Internal Medicine

💢 MK-7 Slows Coronary Artery Calcification, but Clinical Benefit Remains Unproven A new randomized, placebo-controlled trial published in JAMA Cardiology (2026) evaluated the effect of menaquinone-7 (vitamin K2, MK-7) on the progression of coronary artery calcification (CAC) in 180 patients with established, mild coronary artery disease (baseline CAC score 50–400). After two years of treatment with 360 μg/day of MK-7, participants experienced a significantly slower increase in CAC compared with placebo (approximately 19 Agatston units less per year), while the supplement was well tolerated and demonstrated good adherence. These findings support the biological role of vitamin K–dependent matrix Gla protein (MGP) in regulating vascular calcification. Despite these encouraging imaging results, the study did not demonstrate improvements in clinically meaningful cardiovascular outcomes. MK-7 reduced the progression of a surrogate imaging marker but had no significant effect on coronary artery stenosis, the number of affected vessels, or the proportion of patients with rapid CAC progression. Importantly, previous experience with statin therapy has shown that greater coronary calcification may reflect plaque stabilization rather than disease progression, underscoring the complexity of interpreting changes in CAC. Consequently, slowing calcification cannot currently be assumed to reduce the risk of myocardial infarction, stroke, or cardiovascular mortality. The accompanying editorial emphasizes that coronary artery calcification is an excellent marker of cardiovascular risk but not yet a validated therapeutic target. Until large outcome-driven trials demonstrate that MK-7 reduces cardiovascular events, routine vitamin K2 supplementation cannot be recommended solely to slow CAC progression. Current evidence continues to support aggressive management of established cardiovascular risk factors—including LDL-C and apoB reduction, blood pressure control, smoking cessation, and lifestyle modification—as interventions with proven benefits on hard clinical outcomes. Reference: Vossen LM, et al. JAMA Cardiology. Published online June 10, 2026. doi:10.1001/jamacardio.2026.1279. 🆔 @InternalMed .