Recently, creatine has gained popularity among the health-oriented due to evidence—that seems to be accumulating by the day—that creatine has many benefits that aren't related to building bigger or stronger muscles:

Metabolic regulation: Creatine supplementation can lower blood lipids and improve glycemic control. Studies show reductions in cholesterol, triglycerides, and VLDL in adults with high cholesterol and improved glucose control in individuals with type 2 diabetes when combined with exercise.

Pregnancy: Creatine plays a crucial role during pregnancy, supporting fetal development and brain function. Animal studies and research in preterm infants suggest creatine may protect against birth complications like asphyxia and promote neural development, though human trials are lacking.

Cognitive performance: Creatine supplementation may reduce mental fatigue and enhance cognitive performance, especially under stress, in vegetarians, older adults, or sleep-deprived individuals. However, its effects on cognition in healthy individuals remain inconsistent and may depend on supplementation dose and study conditions.

Sleep: While creatine does not broadly improve sleep, it significantly increased sleep duration on workout days in a study of novice resistance trainers. Creatine may help mitigate sleep disruptions caused by physiological stress, such as exercise or sleep deprivation.

Depression: Creatine supplementation improves brain energy utilization and may reduce depressive symptoms when used alongside antidepressant therapy. Studies report reductions in symptoms by up to 79% in some cases, though results vary depending on dose and individual responsiveness.

Neurodegenerative diseases: In animal models, creatine protects neurons in diseases like ALS, Huntington's, and Parkinson's, but human trials have shown limited success. Its benefits may be better suited for prevention or in combination with other treatments rather than as a standalone therapy.

Traumatic brain injury: Creatine supplementation may reduce cognitive and physical impairments following traumatic brain injury (TBI). Studies in animals and humans, including children, suggest improvements in communication, locomotion, and reduced post-injury symptoms like headaches and dizziness with creatine treatment.

This research highlights two main areas of interest for creatine: the muscles and the brain. Now, it seems we should be paying attention to the cardiovascular effects too.

Improvements in vascular tone and function

Beyond its well-known role in energy metabolism, creatine has shown potential as an antioxidant, anti-inflammatory agent, and even a lipid-lowering compound. Creatine and its associated enzymes and transporters are integral to maintaining vascular tone and blood vessel function by energizing endothelial ion channels, making it plausible that this multifaceted molecule could deliver cardioprotective benefits.

To investigate creatine's effects on blood vessel health—specifically the ability to increase in size to accommodate blood flow (known as endothelial function)—12 healthy men and women with an average age of 59 were supplemented with creatine or a placebo for 28 days each.
 

Supplementing involved two phases: A 5-day loading phase during which the participants took 5 grams of creatine four times per day for 20 grams total per day and a 23-day maintenance phase where they just took 5 grams once per day.
 

Supplementing with creatine increased endothelial function in larger arteries (macrovascular function) by 1.2% and smaller arteries (microvascular function) by 1.4%. A 1% improvement in vascular function might not seem like a lot, but this magnitude of a change has been associated with a 13% decrease in the risk of having a cardiovascular event like a heart attack or a stroke.
 

More importantly, both measures of endothelial function were higher after creatine supplementation compared to placebo.

Despite a beneficial improvement in vascular health, creatine did not improve biomarkers of oxidative stress, but it did improve fasting blood glucose from 103 to 99 mg/dL and triglycerides from 100 to 84 mg/dL. In fact, the participants' blood glucose levels dropped from just above prediabetic levels to slightly below after creatine supplementation.

Final thoughts

What's important about these results might not be the degree of the overall change, but the fact that these cardiovascular health markers improved at all.
 

Creatine is not typically considered to be a cardiovascular health supplement and the fact that less than a month of supplementing with it led to improvements in cardiovascular health shifts the way that we think about this molecule.
 

This study seems to indicate that in addition to experiencing the usual benefits of creatine—stronger and larger muscles and better brain health and cognitive function—we may also get some "off target" effects for our heart and blood vessels without the side effects that accompany some medications. Low risk, potentially high reward.
 

I don't think creatine will become an overnight sensation in the world of heart health supplements. In fact, there were several outcomes in this study that creatine didn't improve: Blood pressure, arterial stiffness, and cholesterol, for example. It isn't a miracle supplement and it definitely shouldn't take the place of exercise or other lifestyle practices you engage in to improve heart health.

How to dose creatine for heart health benefits

Do you need to start with a week of 20 grams of creatine per day? The answer to that is no - the researchers likely used this dosing regimen to rapidly elevate the body's creatine stores due to the short-term nature of the study. If you're planning on taking creatine indefinitely, you can start with 5 (or 10) grams per day without the need for a loading dose.
 

As the evidence continues to grow for creatine, it does seem like something nearly everyone should be taking daily. We get a small amount from our diet, but supplementing can help us top off our stores—ensuring we have high levels to support athletic performance, brain health, and now heart health.