Coronary heart disease (CHD) is the Western world's most serious public health threat, accounting for 6.3 million deaths annually worldwide. If stroke is included, treatment of cardiovascular disease (CVD) costs an estimated $250 billion dollars per year in the United States alone. Furthermore, CVD kills more men and women annually than all cancers combined. Despite major advancements in detection and treatment and a significant decline in death rates in the last two decades, CHD remains an epidemic of extremely large proportions. There is a growing body of evidence that nutritional supplements may prove to be of significant benefit in the prevention and treatment of CHD. Although large-scale clinical trials are in their early phases, smaller studies are being published at an increasing rate.
Nearly 40 percent of Americans take vitamins and/or herbal or mineral supplements on a daily basis. Vitamins act as coenzymes in vital chemical pathways and minerals play an essential role in several body systems such as neural and cardiac impulse conduction and fluid and electrolyte regulation.
Antioxidant Group
There is ample evidence that compounds called free radicals can lead to damage to several parts of the body. This "oxidative stress" can lead to aging, cancer, and damage to arteries, leading ultimately to CVD. The body's natural defenses may not always be sufficient to combat excess free radical damage. In fact, such inadequate defense against oxidative stress has been linked specifically to CHD, cancer, and degenerative diseases of the nervous system. The ability of free radicals to damage molecules essential to cellular integrity such as DNA, proteins, and cholesterol and fatty acids has been conclusively demonstrated. As such, the potential of antioxidant nutritional supplementation to prevent and treat these underlying mechanisms of cardiovascular disease is intriguing. Indeed, there is evidence that antioxidant vitamin consumption is associated with an inverse relationship with mortality from CHD. The U.S. Male Health-Professionals Study found that beta-carotene intake had no association with risk of CHD among those who had never smoked, but was inversely associated in current and former smokers. This suggests that some of the damage from smoking is caused by free radicals and can be reversed by antioxidant intake.
Has the time come to integrate nutritional supplements into traditional cardiovascular care? The answer is a definite "yes" for some supplements, "no" for others, and "maybe" for many, if not most. As evidence from scientific studies becomes increasingly available in this arena, which of the above categories these supplements fall into will become increasingly clear.
Jack G.: A Patient Example
After Jack G. had a mild heart attack requiring an angioplasty at age 50, he became interested in any and all forms of preventive cardiology. He sought out a prevention-oriented cardiologist. With his cardiologist's guidance, he started to make several major lifestyle changes. He started a diet very low in saturated fats, with much less meat than he had previously eaten. He enrolled in an outpatient cardiac rehabilitation exercise program for three months, three times per week. After this was over, he continued to exercise on his own with 30 minutes of daily vigorous treadmill walking. He found that he had high cholesterol levels, with a high total and LDL (the "bad") cholesterol, high triglycerides, and a low HDL (the "good") cholesterol. He also discovered that he had undiscovered high blood pressure. Under his cardiologist's guidance, he was placed on a regimen of both prescription medication and nutritional supplements and vitamins. The latter included two fish oil capsules daily, as well as grapeseed extract, and soluble fiber supplements. Today, Jack is at his ideal body weight, exercises daily, and states that he feels more energy than he has had in many years; his cholesterol values are half of what they were at the time of his heart attack, and his last annual stress test was completely normal!
Omega-3 fatty acids
Observations of native populations have yielded intriguing insights into nutritional intake and rates of cardiovascular disease. Early observers noted that Eskimo populations in Greenland have very low rates of heart disease and cancer despite a diet that is more than 50 percent in fat; this has led to extensive research into omega-3 fatty acids, a kind of fat typically found in cold water fishes such as salmon, tuna, herring, and mackerel, as well as flax seeds. A recent large randomized trial found that in men with a history of heart attack, fish oil supplementation can dramatically reduce the risk of recurrent heart attacks, death, and stroke. Multiple studies have shown that fish oil can lower triglycerides in men, potentially improving the overall cholesterol profile, and reducing the risk of CHD.
One recent study extended these results to postmenopausal women as well. Several studies have documented an improved electrical stability of the heart with fish oil supplementation, leading to fewer heart rhythm abnormalities, reducing ultimately the risk of sudden death. Early studies show a potential protection of the coronary arteries from cholesterol deposition and a modest anti-clotting effect, which could also potentially lead to fewer heart attacks and strokes. Animal studies have shown a reduction in blood pressure in rats with hypertension. There is evidence that the function of the arteries is improved with an improved ability of arteries to relax. There are clear anti-inflammatory effects to omega-3 fatty acids, and they have been studied in kidney disease, inflammatory bowel disease, immune disorders, mental illness and behavioral disorders, and cancer prevention.
Oligoprocyanidins (OPCs):Resveratrol (grapeseed extract) and Pycnogenol (pine bark extract). Early observations of lower rates of heart disease and cancer in populations of the world that drink red wine on a regular basis led to the discovery of an extremely potent antioxidant substance in the skins and seeds of grapes. This substance, resveratrol, or grapeseed extract, was found to be chemically similar to pine bark extract, called pycnogenol, used for generations in parts of the world as a natural treatment for varicose veins, and vascular diseases in general. This class of compounds has been found to be amongst the most powerful antioxidants ever discovered. Recent research has linked resveratrol to improved function of both arteries and veins through release of the body's natural blood vessel relaxing factor nitric oxide. In a number of basic science studies, resveratrol has been found to reduce smooth muscle cell proliferation, reduce the amount of several early chemical markers of atherosclerosis (hardening of the arteries), reduce oxidation of LDL cholesterol and block the process of negative remodeling of the vascular system seen in many, very early stages of several cardiovascular diseases. In addition, resveratrol has been shown to reduce aggregation of platelets, thereby acting as a mild blood thinner, potentially preventing heart attacks and strokes. Very early research is also showing anti-inflammatory and anti-cancer properties as well.
Soluble fiber: It is well known that increasing fiber intake can lead to several health effects. Fiber comes in two main forms—soluble and insoluble. Insoluble fiber, meaning non-dissolvable, derived from wheat bran and other sources, has been shown to reduce rates of colon cancer and diverticulitis, an inflammatory condition of the colon. Soluble fiber, meaning dissolvable in the bloodstream, derived from oat bran and fruit pectin, has been shown to significantly lower blood cholesterol. Other sources include psyllium husks and flax seeds. Soluble fiber supplements are now available in most health food stores. One recent study found that Americans tend to eat very little soluble fiber; when the amount was increased, there were dramatic reductions in serum cholesterol. A recent pooled analysis of eight major studies found that supplementation with ten grams per day of psyllium husks (a good source of soluble fiber) significantly reduced both total and LDL cholesterol, with no adverse effects. High intake of fruit pectins has been found to significantly reduce fibrinogen, a known risk factor for stroke and coronary heart disease.
Co-enzyme Q10 (ubiquinone): A necessary part of the cellular respiratory process, Co-Q has been reported to have significant health benefits in a wide variety of conditions. In people with normal heart function, normal levels of Co-Q have been measured in heart tissue, and supplementation is controversial. However, in people with reduced heart function and clinical congestive heart failure, there is clear evidence that at high doses, Co-Q can be of significant benefit. There is also promising early evidence suggesting that its anti-oxidant properties may have valuable effects in other body systems as well. A recent study found significant survival benefit in patients about to undergo coronary artery bypass surgery. Like other supplements, Co-Q has been found to have a mild anti-clotting effect, again potentially reducing the risk of stroke or heart attack. A recent study from Sweden found a significant reduction in blood pressure in patients with hypertension treated with Co-Q; in the same study, symptoms of congestive heart failure also dramatically improved. In another study of the use of C0-Q in congestive heart failure, symptom status significantly improved, and the number of other prescription medications was markedly reduced.
L-Carnitine
In patients with a wide variety of heart diseases, supplementation with L-Carnitine, a molecule necessary to heart cell function, has been shown to improve both symptoms and outcome. Patients with congestive heart failure who were given L-Carnitine had improved exercise tolerance and reduced symptoms. Patients with chronic chest pain had a significant reduction in symptoms. Finally, in patients experiencing a heart attack, supplementation with L-Carnitine can limit the extent of damage, improving long-term heart function after a heart attack. In general, numerous animal and human studies support the conclusion that L-Carnitine supplementation seems to act as a preservative and protector of heart muscle during times of oxygen starvation, such as in severe angina, coronary heart disease, heart attack, and congestive heart failure.
Conclusion
The era of nutritional supplements has clearly arrived, and the public is far ahead of traditional medicine. The challenge, which is already being answered by a growing number of well-trained, "traditional" physicians, is to identify, through rigorous scientific investigation, which supplements carry the promise of real benefit in the treatment and prevention of cardiovascular disease, currently the greatest epidemic in the Western world.
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