Are you worried about your cardiovascular health?

Are you worried about your cardiovascular health?

Dr. Nuria Roda.

Cardiovascular diseases (CVD) are the most frequent cause of death worldwide. Specifically in Spain, even in “pandemic times”, the number of deaths caused by diseases of the circulatory system (23.0% of the total) was higher than deaths caused by infectious diseases, including CVID-19 (20.9%) and deaths due to oncological diseases (20.4%).¹

Atherosclerosis is a condition of inflammatory origin that affects the blood vessels and is the main cause of CVD-related events such as myocardial infarction, venous thrombosis or various strokes. It is characterized by thickening and hardening of the vascular wall. The blood vessels lose elasticity and narrow so that blood flow is reduced and therefore the transport of oxygen and nutrients to the different organs and tissues is reduced. Depending on the region affected, the symptoms of this condition vary widely. For example, if the lack of irrigation occurs in the aorta, aneurysms are frequent, if it affects the coronary arteries there is a risk of infarction, if it affects the extremities there is a risk of peripheral arterial disease (PAD), which locally can cause intermittent claudication syndrome, in addition to increasing, in turn, the risk of heart attack and stroke. At the same time, if the lack of blood flow occurs in the brain, cerebral ischemia or stroke can occur. Similarly, the disease can lead to renal failure or hypertension if it originates in the kidneys.

According to a study conducted by the Spanish Society of Cardiology in 2015, it has been shown that this disease especially affects middle-aged people. Moreover, a large proportion of those diagnosed were still asymptomatic.² Obesity, sedentary lifestyle, smoking as well as some pathologies such as diabetes, dyslipidemia or arterial hypertension may be risk factors for the development of atherosclerosis.

It was formerly believed that the development of atherosclerosis had its origin in the accumulation of cholesterol in the inner layer of the arteries. For this reason, the classic strategies for the prevention and treatment of the disease are aimed at reducing the levels of “bad cholesterol”, using statin-type drugs.³ It is now known that atherosclerosis is not only caused by a problem of dyslipidemia but that many factors are involved, such as inflammation, impaired autophagy, mitochondrial dysfunction or the overproduction of free radicals. All these factors promote a complex endothelial dysfunction accompanied by an alteration in the coagulation system, which together induce atheroma plaque rupture and consequent thrombus formation. It should be taken into account that atherosclerosis is not only characterized by the formation of the atheromatous plaque but also by the accumulation of immune system cells within the arterial wall whose function is to digest the deposited fat. The uptake of oxidized lipids by these cells promotes the differentiation of monocytes/macrophages into large foamy and inflammatory cells leading to the release of reactive oxygen species (ROS), cytokines and proteolytic enzymes that induce plaque and fibrous capsule degradation. Plaque rupture causes platelet adhesion/activation with consequent activation of the coagulation cascade, leading to thrombus formation and the clinical manifestation of the disease.⁴ In turn, the generation of excess ROS can lead to neutrophil activation, protein modification, lipid peroxidation and even DNA damage.

For all these reasons, there is a need for new approaches in the treatment of atherosclerosis, considering the participation of the immune system, the anti-inflammatory response and antioxidant action to be essential.⁵

Finally, it should not be forgotten that diet plays a fundamental role in the development of CVD. Restoring the omega-6/omega-3 balance, leading a healthy lifestyle and consuming foods that contribute to boosting the health of our circulatory system is undoubtedly a key tool for the prevention of this disease.⁵ This article details the suitability of certain ingredients for the maintenance of good cardiovascular health.

BLACK GARLIC (Allium sativum)

Allium sativum has been commonly used in traditional medicine due to its wide range of biological properties. It has been investigated for its potential anticarcinogenic, antioxidant, antidiabetic, anti-atherosclerotic, antibacterial and antihypertensive activity, among others. It is rich in sulfur antioxidant compounds such as alliin, allicin, ajoene, S-allyl-cysteine (SAC) and flavonoids such as quercetin.⁶ These bioactive compounds increase the activities of some antioxidant enzymes (e.g., superoxide dismutase (SOD)) and decrease glutathione peroxidase (GSH-Px). Regarding its anti-atherosclerotic properties, some studies suggest that Allium sativum can promote normal blood lipid levels, slow lipid peroxidation, inhibit platelet aggregation, stimulate fibrinolytic activity, reduce age-related morphological changes of the endothelium and also possess hypotensive effects. Specifically, aged black garlic is one of the most potent Allium sativum varieties. In a study with ABG10+ (standardized black garlic extract with high SAC content) it was shown that after one month of treatment LDL levels were reduced and HDL increased, reducing the risk of atheroma plaque formation. Furthermore, due to its anti-inflammatory power, ABG10+ attenuated vasoconstriction in treated animals.⁷ There are also studies showing that black garlic increases nitric oxide (NO) production and improves vasodilation, thereby increasing the flow of nutrients to the heart and preventing the occurrence of ischemic events. In addition, black garlic also acts on platelet aggregation, one of the phenomena that produces a greater predisposition to suffer cardiovascular diseases. In this regard, it could prevent platelets from adhering to the subendothelium and forming fibrinogen chains in the arteries.

OLIVE TREE (Olea Europaea)

Olive extract has numerous benefits from the point of view of cardiovascular health. Among the polyphenolic compounds it contains, oleuropein and hydroxytyrosol are the most important due to their excellent antioxidant, anti-inflammatory, anti-atherosclerotic, hypolipidemic and anti-ischemic properties.⁸ According to some studies, polyphenols in Olea europaea extract could reduce platelet activation and scavenge free radicals, inhibiting oxidation and delaying the progression of atherosclerosis. The process involves activation of phospholipase C, regulation of arachidonic acid metabolism and reduction of peroxide anions.⁹ Other studies reveal that phenolic compounds from olive oil and red wine appear to reduce inflammatory angiogenesis of cultured endothelial cells by inhibiting MMP-9 and COX-2. Furthermore, these effects are accompanied by a significant reduction in ROS and NF-KB levels.¹⁰ For its part, oleuropein exhibits an excellent antithrombotic effect by inhibiting the phosphodiesterase (PDE) signalling pathway. In animal models, pretreatment with oleuropein before inducing ischemia resulted in a significant reduction in creatine kinase and a decrease in glutathione release in the perfusate. In addition, oleuropein has been shown to reduce the infarction rate in rabbits with hypercholesterolemia by decreasing total cholesterol and triglyceride levels.⁸ On the other hand, hydroxytyrosol also appears to be a potent inhibitor of LDL oxidation by inhibiting the production of isoprostanes. A study with animals subjected to an atherogenic diet (rich in saturated fats) showed that an intake of hydroxytyrosol at 4 mg/kg for one month resulted in an improved antioxidant capacity of the myocardium and a reduction in the size of atherosclerotic lesions compared to control animals.¹¹

ARTICHOKE (Cynara cardunculus)

Artichoke is a plant known for its antioxidant and lipid-lowering properties. Numerous studies show that artichoke extracts inhibit endogenous cholesterol synthesis and prevent LDL oxidation, thus combating the process of atherogenesis.¹² It is well known that atherosclerotic disease begins with endothelial dysfunction, which is assessed by measuring several humoral markers such as vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM- 1) and E-selectin. These markers were measured in a trial of 18 hyperlipemic patients supplemented with artichoke juice. The results are encouraging and seem to indicate that artichoke extract positively modulates endothelial function in hypercholesterolemia.¹³ On the other hand, artichoke leaves have a high content of caffeic acid, which plays a hepatoprotective and hepato-stimulant function. Likewise, they contain sesquiterpene lactones, such as cynaropicrin, which facilitates the function of the digestive system, which ensures that the body obtains the nutrients necessary for proper blood flow. It is also known that the polyphenols present in artichoke leaf protect against oxidative damage through the uptake of free radicals and regulate the expression of genes involved in cellular defence through the activation of the nuclear factor Nrf2. In a study carried out with artichoke leaf tincture, the positive effects of this plant in the regulation of the plasma lipid profile as well as in the suppression of the expression of inflammatory genes and reducing the levels of ROS in the arterial wall were demonstrated. In addition, the expression of MCP-1 (a key monocyte chemokine in atherosclerosis) is inhibited. In the absence of MCP-1 or its receptor, arterial lipid deposition is substantially reduced.¹⁴

NATTOKINASE

Nattokinase is a serine protease obtained by purifying a component called natto, which, in turn, comes from the fermentation of soybeans with the bacterium Bacillus subtilis. This enzyme has fibrinolytic properties that are of vital importance for the maintenance of good cardiovascular health. It acts by breaking down blood clots through the hydrolysis of fibrin. In addition, it stimulates the production of endogenous substances with anticoagulant capacity, such as plasmin.¹⁵ Thus, its daily intake could reduce the risk of thrombosis. Its consumption has also been shown to reduce oxidative damage to arteries and inflammation in veins. There is also evidence that it decreases platelet aggregation to keep blood vessels in good condition and prevent hardening over time.¹⁶ Oral administration of nattokinase is considered safe and provides support to the circulatory system in the prevention of cardiovascular disease.¹⁷

COENZYME Q10

CoQ10 is a potent antioxidant that has been found to be very useful in protecting against cardiovascular disease. In that sense, it seems that it could reverse most of the cellular alterations that cause atherosclerosis, such as dysregulation in cholesterol biosynthesis, altered autophagy flux and mitochondrial dysfunction, all thanks to its redox and signalling properties.¹⁸ At the mitochondrial level, CoQ10 acts as a carrier of electrons and protons and through oxidative phosphorylation provides cells with the ability to produce ATP, essential for proper cellular function. Outside the mitochondria, Q10 activates AMPK, regulates the inflammasome, modulates macrophage autophagy, prevents membrane peroxidation and regulates the physicochemical properties of cell membranes. In addition, it is thought that it can improve endothelial dysfunction, cardiac ATP production and has a blood pressure lowering effect.¹⁹ From the point of view of inflammation, CoQ10 reduces most inflammatory parameters such as IL-6, IL-1β or TNF-α, so that cardiac damage and mitochondrial function are improved. On the other hand, Q10 reduces macrophage accumulation, foam cell formation and lipid accumulation leading to atherosclerosis-induced arterial damage.¹⁸ Similarly, Q10 may inhibit atheroma formation by reducing LDL levels and preventing its oxidation. It has also been shown that it is advisable to combine the intake of CoQ10 with statins, since the latter decrease its endogenous synthesis. Moreover, as the phenotype of atherosclerosis is closely related to aging, it is reasonable to believe that CoQ10 supplementation could be beneficial for both conditions. In short, numerous studies seem to indicate that some natural ingredients could be useful in the treatment of atherosclerosis. Thus, consuming products made from selected ingredients with research-proven efficacy could be an appropriate way to prevent atherosclerosis. Undoubtedly, it is important to continue research in this line to contribute to the prevention of this and other cardiac pathologies.

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