By Dr. Ananya Mandal, MD

Glucosamine supplements are used by hundreds of thousands of patients worldwide to relieve the joint pain caused due to osteoarthritis. There are controversies about its actual benefits in the joint. Now a large study with data from the UK Biobank reveals that regular use of glucosamine supplements could reduce the risk of getting cardiovascular disease (CVD) and cardiovascular events. The study appeared this week in the latest issue of The BMJ and was titled, “Association of habitual glucosamine use with risk of cardiovascular disease: prospective study in UK Biobank”.

The researchers from Tulane University, Harvard University, and Harbin Medical University in China noted that habitual or regular use of these supplements could prevent CVD events such as coronary heart disease and stroke. Professor Lu Qi at Tulane University in New Orleans and his team gathered data from the UK Biobank that includes data from over half a million British population. For this study they analyzed 466,039 participants without CVD. These participants were provided with a questionnaire that they completed and in it they mentioned their use of Glucosamine supplements. Over time the patients were followed up and hospital records and death certificate information revealed the numbers of CVD events or deaths that took place among these participants. An average seven years of tracking was done where CVD events such as events due to coronary heart disease and stroke were recorded.

Results revealed that 19.3 percent of the participants were using glucosamine supplements since the start of the study. On analysis they noted that use of these supplements reduced the risk of all CVD events by 15 percent and lowered the risk of coronary heart disease, stroke and deaths due to CVD by 9 to 22 percent when compared with those who did not use these supplements. During the follow up there were 10 204 CVD events, 3060 deaths due to CVD, 5745 coronary heart disease events and 3263 strokes.

“I am a bit surprised but not very much, because previous studies from humans or animals have shown that glucosamine may have protective effects on inflammation, which is a risk factor for cardiovascular disease [CVD],” Qi said. Before making conclusive statements the team meticulously also took into consideration other risk factors such as age, gender, weight, body mass index (BMI), lifestyle choices, diet, ethnicity, other medication and supplement use etc. these were all adjusted for before the benefits of glucosamine were ascertained. For example they found that glucosamine reduced the risk of coronary heart disease by 37 percent among smokers, by 18 percent among former smokers and by 12 percent among those who had never smoked.

Authors explain that glucosamine use reduced levels of C-reactive protein (CRP). CRP is normally associated with inflammation and is raised among those with various conditions including CVD. It is also raised among smokers. Glucosamine use reduces the CRP and thus its benefit is reduction of CVD events among smokers is more pronounced. Glucosamine use also mimics a low carbohydrate diet and thus may benefit in prevention of heart disease. Low carbohydrate diet has been associated with less risk of development of CVD.

Senior author, Lu Qi, in a statement said, “This is good news for people who take these supplements.” He warned however, “we really need additional data from population studies and further, more solid data from clinical trials.”

The authors of the study agree that they did not have clear information regarding the dose of the glucosamine supplements taken and they also did not have data on the side effects of such use. They however conclude, “…habitual use of glucosamine supplements to relieve osteoarthritis pain might also be related to lower risks of CVD events. Further clinical trials are warranted to test this hypothesis.”

Glucosamine

Glucosamine is a “non-vitamin, non-mineral supplement”. It is sold only on prescription in the European countries but is available over the counter in United States and Australia. In the US and Australia, around one in five adults consume glucosamine supplements regularly. In the US around 20 percent adults regularly took glucosamine supplements said a 2008 CDC report. It is the second most common nutritional supplement (that is not a vitamin or a mineral) in the United States after omega 3 supplements said the report.

Glucosamine is said to have anti inflammatory properties. It can mimic a low carbohydrate diet and can thus benefit health say previous studies. It is a naturally occurring compound found in the joint cartilages.

Glucosamine supplements should not be taken by people who are allergic to shellfish and by women who are pregnant or breast feeding. It can affect blood clotting in people who are taking blood thinners such as Warfarin. The supplement is also not to be taken along with certain anti-cancer drugs as it may interfere with their efficacy. It is sold as a food supplement rather than medicine in most pharmacies.

Expert comments

Prof Naveed Sattar, from the University of Glasgow in his comment on the study said, “Only a trial can determine whether there is any truth to the lower observed risk. Observational studies can only ever generate new ideas to test. Many other supplements have not proven benefits in trials even when observational data suggested there may be health benefits. Some supplements have even been shown to cause harm in trials.” He added “So, for now, I would not rush to buy glucosamine to lessen my heart risks when there are many other cost-effective proven ways to do so.”

Dr Sonya Babu-Narayan, from the British Heart Foundation in her comment said, “One in four people in the UK still die from heart and circulatory disease. We urgently need to fund research that could result in improved prevention, diagnosis and treatment. If a well-known and widely available supplement like glucosamine could help prevent heart and circulatory diseases, including heart attack and stroke, it is an avenue of research worth exploring. Meanwhile, an important way to reduce your risk is to maintain a healthy lifestyle and – when relevant – take medications as recommended to you by your doctor.”

Dr. Gregg Fonarow, co-director of the preventative cardiology program at the University of California, Los Angeles was also not very convinced about drawing conclusions from this study. He said in a statement, “Observational studies for multiple different dietary supplements have produced similar types of findings, only to then be tested in large-scale, randomized clinical trials which failed to confirm any benefits.” He said that final conclusions are, “there is not a sufficient evidence basis to recommend glucosamine supplements for cardiovascular benefit.” He advised, “Those wishing to lower their cardiovascular event risk should follow current guideline recommendations to not smoke, be physically active, and maintain a healthy blood pressure, cholesterol levels, and body weight.”Source:

Ma Hao, Li Xiang, Sun Dianjianyi, Zhou Tao, Ley Sylvia H, Gustat Jeanette et al. Association of habitual glucosamine use with risk of cardiovascular disease: prospective study in UK Biobank BMJ 2019; 365 :l1628, https://www.bmj.com/content/365/bmj.l1628