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Vitamin K, specifically vitamin K2, has been almost universally hyped by social media's health influencers for the past 10 years as a cheap, risk-free, alternative preventive therapy for cardiovascular disease. But what evidence is there that it actually works?

Many highly plausible preventive therapies for cardiovascular disease have been shown not to work over the past 50 years. In many cases they have been shown to be harmful. Starting with anti-arrythmics, which were shown in the CAST trial to dramatically increase mortality in heart attack survivors despite having been used for over a decade prior (likely the cause of tens of thousands of deaths), the history of plausible mechanisms for cardiovascular disease prevention is grim indeed. Among these can be included homocysteine-lowering therapies (which may increase rates of some cardiovascular events), HDL-lowering therapies like CETP inhibitors (which in some trials also increased cardiovascular events), and antioxidant therapies (which in some cases, such as with beta-carotene, increased rates of cancer). One thing can be said for certain: what seemed promising according to observational and mechanistic research has often proved deadly when tested in actual clinical trials.

Could this also be true for vitamin K2 supplements?

According to some of the prevailing theories of cardiovascular disease among researchers, the mechanism of action of vitamin K2 for preventing cardiovascular disease is nonsensical. After all, simply reducing arterial calcification does not address the primary cause of calcification: the existence--and healing--of atherosclerotic plaques. Indeed, formation of non-calcified plaques occurs prior to the presence of calcifications. Calcifications are part of the healing process--indeed, part of a healing process that is universal across many different types of injuries in mammalian biology. Calcifications may in fact stabilize atherosclerotic plaques. Correspondingly, statins are thought to act in part by acceleration the formation of calcified plaques, thereby protecting atherosclerotic lesions from destabilization and breaking off to form thromboembolism, a blood clot which blocks the artery--the cause of most cardiovascular events, including heart attacks. People who exercise also have a dose-response increase in calcified plaques--despite having lower rates of heart attacks.

Vitamin K2 may reverse the formation of calcifications that are protecting the arterial vessels from the formation of thrombi due to atherosclerotic plaques. Vitamin K2 may convert dense calcifications--good--into spiculated, patchy calcifications--bad. In other words, vitamin K2 may increase the risk of cardiovascular events--and death.

Or it may not. Without the actual hard outcomes evidence of randomized controlled trials, we simply do not know whether vitamin K2 is helpful or harmful. One thing is for sure: on the basis of a long history of failed treatments, unproven mechanistic speculations should never be the basis for the prevention of cardiovascular disease. Even more dangerous is in the more extreme parts of the alternative health industry, where vitamin K2 supplements are often promoted as alternatives to conventional treatment like statins, such as by influencer Ivor Cummins.

This practice among health influencers must stop, and we must be more circumspect about the kind of evidence that we deem adequate to overhype a recommendation. The lives of actual human beings depend on this.

(I will add references when I get the chance--needed to get this out. If you would like to find them before I have that opportunity, please watch the video on Youtube. Thank you for your patience.)

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