Cardiovascular Health

Cardiovascular Health

by Kim Schoenhals

Graph: Sales Numbers for Cardiovascular Supplements

With the New Year behind us, millions of Americans have no doubt remade a commitment to shed unwanted pounds and live healthier lifestyles. This commitment is becoming more important as the years pass because America continues to grow fatter, contributing to a deteriorating state of cardiovascular health. Heart disease remains the No. 1 cause of death in the United States, with 950,000 people dying each year from heart-related complications, according to the Centers for Disease Control and Prevention (CDC). The next closest leading cause of deathcancer killed an estimated 555,500 people in 2002, as noted by CDC.

Weight loss and exercise are known to improve heart health and, similarly, incorporating a multivitamin into a healthy lifestyle may also benefit cardiovascular wellness. Researchers at The Cooper Institute in Dallas conducted two trialsone six-month trial with 182 participants and one 24-week trial with 150 participantsand found those taking vitamin supplements experienced improvements in LDL cholesterol oxidation indices.^1,2 Researchers from the Karolinska Hospital in Stockholm, Sweden, also showed multivitamin supplements benefit heart health.³ Their trial of 1,296 cases (910 men, 386 women) who had a first nonfatal heart attack and 1,685 controls (1,143 men, 542 women) indicated low-dose multivitamin use reduced the risk of heart attack among women by 21 percent and among men by 34 percent.

According to data from the market research firm SPINS/AC Nielsen, consumers are spending money on supplements supporting cardiovascular health. In fact, the market research showed a 2.5-percent increase in spending in the 52 weeks ended Oct. 4, 2003, compared to the 52 weeks ended Oct. 3, 2002. Some specific ingredients that enjoyed increased sales were hawthorn, calcium, carnitine, coenzyme Q10 (CoQ10) and grapeseed extract.

Antioxidants

CoQ10 and grapeseed extract, both antioxidants, are only two of the categorys many that have been studied recently for their effects in heart health. Countless studies revolving around the role antioxidants play in protecting heart health have been conducted over the decades to determine whether they can help. The hypothesis behind using antioxidants to stave off heart disease stems from the idea that lowdensity lipoprotein (LDL) oxidation plays a crucial role in the etiology of atherosclerosis. So, by preventing LDL oxidation (or lipid peroxidation), antioxidants are believed to inhibit atherosclerosis, as well as prevent clinical manifestations of the disease, such as myocardial infarction (heart attack) and stroke.

One of the more mainstream antioxidants is vitamin C. An interesting development in vitamin C research showed the antioxidant induced cardiac differentiation in embryonic stem cells, as noted by researchers at Brigham and Womens Hospital in Boston.⁴ They noted their study brought up some questions as to how vitamin C is involved in embryonic heart development, as well as whether this knowledge can be used to improve failing heart health.

Additional research has shown the antioxidant is beneficial during myocardial infarction. French researchers showed vitamin C-treated patients had a 10-percent greater reduction in platelet-derived microparticles (which may increase the incidence of clotting) compared to controls.⁵ Researchers also found that in patients with diabetes, dyslipidemia or more than two cardiovascular risk factors, vitamin C decreased endothelial and platelet-derived microparticle levels by approximately 70 percent and 13 percent, respectively.

Smokers, who are known to be at an increased risk of cardiovascular disease, may further harm their heart health by not getting enough vitamin C. Research conducted at Yonsei University College of Medicine in Seoul, Korea, showed nonsmokers in the highest tertile of vitamin C intake were at a significantly reduced risk of nonfatal ischemic heart disease compared to current smokers in the lowest tertile.⁶

Like smokers, postmenopausal women are at an increased risk of cardiovascular disease, although vitamin C may improve endothelial function in this population. Irish researchers studied whether intravenous vitamin C could reduce the risk of cardiovascular disease and endothelial dysfunction.⁷ Of the 18 postmenopausal women involved in the study, those given a one-time dose of 1.5 g of vitamin C had improved endothelial function, which plays a central role in regulating vascular homeostasis and is believed to protect against the pathogenesis and clinical expression of cardiovascular disease.

Animal research has also demonstrated vitamin Cs propensity to protect against endothelial dysfunction.⁸ Researchers at the Mayo Clinic and Foundation in Rochester, Minn., showed chronic supplementation with vitamin C prevented endothelial dysfunction in an animal model of hypercholesterolemia.

Taking vitamin C and vitamin E may improve endothelial function in children with high lipid levels.⁹ Investigators at the University of California, San Francisco, randomly assigned 15 children with familial hypercholesterolemia or the phenotype of familial combined hyperlipidemia to either an antioxidant regimen (500 mg/d of vitamin C plus 400 IU/d of vitamin E) or placebo for six weeks. Antioxidant therapy was shown to restore endothelial function, which researchers said could slow the progression of atherosclerosis in high-risk children. Another study of 120 middle-aged and elderly subjects showed the combination of vitamins C and Eas well as each vitamin individuallyeffectively lowered total and LDL cholesterol and raised HDL cholesterol after 75 days of treatment.¹⁰

A combined regimen of 250 mg of slow-release vitamin C and 136 IU of vitamin E (as alpha-tocopherol) twice daily for six years was shown to reduce lipid peroxidation and slow the progression of atherosclerosis in the 520 subjects who participated in the Antioxidant Supplementation in Atherosclerosis Prevention Study (ASAP), according to investigators at the University of Kuopio in Finland.¹¹ The trial also indicated this effect was more pronounced in men than in women. A review of the ASAP study conducted by researchers at the University of Copenhagen in Denmark indicated that while the vitamins improved heart health, they did not act via anti-inflammatory mechanisms.¹²

Independently of vitamin C, vitamin E has been researched for its role in heart health. A research review of studies involving antioxidant vitamins for cardiovascular health showed the strongest evidence from basic research and epidemiological studies was behind vitamin E.¹³ However, researchers from the Radcliffe Infirmary in Oxford, England, also stated their review of five large-scale trials involving a total of 29,000 patients at high risk of cardiovascular disease failed to confirm vitamin Es protective effects. A comparable review conducted by researchers at the Cleveland Clinic Foundation in Ohio had a similar conclusion.¹⁴ The meta-analysiswhich involved a total of 81,788 patientsdid not indicate a benefit in mortality or a decreased risk of cardiovascular death or cerebrovascular accident in subjects taking vitamin E compared with controls.

Vitamin Es effect in cardiovascular health has become more controversial in recent years because, while early studies showed the vitamin protected heart health, many newer studies are failing to confirm these results. One hypothesis for the discrepancy in the evidence is that alpha-tocopherol, the single isomer of vitamin E commonly used in supplements and the majority of clinical trials, is not as effective as the naturally occurring combination of tocopherols and tocotrienols found in foods. There is extensive research reported throughout the 1990s regarding palm tocotrienol complex (as Tocomin from Edison, N.J.-based Carotech) as a natural source of all the tocopherols and tocotrienols.

There is also evidence that taking alpha-tocopherol alone may actually deplete the body of its stores of gamma-tocopherol and deltatocopherol.¹⁵ Researchers out of Johns Hopkins University in Baltimore found alpha-tocopherol supplementation reduced gamma-tocopherol concentrations by an average of 58 percent and inhibited detectable levels of delta-tocopherol, which may reduce alpha-tocopherols efficacy in protecting the heart.

There is a lot more to learn about the role of tocotrienols and the other tocopherols in heart disease, wrote Andreas Papas, Ph.D., in The Vitamin E Factor (HarperPerennial, 1999). It will take years (probably over a decade) before we have all the answers in. There is, however, good reason from our existing knowledge of how vitamin E works to take advantage right away of the whole vitamin E teamtocopherols and tocotrienols.

Researchers at the University of Uppsala, Sweden, compared the efficacy of a mixed tocopherol preparation rich in gamma-tocopherol with alpha-tocopherol alone in platelet aggregation.¹⁶ Researchers randomly divided 46 subjects into three groups: alpha-tocopherol, mixed tocopherols and placebo. After eight weeks, platelet aggregation was significantly decreased in the mixed tocopherol group compared to in the other two groups, which had no change. This was supported by earlier research conducted at the University of North Carolina, Chapel Hill, that found mice predisposed to atherosclerotic disease that were given palm tocotrienol complex (as Tocomin) had significantly smaller atherosclerotic lesions compared to control, as well as lower plasma cholesterol levels.¹⁷

Like alpha-tocopherol, there is conflicting evidence regarding using vitamin Es tocotrienols by themselves for heart health. Researchers at the Ross Products Division of Abbott Laboratories randomly assigned 67 hypercholesterolemic men and women to take one of three commercially available tocotrienol supplements or placebo for 28 days, at which point no beneficial effect on cardiovascular disease risk factors was seen.¹⁸

In comparison, several studies have shown benefits linked to taking mixed tocotrienols, as well as some of the isomers singularly. In an animal model, researchers from Advanced Medical Research in Madison, Wis., showed the tocotrienol-rich fraction of rice bran induced a 42-percent reduction in atherosclerotic lesion size while alphatocopherol only induced an 11-percent decrease.¹⁹ Additional animal research out of Texas Southern University in Houston showed gammatocotrienol increased nitric oxide (NO) activity, which was correlated with a decrease in blood pressure.²⁰ And, researchers at the Universiti Kebangsaan Malaysia in Kuala Lumpur stated alpha-tocotrienol, as a more potent antioxidant, may be a superior means of protecting heart health.²¹

Vitamin E may also be effective for cardiovascular wellness when combined with dietary carotenoids. A trial out of Unilever Research and Development in Vlaardingen, The Netherlands, showed healthy adults randomly assigned to consume a spread fortified with moderate amounts of alpha-tocopherol and carotenoids exhibited improvements in antioxidant status and a reduction in oxidative stress.²² A research review indicated long-term supplementation with vitamin E and carotenoids appeared to reduce LDL oxidation and lipid peroxidation.²³

Conversely, a prospective, nested case-control analysis of the Physicians Health Study conducted by researchers at the Harvard School of Public Health failed to show a protective effect against heart attack in men with higher baseline plasma levels of retinol or any other measured carotenoids.²⁴ In women, however, carotenoid intake appears to reduce the risk of coronary artery disease, according to some of the same researchers.²⁵ They found higher intakes of foods rich in alphacarotene and beta-carotene were associated with a reduced risk of coronary artery disease, although they did not find an association for lutein/zeaxanthin, lycopene or beta-cryptoxanthin.

While the Harvard researchers did not find a protective effect from lycopene consumption in womens heart health, additional research out of Brigham and Womens Hospital showed inverse associations for higher intakes of tomato-based products and cardiovascular disease, which researchers attributed to higher intakes of dietary lycopene and/or other phytochemicals consumed in oil-based tomato products.²⁶

The combination of tomato phytochemicals may be behind its beneficial effects. Researchers at Ben Gurion University in Israel conducted a trial using a tomato complex (as Lyc-O-Mato, provided by Beer Sheva, Israel-based LycoRed Natural Products) and found that the 30 hypertensive patients taking the supplement experienced reductions in systolic and diastolic blood pressure.²⁷ The researchers also cited beneficial effects on blood lipids, lipoprotein and oxidative stress markers. Additional research with the tomato complex (as Lyc-O-Mato) conducted at Rambam Medical Center in Haifa, Israel, showed the natural complex rendered LDL particles 90-percent more resistant to oxidation than LDL alone compared to 22-percent more resistant with tomato lycopene.²⁸ In fact, LycoRed was awarded a U.S. patent (No. 6,515,018 B1), Synergistic compositions for lycopene and vitamin E for the prevention of LDL oxidation, which describes the formulation as a synergistic mixture of lycopene (as Lyc-O-Mato) and vitamin E.

A study of whole tomato product consumption conducted at the University of Milan, Italy, suggested lycopene may prevent atherosclerosis and cardiovascular disease.²⁹ They evaluated the effects of tomato consumption (providing approximately 8 mg/d of lycopene) on lipid peroxidation in 12 healthy volunteers and saw an increase in lycopene concentrations and a decrease in LDL oxidizability after tomato product consumption.

In men, low lycopene concentrations were correlated with an increased intima-media thickness of the common carotid artery, which is a risk factor for atherosclerosis.³⁰ Researchers at the University of Kuopio in Finland evaluated the Kuopio Ischemic Heart Disease Risk Factor Studya cohort of 1,028 menand found those in the lowest quarter of serum lycopene concentrations had significantly higher mean intima-media thickness, suggesting lycopene intakes and serum concentrations may have clinical and public health relevance.

Like carotenoids, flavonoids are antioxidant plant pigments that may confer cardioprotective effects in humans. In particular, the flavonoids found in grapes and grape products seem to harbor significant protection. Research out of the University of Wisconsin Medical School in Madison indicated the flavonoids in grape juice and red wine may inhibit atherosclerosis through one of several mechanisms, such as antiplatelet action, antioxidant properties or improved endothelial function.³¹ A study out of the University of Texas Southwestern Medical Center, Dallas, showed Concord grape juice flavonoids are potent antioxidants and may protect against oxidative stress, as well as reduce the risk of free radical damage and chronic disease.³² Similarly, the flavonoids found in red wine are thought to protect heart health; researchers at the University of Padova in Italy stated wine may prevent atherosclerotic lesions even in hypercholesterolemic subjects.³³

While intake of grape juice and red wine appear to protect cardiovascular health, consuming grapeseed extract may also be protective by reducing oxidative stress, particularly in smokers, who are known to exhibit higher levels of oxidative stress than nonsmokers, according to investigators at the University of Ferrara in Italy.³⁴ Animal research out of Creighton University Health Professions in Omaha, Neb., indicated a novel grapeseed proanthocyanidin extract may act via several mechanisms, including a reduction in foam cells (a marker for early-stage atherosclerosis) and a decrease in oxidized LDL cholesterol.³⁵

A flavonoid extract of French maritime pine bark is also known to exhibit antioxidant effects. Researchers at the University of California, Davis, assigned 25 healthy subjects to take 150 mg/d of the extract (as Pycnogenol, available from Hillside, N.J.-based Natural Health Science) for six weeks, at which point the volunteers exhibited significant increases in antioxidant capacity and HDL cholesterol, as well as decreases in LDL cholesterol.³⁶ A research review of Pycnogenol, from Westfalische Wilhelms-Universitat Munster in Germany, indicated in addition to its antioxidant properties, Pycnogenol demonstrated antiinflammatory and immunomodulatory activities, and was able to increase endothelial nitric oxide synthase and dilate small blood vessels in patients with cardiovascular disease.³⁷ Researchers added Pycnogenols antioxidant properties appeared to be enhanced through its propensity to assist in the bodys regeneration and protection of vitamins C and E.

Like Pycnogenol, the vitamin-like compound CoQ10 is known for regenerating plasma concentrations of vitamin E, as well as for its antioxidant properties.³⁸ A human trial out of the Medical Hospital and Research Centre in Moradabad, India, showed CoQ10 therapy increased vitamin E and HDL cholesterol levels, as well as decreased total and LDL cholesterol levels in heart attack patients.³⁹ Additional research with CoQ10 has shown it improves endothelial function in subjects with Type II diabetes and dyslipidemia.⁴⁰

Another vitamin-like antioxidant compound, alpha-lipoic acid, is believed to protect against risk factors of cardiovascular disease, according to researchers at McGill University in Quebec.⁴¹ They stated in a research review that alpha-lipoic acid is involved in the bodys recycling of various antioxidants, including vitamins C and E, and may have blood lipid modulating characteristics. They also stated alpha-lipoic acid could protect against LDL oxidation and modulate hypertension.

Selenium has also shown potential in human heart health. Researchers in Saudi Arabia noted selenium deficiency is linked with the etiology of cardiovascular disease, although selenium supplementation has not been definitively shown as an effective treatment.⁴³ Investigators at the University of Surrey in England also pointed out seleniums link in heart health, saying findings have been equivocal in correlating selenium and cardiovascular disease risk.⁴⁴

Vitamins & Minerals

Several additional vitamins and minerals are known to improve heart health through different mechanisms than antioxidant effects. One group of vitamins that is widely researched for its role in cardiovascular wellness is the B vitamins. Researchers at the Harvard School of Public Health conducted a prospective study among a cohort of 51,529 men and found a strong inverse association between folic acid intake and peripheral arterial disease; for every 400 mcg/d increment of folate intake, the risk of peripheral arterial disease was reduced by 21 percent, and men in the highest intake group (median intake of 840 mcg/d) were at a 33-percent lower risk of peripheral arterial disease than men in the lowest intake group (median intake 244 mcg/d). Researchers also noted weak associations for heart health for vitamin B6 and vitamin B12.⁴⁵ However, research out of Australia failed to show a positive association between folate and vitamin B12 intake and death from coronary heart disease (CHD).⁴⁶

Despite some conflicting evidence for the B vitamins role in heart health, there is significant evidence that they do improve cardiovascular wellness. One popular theory for why B vitamins are helpful for heart health is their propensity to reduce homocysteine, an amino acid that, when found in high levels in the blood, may increase the risk of heart disease.

To study the correlation between B vitamin levels, homocysteine and CHD, researchers at the University of New Mexico School of Medicine, Albuquerque, analyzed serum concentrations of homocysteine, folate and vitamin B12 among elderly Hispanic and non-Hispanic white men and women.⁴⁷ There was a direct association between serum homocysteine concentrations and the prevalence of CHD, primarily in women and, most significantly, among Hispanic women. Researchers concluded the higher serum homocysteine concentrations seen in Hispanics compared to non-Hispanic whites could be explained by lower levels of serum folate and vitamin B12.

Studies giving B vitamins to patients following a pharmaceutical homocysteine-lowering therapy have shown promising results in various realms of cardiovascular wellness. Researchers at the Karl-Franzens University School of Medicine in Graz, Austria, noted men with coronary artery disease who were given 5 mg/d of folic acid for six weeks exhibited a 21.3-percent reduction in homocysteine concentrations, as well as improved resistance vessel reactivity.⁴⁸ Patients in The Netherlands with high homocysteine levels treated with 5 mg/d of folic acid plus 400 mcg/d of vitamin B12 exhibited improved endothelial function after six months.⁴⁹ And, a Swiss study of 550 patients indicated homocysteine-lowering therapy with 1 mg/d of folic acid, 400 mcg/d of vitamin B12 and 10 mg/d of vitamin B6 significantly reduced the incidence of major adverse events after percutaneous coronary intervention (a medical procedure capable of relieving coronary narrowing).⁵⁰

A human trial carried out by Dutch researchers indicated vitamin K2 reduced atherosclerotic calcification, and after five years, subjects with the highest intakes of the vitamin exhibited a more than 50-percent reduction in the risk of atherosclerosis.⁵³ Similarly, an analysis of The Rotterdam Study indicated subjects with a high intake of vitamin K2 had reduced risks of incident myocardial infarction.⁵⁴ One bioavailable source of K2 is Natto K2 from Vernon Hills, Ill.-based Natural Inc.; a human trial showed consumption of Natto K2 increased vitamin K2 serum levels.⁵⁵

In addition to vitamins, mineral supplements also show promise in the fight against heart disease. A research review out of the University of Helsinki in Finland indicated calcium and magnesium can lower blood pressure, with calcium specifically beneficial to serum lipid levels.⁵⁶ The review also remarked on the ability of calcium to enhance the cholesterol-lowering effects of plant sterols, and how a combination of the two could provide a novel approach to modifying cardiovascular disease risk factors. Additional research has shown a high-calcium diet can improve vasorelaxation by reducing plasma total cholesterol and improving the HDL-to-LDL ratio.⁵⁷

The literature involving magnesium and heart health is somewhat conflicting. In an animal model of potassium-induced cardiac arrest, pretreatment with calcium and magnesium did not show a benefit.⁵⁸ And, a human study conducted in Sweden did not show a significant correlation between dietary magnesium and major cardiovascular risk factors, although the investigation did indicate there were positive correlations between calcium content in household water and systolic blood pressure, as well as negative correlations between calcium and LDL cholesterol.⁵⁹

On a more positive note, adequate magnesium intake may reduce the risk of high blood pressure. Researchers in Buffalo, N.Y., suggested magnesium deficiency could contribute to increased insulin resistance, and thereby accelerate atherosclerosis and premature death among black Americans, who are at an increased risk of hypertension, insulin resistance and diabetes.⁶⁰ Additional human research has linked low magnesium levels to a two-fold decrease in event-free survival rate after a primary coronary artery bypass graft surgery.⁶¹ And, a review of the Honolulu Heart Program (a cohort of 7,172 men) indicated dietary magnesium intake reduced the risk of CHD.⁶²

Another mineral that may be of benefit in cardiovascular health is chromium. Chromium deficiency is associated with a disruption in lipid metabolism, and cardiovascular disease may be related to a lack of chromium in the diet, according to Vijaya Juturu and James Komorowski of Purchase, N.Y.-based Nutrition 21, who presented research on this subject at Experimental Biology 2002.⁶³ They also reported chromium supplementation improves high cholesterol and dyslipidemia, and may reduce the risk of early onset CHD by offsetting associated complications.

Chromium is essential for insulin function and may affect insulin resistance and lipid abnormalities, according to researchers at the Hanyang University College of Medicine in Seoul, Korea.⁶⁴ Their animal study indicated chromium picolinate supplementation during corticosteroid treatment (pharmaceutical steroid treatment used in inflammatory conditions) decreased fasting serum insulin levels by nearly 47 percent compared to the control group, as well as lowered plasma triglycerides and improved carbohydrate and lipid metabolism. Additional animal research conducted at the University of Vermont College of Medicine, Burlington, showed chromium picolinate supplementation reduced plasma total cholesterol and increased HDL cholesterol in obese rats compared to controls.⁶⁵ In a human study, overweight women taking 400 mcg/d of chromium picolinate (as Nutrition 21s Chromax) exhibited a significant decrease in serum cholesterol, although the placebo group experienced the same results.⁶⁶ The researchers, from the University of Massachusetts, Amherst, attributed the similar outcomes to the exercise regimen all participants followed.

Another form of trivalent chromium, niacin-bound chromium (also called chromium nicotinate or chromium polynicotinate), is believed to lower blood pressure, decrease lipid peroxidation and lower total and LDL cholesterol. An animal study indicated niacin-bound chromium prevented a sugar-induced elevation of blood pressure in an animal model of hypertension.⁶⁷ Niacin-bound chromium (as ChromeMate, available from Benicia, Calif.-based InterHealth Nutraceuticals) was also shown to lower serum cholesterol by an average of 14 percent in young males with moderate cholesterol levels.⁶⁸

More recently, niacin-bound chromium has been combined with additional nutritional compounds in studies of atherosclerosis and diabetes. In an animal model of atherosclerosis, researchers from the University of Scranton, Pa., showed niacinbound chromium (as ChromeMate) combined with a grapeseed proanthocyanidin extract (as ActiVin from Fresno, Calif.-based San Joaquin Valley Concentrates) dramatically reduced the incidence of atherosclerosis by reducing the formation of foam cells.⁶⁹ Another animal model indicated niacin-bound chromium (as ChromeMate), when combined with the SX fraction of Maitake mushroom (from Paramus, N.J.- based Maitake Products) and (-)-hydroxycitric acid from Garcinia cambogia (as InterHealths CitriMax), lowered systolic blood pressure and assisted in weight maintenance in an animal model of diabetes.⁷⁰

Specialty Ingredients

One of the more well-known group of specialty ingredients on the market these days is omega-3 fatty acids. Researchers at the University of Washington, Seattle, conducted a nested case-control study of the Cardiovascular Health Study and found older adults who consumed higher concentrations of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) from fatty fish exhibited a lower risk of fatal ischemic heart disease.⁷¹ The researchers also spotted a tendency of alpha-linolenic acid (ALA) to lower risk. A review of the EUROASPIRE study garnered similar results: Adults in the highest tertile of ALA, EPA and DHA consumption were at significantly reduced risk of death from coronary artery disease compared to those in the lowest tertile.⁷²

Long-chain polyunsaturated fatty acids (LC-PUFAs) also appear to benefit heart health when they are given to infants, according to researchers from the University of Milan.⁷³ Researchers randomly assigned 237 newborns to receive a formula supplemented with LC-PUFAs or an equally nutritious formula without LC-PUFAs. At six years of age, children in the LC-PUFA group had significantly lower mean blood pressure compared to the non-supplemented group.

Researchers at the Harvard School of Public Health determined that omega-3 consumption, as well as fish consumption in general, reduced the incidence of CHD in a cohort of diabetic women.⁷⁴ Their study indicated fish consumption five or more times per week reduced the risk of CHD by 64 percent, although eating fish one to four times a week also reduced risk. A study out of France showed similar results for male heart health, with fish consumption decreasing triglycerides and systolic and diastolic blood pressure.⁷⁵

Adding carotenoids to omega-3 intake can also improve parameters of cardiovascular wellness. Researchers at the University of Reading in England showed a carotenoid mixture (beta-carotene, alpha-carotene, lycopene, bixin, lutein and paprika carotenoids) combined with fish oil was more effective for reducing oxidative stress and decreasing triglycerides than fish oil alone.⁷⁶

Krill is another abundant source of EFAs; Neptune Biotechnologies has conducted studies on its NKO (Neptune Krill Oil), a rich source of omega-3 EFAs that include EPA and DHA. A company-sponsored study investigated the effect of 1 g/d for 30 days with a maintenance dose of 500 mg/d thereafter. NKO was found to significantly reduce glucose, total cholesterol, LDL and triglyceride levels, while increasing HDL levels. In addition, the company found patients with hyperlipidemia who followed the maintenance regime had improved physical function, reduced physical pain and improved general health.

Another marine byproduct, fish protein, can also benefit the heart. Researchers from Algeria compared fish protein consumption to casein in an animal model of hypertension.⁷⁷ The fish protein diet lowered blood pressure and plasma total cholesterol compared with casein, leading researchers to conclude fish protein attenuated the development of hypertension.

More positive soy research was attained by investigators at the Shanghai Cancer Institute in China.⁸¹ They examined the relationship between soyfood intake and the incidence of CHD among participants in the Shanghai Womens Health Study (a cohort of approximately 75,000 Chinese women). After 2.5 years, women in the highest quartile of soyfood intake exhibited a clear reduction in CHD risk compared to women in the lowest quartile.

Soys isoflavones have also been independently studied for their application in improving heart health. While researchers at McGill University in Quebec stated there is not enough data to recommend isoflavone supplements for reducing plasma cholesterol,⁸² animal research conducted at Oklahoma State University, Stillwater, showed soy isoflavones prevented hypercholesterolemia and the formation of atherosclerotic lesions induced by estrogen-deficiency.⁸³

Like soy, red clover contains isoflavones that are of potential benefit in heart health. Australian researchers conducted a double blind trial with 80 healthy subjects who received isoflavones enriched with biochanin or formononetin for six weeks.⁸⁴. Isoflavone intervention was shown to significantly reduce arterial stiffness and improve systemic arterial compliance. Researchers concluded their study partially explained the lower cardiovascular health risk in populations eating isoflavone-rich diets. Another study of red clover isoflavones was conducted at St. George Hospital in Australia, where researchers found red clover isoflavone supplementation positively affected blood pressure and endothelial function in postmenopausal women with Type II diabetes.⁸⁵

While individual specialty ingredients have been shown to positively benefit heart health, a dietary intervention program was recently shown to be as effective as statin therapy for lowering cholesterol levels in adults after one month.⁸⁶ Researchers assigned subjects to one of three regimens: 1) a control diet low in saturated fat; 2) the control diet plus lovastatin; or 3) a portfolio diet consisting of soy protein, plant sterols, fiber and almonds. After one month of treatment, the groups taking the statin drug or the portfolio diet exhibited similar reductions in LDL cholesterol and Creactive protein (a marker for inflammation that predicts heart attack risk).

Plant sterols have also been studied independently for their effects in cardiovascular wellness. Researchers in The Netherlands randomly assigned 70 hypercholesterolemic participants to consume dietary chocolates enriched with a wood-based phytosterol/phytostanol mixture (containing 18-percent sitostanol) or placebo.⁸⁷ After four weeks, subjects in the treatment group had significant reductions in plasma total and LDL cholesterol levels, while plasma HDL cholesterol remained unaffected. The treatment also appeared to increase endogenous cholesterol synthesis and plasma levels of sitosterol and campesterol compared with placebo.

Like plant sterols, fiber was also included in the portfolio diet that improved cholesterol levels. Independently, fiberparticularly watersoluble fibercan reduce the risk of CHD, according to researchers at Tulane University School of Public Health and Tropical Medicine, New Orleans.⁸⁸ Fiber may act through a variety of mechanismsincluding lowering blood cholesterol and triglycerides, decreasing blood pressure, and normalizing postprandial blood glucose levelsas noted by researchers at Texas A&M University in College Station.⁸⁹ Dietary fiber intake, particularly from cereal, also reduces the risk of peripheral arterial disease in men, according to a 12-year follow-up study conducted out of the Harvard School of Public Health.⁹⁰

Also generally categorized in the realm of food, tea has been featured in several studies that show its benefit in heart health. Higher tea intake has been linked to lower systolic and diastolic blood pressure in older women,⁹¹ and appears to protect endothelial function in men and women.⁹² A research review also pointed out tea consumption is associated with a reduction in LDL oxidation and an inhibition of atherosclerosis and heart disease risk.⁹³ Conversely, a study out of the Harvard School of Public Health failed to show a strong association between tea consumption (black tea specifically) and a reduced risk of cardiovascular disease in older subjects.⁹⁴

However, tea catechins have been widely shown to protect various facets of heart health. A study out of Hirosaki University in Japan indicated green tea catechinsparticularly (-)-epigalocatechin gallate (EGCG) and (-)-epicatechin gallate (ECG)inhibit LDL cholesterol oxidation, thereby inhibiting the development of atherosclerosis.⁹⁵ An animal study investigating the effects of a catechin-rich tea extract showed similar results, with the mixture reducing plasma lipid peroxides, cholesterol and triglycerides.⁹⁶ A human trial of a theaflavin-enriched green tea extract demonstrated an improvement in total and LDL cholesterol levels when combined with a diet low in saturated fat.⁹⁷ Researchers from Roche Vitamins Ltd. in Basel, Switzerland, conducted animal research and found the cholesterol-lowering effect of green tea is mainly due to EGCG.⁹⁸

Another specialty ingredient used in heart health is L-carnitine, which is essential in fatty acid oxidation and may reduce intracellular accumulation of toxic metabolites during ischemia, according to a research review out of Temple University Medical Center, Philadelphia.¹⁰² The review also explained carnitine therapy may assist in treating various cardiac diseases, including congestive heart failure, arrhythmia, peripheral vascular disease and acute ischemia. Animal research showed L-carnitine treatment normalized plasma cholesterol and triglycerides, and partially restored blood glucose levels after diabetes was induced.¹⁰³ A trial of L-carnitine supplementation in diabetic humans showed the supplement significantly lowered plasma lipoprotein(a) levels compared to placebo after three and six months.¹⁰⁴

Being the No. 1 killer in America, cardiovascular disease has earned a top spot on the research agenda, specifically in the realm of cures and treatments. Antioxidants are a popular study topic, as are vitamins, minerals and several specialty ingredients, including the omega-3s, plant sterols and stanols, and soy. These ingredients have the ability to improve lipid levels, lower blood pressure and generally enhance overall cardiovascular wellness. The heart is a busy organ, and the proper nutrition and supplementation may prove fruitful for making sure its job is done well for a long time to come.

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