Originally Published NO April 2010
Cardiovascular disease remains the leading cause of death both in the United States and globally. More people die annually from cardiovascular diseases than from any other cause. According to the World Health Organization, by 2015, almost 20 million people will die from cardiovascular diseases, mainly from heart disease and stroke. These are projected to remain the single leading causes of death.
Treatment consists of a wide variety of interventions, from lifestyle changes to surgical revascularization. When it comes to nutritional supplementation, many key ingredients can also help maintain cardiovascular health.
Carotenoids have been reported beneficial in helping to maintain heart health against certain cardiovascular diseases, particularly high cholesterol levels or hypercholesterolemia. Many studies have been performed on the various carotenoids in decreasing oxidation of low-density lipoprotein (also known as LDL or so-called "bad" cholesterol) and thereby decreasing the incidence of atherosclerosis, a condition in which fatty material collects along the walls of arteries.20
Vitamin E is a well-researched substance with evidence suggesting it may help combat oxidative damage that leads to atherosclerosis. In one study, patients taking 1600 mg per day of vitamin E recorded a 50% decrease in oxidative damage to LDL cholesterol.23
In the Cambridge Heart Antioxidant Study (CHAOS), more than 2000 patients with angiographically proven coronary atherosclerosis were followed for periods ranging from three to 910 days (median 510 days). In this double-blind, placebo-controlled trial, three groups of patients were randomly assigned to receive daily doses of 400 IU of vitamin E, 800 IU of vitamin E, or a placebo. The patients taking the doses of vitamin E had a 47% reduction in subsequent heart attacks (both fatal and non-fatal) compared to the placebo controls. The overall reduction in non-fatal secondary heart attacks was 77%.24
Vitamin C also plays an important role in helping to maintain health against cardiovascular disease. In a study conducted at the University of California Los Angeles, it was reported that men who took 800 mg of vitamin C daily had a 42% reduction in mortality from cardiovascular disease, compared to men who only consumed the Food and Drug Administration's (FDA) Recommended Daily Intake (RDI) of 60 mg of vitamin C daily.27
In another study, 316 women and 511 men (ages 19 to 95 years) were administered vitamin C well above RDI. The results were improved lipid profiles corresponding to possible reduced risk of cardiovascular disease.28
Carnitine is an important nutrient for cardiovascular health. Carnitine's primary function is to facilitate the transport of fatty acids across cellular membranes into the mitochondria, where they are utilized in the production of energy. This is extremely important for the heart, which is the most energy-demanding muscle in the body.
Studies report that carnitine can be therapeutically useful in helping to maintain heart health against various forms of cardiovascular disease, such as angina,29,30 acute myocardial infarction,31 congestive heart failure,32 peripheral vascular disease,33 arrhythmias,34 and abnormal blood lipids.35
Coenzyme Q10 functions as an antioxidant and is also a cofactor in several enzymatic steps in the generation of energy in the mitochondria of all cells. The heart is the most active muscle in the human body, and a decline in energy due to a deficiency of CoQ10 can first affect heart function.
In one double-blind study, patients with severe congestive heart failure who were given 150 mg per day of CoQ10 had a 38% decrease in hospitalizations due to worsening of heart failure compared to the control group. At the same time, episodes of pulmonary edema decreased by 60%, and angina episodes decreased by 53%.36
In another study, it was shown that the symptoms of cardiovascular disease got progressively worse as CoQ10 levels declined. Treatment with 100 mg of CoQ10 daily resulted in both subjective and objective improvement in 69% of patients with cardiomyopathy and 43% of patients with ischemic heart disease.37
Magnesium is a key mineral for cardiovascular health. It inhibits platelet aggregation, thins the blood, blocks calcium uptake, and relaxes blood vessels. Magnesium also increases oxygenation of the heart muscle by improving cardiac contractibility.47
Adequate magnesium levels are associated with reduced incidence of angina, cardiac spasms, and arrhythmias, as well as having relaxing and antispasmodic effects of the blood vessels. On the other hand, magnesium deficiency is associated with increased incidence of atherosclerosis, hypertension, strokes, and heart attacks.48
Omega-3 Fatty Acids
The authors of a paper in the June 2000 issue of Mayo Clinic Proceedings provide a nice summary of the history of omega-3 fatty acids as they have been recognized for their role in heart health. "From epidemiology to cell culture and animal studies to randomized controlled trials, the cardioprotective effects of omega-3 fatty acids are becoming recognized. These fatty acids, when incorporated into the diet at levels of about 1 g per day, seem to be able to stabilize myocardial membranes electrically, resulting in reduced susceptibility to ventricular dysrhythmias, thereby reducing the risk of sudden death.
"The recent GISSI (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico)-Prevention study of 11,324 patients showed a 45% decrease in risk of sudden cardiac death and a 20% reduction in all-cause mortality in the group taking 850 mg per day of omega-3 fatty acids. These fatty acids have potent antiinflammatory effects and may also be antiatherogenic. Higher doses of omega-3 fatty acids can lower elevated serum triglyceride levels; 3 to 5 g per day can reduce triglyceride levels by 30% to 50%, decreasing risk of both coronary heart disease and acute pancreatitis."50
People consuming diets containing foods high in potassium may have a lower incidence of hypertension.52 Epidemiological evidence reveals that increasing potassium intake can play a role in lowering blood pressure in individuals who have essential hypertension.53 Diets high in potassium may possibly also be related to lower incidence of strokes. In a 12-year study, individuals who died from strokes were found to have significantly lower potassium intake than survivors of strokes and individuals who died from other causes.54
Low plasma selenium (less than 45 micrograms/L) has been considered a significant risk factor for cardiovascular disease.55 Selenium's protective mechanisms include its role in the enzyme glutathione peroxidase, which helps remove hydrogen peroxide and lipid peroxides. Lipid peroxidation may damage cell membranes, and it may also activate the liberation of arachidonic acid from phospholipids, which may ultimately increase the risk to thrombogenesis, platelet aggregation, and vasoconstriction.
Over the past several years, elevated homocysteine has become recognized as one of the primary risk factors to cardiovascular disease. Homocysteine is a toxic intermediate metabolite of the amino acid methionine that is capable of causing damage to arteries leading to atherosclerosis.57
In one metabolic pathway, vitamin B6 is necessary to convert homocysteine to cystathionine. In another metabolic pathway, folic acid and vitamin B12 are required to remethylate homocysteine back to methionine. A deficiency of any one of these three B-vitamins can lead to elevated homocysteine.57
Soy isoflavones have demonstrated a beneficial role in atherosclerosis and platelet aggregation. Specifically, genistein reportedly inhibits platelet aggregation and smooth muscle cell proliferation. Smooth muscle cells are one of the primary cell types comprising plaques.65,66 It has been proposed that isoflavones play a beneficial role in the prevention of atherosclerosis via several mechanisms.
Results of a randomized, double-blind, placebo-controlled, parallel-group dietary intervention study involving 61 men at high risk for cardiovascular disease found that intake of 20 g (with 80 mg of isoflavones) of soy protein for five weeks could help reduce total cholesterol and blood pressure, which might be effective in reducing cardiovascular disease.69 Studies have found that supplementation with soy isoflavones exerted favorable effects of a reduction in LDL and an increase in HDL levels.70,71,72
Beta-glucans appear to be the major cholesterol-lowering agents in oat bran fiber. This dietary fiber, 0.75 g per serving and four servings a day, has been noted by FDA in helping to reduce cardiovascular disease risk.73
A randomized crossover study fed a high-fiber (beta-glucan or psyllium) and a control low-fat, low-cholesterol diet for one month each to 68 hyperlipidemic adults. Based on various reductions in cholesterol measures and ratios, a risk reduction of 4.2 +/- 1.4% (P=0.003), as calculated by the Framingham cardiovascular disease risk equation, was noted for cardiovascular disease.73
One study matched a control group of 483 healthy middle-aged to elderly women to an equivalent group that had cardiovascular disease. Blood levels of lycopene, other carotenoids, and retinol were measured in both groups.74
The results found that those who had the highest blood levels of lycopene had a 50% reduced risk of cardiovascular disease when compared to those who had the lowest levels. These results were not seen in the other carotenoids measured. The authors concluded that the results of this study warrant further investigations into the mechanisms of lycopene.74
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