Nutritional Ingredients to Prevent, Recover from Heart Attack, Stroke (Escaping from Ischemia)

In the United States, more than 80.7 million adults have one or more types of cardiovascular disease (CVD), according to the American Heart Association (AHA). The association reported there are 8.1 million incidents of myocardial infarction (MI), also known as heart attack, and 5.8 million stroke incidents reported annually. Further, while men have a higher incidence of MI and women a higher incidence of stroke, women are more likely to die from a heart attack within a few weeks of occurrence, in part because women tend to suffer MI at older ages than men.

At the core of these conditions is ischemia, a situation in which the flow of blood to a part of the body is restricted. This is often the result of coronary heart disease (CHD), in which atherosclerotic plaques have narrowed the arterial walls, thereby setting the stage for ruptures and clots that can impede blood flow. Cardiac ischemia refers to a lack of blood flow and oxygen to the heart muscle, while a restriction of blood flow and oxygen to the brain results in ischemic stroke. Ischemic stroke accounts for approximately 87 percent of stroke incidence; hemorrhagic stroke results from ruptured blood vessels in the brain, and has a significantly higher fatality rate than ischemic stroke.

There are several basic tips provided by organizations like AHA to reduce the risk of suffering a heart attack or stroke. Primary among them is to stop smoking. Further suggestions include engaging in physical activity, maintaining or reducing weight, controlling blood pressure, controlling blood sugar, limiting alcohol intake and following a healthy diet. Some healthy diets have been examined for their ability to stave off incidence of heart attack or stroke, or to increase survival rates after incidence.

The Mediterranean diet, for example, emphasizes fruits and vegetables, lean protein, fish, whole grains and healthy fats such as olive oil. A review from Ontario’s Robarts Research Institute noted adherence to such a diet has been shown to reduce stroke and MI by 60 percent compared to following even the AHA recommended diet, an effect the researchers noted was twice that of studies investigating the impact of statin intervention on MI incidence.¹ Further, French researchers reported MI patients who followed a Mediterranean diet compared to a “prudent” Western diet significantly increased quality-adjusted life years in a cost-effective way, representing an “exceptional return on investment.”²

Population studies support the recommendation. Data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study found increased adherence to a Mediterranean diet among 2,671 adults with MI lowered mortality rate by 18 percent.³ Similar findings were reported by Dutch researchers, who found among adults with previous MI, following a Mediterranean diet, along with moderate alcohol consumption and not smoking, lowered all-cause mortality by 40 percent.⁴ And the GISSI-Prevenzione investigators noted following such a diet could halve mortality, leading them to urge clinicians to advise MI patients to follow a Mediterranean-style diet, regardless of any drug treatment prescribed.⁵

The DASH diet (Dietary Approaches to Stop Hypertension) may also have a beneficial effect on MI and stroke incidence. Researchers from Boston’s Brigham & Women’s Hospital recently reported on the results of a prospective cohort study assessing the association between adherence to a DASH-style diet and risk of CHD and stroke in women.⁶ The quintile with the highest adherence had a 24 percent reduction in relative risk of nonfatal MI and fatal CHD, and a 18 percent lower risk of stroke. Results in the three lowest quintiles were fairly similar, a result seen as well in a study out of the University of Minnesota, Minneapolis, in which only the highest quintile of adherence to a DASH-style diet had a significant impact on MI and stroke incidence.⁷

One commonality between these dietary approaches is the emphasis on including fish as a primary protein source. Research suggests greater intake of long-chain omega-3 fatty acids, as found in fish, may help to reduce CVD end points including fatal and non-fatal MI and stroke.⁸ In fact, a meta-analysis out of Chicago’s Northwestern University found fish consumption even as seldom as one to three times per month could have a protective effect against ischemic stroke.⁹

Austrian researchers have noted the use of standardized omega-3 supplements may make the most sense for MI patients hoping to realize a reduction in sudden cardiac deaths, as the level of essential fatty acids (EFAs) needed and the standardization of dosage may be easier to comply within a supplemental form.¹⁰ For example, researchers from Kobe University, Japan, examined whether the use of eicosapentaenoic acid (EPA) supplements (1,800 mg/d) could prevent major (fatal and non-fatal) coronary events in hypercholesterolemic patients (n=18,645) when given with a statin.¹¹ EPA helped reduce major coronary events in patients with a history of CHD; among patients without CHD, there was a non-significant reduction seen, particularly among non-fatal coronary events.

That said, some caution may be needed in the area of EFA intake. A review of the Diet and Reinfarction Trial (DART) and DART-2 trials noted in the DART trial, increasing fish intake reduced all-cause mortality among men recovering from MI; however, increasing fish intake in DART-2 by men with stable angina did not affect mortality.¹² In fact, in DART-2, men taking fish oil capsules had an increase in sudden cardiac death, which the reviewer noted conflicts with other studies. There have also been some concerns that fish oil may be pro-arrythmic in some patient populations, leading researchers from the University of Amsterdam, The Netherlands, to encourage patients to discuss their use with health care providers.¹³