Google searches for “should I take creatine” have nearly doubled since the beginning of 2025, which is not surprising given that this supplement, long favored by athletes, has been gaining increasing traction among all walks of the population thanks to expanded exposure in both the popular media and on social platforms. 

An increasing body of research points to the benefits of creatine to prevent cognitive decline and has uncovered some other positive features unrelated to achievements in the gym. For that reason, as well as exercise being an important part of rehabilitation from cardiovascular disease (CVD), physicians may want to consider the role that creatine could play in patients with CVD.

The Background on Creatine

Creatine is crucial for how the body’s muscles get energy. Inside muscle cells, it’s largely converted into phosphocreatine, an energy reserve. The body’s cells primarily use adenosine triphosphate (ATP) for immediate energy, but supplies are limited. During intense activity, when ATP is used up, phosphocreatine quickly regenerates it, ensuring a continuous energy supply for sustained effort and faster recovery. Beyond energy, creatine also pulls water into muscle cells, potentially signaling growth, and supports muscle repair processes.

When someone takes supplements with creatine monohydrate, commonly referred to as creatine, they’re boosting these muscle stores of creatine and phosphocreatine. This larger reserve means more readily available phosphate to regenerate ATP during demanding exercise. By increasing this energy buffer, supplementation allows for greater power output and extended high-intensity performance.

Creatine has been around for decades, and the first clinical study was performed on it in 1992. Since then, more than 680 peer-reviewed studies have been performed on creatine, making it one of the most studied supplements on the market today. 

Implications for Patients With CVD

A growing body of research suggests that creatine supplementation may have therapeutic relevance in patients with CVD. While it is not a substitute for guideline-based medical therapy, creatine may support cardiac rehabilitation by enhancing skeletal muscle performance, improving fatigue resistance, and potentially offering cellular energy support during myocardial stress.

Srihari S. Naidu, MD, professor of medicine at New York Medical College, Valhalla, New York, and triple board-certified doctor in internal medicine, cardiology, and interventional cardiology, said creatine does maintain higher energy stores in the muscles, including the heart muscle.

“Creatine appears to increase muscle mass by incorporating more fluid in the muscle but also appears to improve recovery of muscle by maintaining higher energy stores,” Naidu said. The downsides of creatine appear meager and include, namely, bloating and gastrointestinal upset when taken at low doses. In patients with long-term heart failure, the heart often doesn’t have enough creatine, as found in this 1996 study, which describes these hearts as “energy starved.”

A 43-person pilot study was published in the April-June issue of REC: CardioClinics, the official journal of the Spanish Society of Cardiology. In the study, José Carlos López-Clemente, MD, of Hospital General Universitario de Alicante, Alicante, Spain, was the lead investigator. He posited that creatine monohydrate is not just safe for patients with heart failure but may serve as a valuable complementary therapy for those with the disease. This small study showed increases in both functional capacity and heart-related quality of life.

Naidu said he has not observed negative effects in his patients who are taking creatine at lower dosages and is familiar with studies that have shown the benefits of creatine for various cardiovascular conditions.

“One study has shown potential benefit to prevent statin-induced myopathy, but this is not something widely accepted in the medical literature, nor is it recommended in cardiovascular guidelines,” Naidu said.

The study to which he referred is this 2019 study that showed creatine administration prevents statin myopathy in statin-intolerant patients. However, a 2016 article in The Lancet found that the risk of muscle-related side effects of statin use is actually quite small. Regardless, creatine may provide some extra insurance to patients on statins, and if nothing else, they may be able to perform better physically as they exercise, which benefits their cardiovascular health.

Related to that study and to the original athletic performance-related benefits of creatine, Naidu said, “The most consistent benefit that I have seen is slightly more lean muscle mass in those taking it, and they do appear to have better functional muscle recovery, but no direct cardiac benefits have been noted, nor should they be expected.”

“From a theoretical standpoint, healthier muscles with more energy stores would be beneficial to all patients, as a more fit body always better tolerates other disease states that occur abruptly, including heart attacks, so for me personally, I do not have a problem with low doses of supplemental creatine in the healthy patient without kidney disease,” Naidu continued.

Naidu brings up one adverse effect that needs to be considered. For healthy people, any ill effects creatine was thought to have had on kidney function have been largely debunked, as detailed in this meta-analysis. However, for those who have pre-existing kidney disease or kidney failure, it is important to caution patients about its use, not only to preserve remaining renal function, but also to reduce the risk for atrial fibrillation that can be triggered by poor clearance in the kidneys.

Common Safety Tips Apply to Cardiac Patients, Too

As Naidu said, it’s important to stick to the typical daily dose of creatine, which is 3-5 grams. It’s usually sold as a powder that can easily be mixed into water, juice, or a sports drink. Always remember to follow the specific mixing instructions on the supplement’s label.

The most important safety tip for patients to remember when they choose to supplement with creatine is to stay hydrated. Since one of the functions of creatine is assisting the cells with drawing in water, drinking enough water will ensure that it doesn’t get pulled from other places. It also ensures that the creatine is effectively absorbed and transported to the muscles where it can be utilized. Finally, while people who take creatine may experience some bloating in the first 7-10 days of taking the supplement, adequate hydration will help the body get accustomed to the elevated creatine levels.

It’s also important to be consistent. While there are some studies that show that creatine is most effective when taken after a workout, it’s more important to take it at the same time each day. 

More Studies Needed, But It’s Here to Stay

In terms of popularity, creatine monohydrate is not going anywhere anytime soon: The market size for the supplement is already over $1 billion globally with a compounded annual growth rate of more than 25%.

While more large-scale trials are needed, creatine may serve as a safe and accessible complementary therapy for some cardiovascular patients — particularly those with skeletal muscle deconditioning or decline, or exercise intolerance. Clinicians should consider its potential benefits on a case-by-case basis within the broader context of comprehensive cardiac care.