies indicate that dietary intake of key nutrients among statin users is associated with better CVD outcomes, and mortality risk may be lower among those who consume greater amounts of vitamin D, niacin, and omega-3 fatty acids from various sources, including dietary supplements.