Cardiovascular Health

by Kim Schoenhals

With the high rates of stress, smoking and bad diets in the world,cardiovascular disease continues to claim nearly 1 million lives each year, morein men than women. The American Heart Association (AHA) (www.americanheart.org)ranks the category of cardiovascular diseases as the number one killer in theworld, as they collectively claim an estimated 950,000 lives annually. Amongthese are approximately 460,000 deaths from coronary heart disease (CHD), orischemic heart disease. AHA estimates also suggest that approximately 60 millionAmericans (about one in four) have one or more types of cardiovascular disease,including high blood pressure, CHD (myocardial infarction and angina pectoris),stroke, congenital cardiovascular defects and congestive heart failure.

While the majority of Americans are aware of the dangers of unhealthylifestyles and diets, they often do not take the necessary steps to preventtheir cardiovascular system from becoming sick. According to the NutriSoyHeart Health Poll, which involved 1,011 adults, 73 percent of respondentsadmitted to skipping workouts because they were "too tired" or didn'thave enough time. According to AHA, physical activity--only 30 minutes perday--can reduce the risk of heart attack and stroke significantly.

In addition to regular exercise, AHA cites a healthy diet as a good way toimprove cardiovascular health. In combination with a good diet, medications andsupplements can also improve heart health. Because of the high rate of deathsfrom cardiovascular diseases, scientists and physicians are constantly on thelookout for cardioprotective agents and the natural products industry continuesto promote heart-healthy ingredients that may be able to bolster cardiovascularwellness.

Heart-Helpful Ingredients

Soy has long been in the lime light for its heart-healthy properties,especially since the Food and Drug Administration (FDA) approved a claim forcardiovascular health in October 1999. According to the 2001 Natural MarketingInstitute's (NMI) The Health & Wellness Trends Report, 7.1 percent ofconsumers polled--out of 2,000--cited taking soy supplements, including powders,shakes and combination supplements, making soy the seventh most popular dietarysupplement in 2001. In addition, NMI noted that soy supplements' popularity in2001 increased 65 percent compared to 2000 numbers.

Australian researchers recently studied 20 hypercholesterolimicpostmenopausal women who were instructed to consume foods containing soy andlinseed. The women demonstrated decreased plasma total and decreased low-densitylipoprotein (LDL) within three weeks of beginning the diet, and the reduction in"bad" cholesterol continued through eight weeks of the study (AsiaPac J Clin Nutr, 10,3: 204-11, 2001) (http://elecpress.monash.edu.au/APJCN).The scientists from the University of Wollongong concluded that regularinclusion of foods containing soy and linseed may improve plasma lipids insubjects with high cholesterol.

More specifically, soy isoflavones may also have a cardioprotective role,especially in postmenopausal women. A study conducted by researchers at theUniversity of California, San Diego, analyzed cholesterol levels of 208postmenopausal women in terms of isoflavone intake. High intakes of genistein,daidzein and total isoflavones were positively associated with high-densitylipoprotein (HDL) cholesterol, leading researchers to conclude that dietary soyintake plays a protective role against cardiovascular disease in postmenopausalwomen (J Nutr, 131,4: 1202-6, 2001) (www.nutrition.org).

Antioxidants have been studied together and separately as potentialcardioprotective agents. According to NMI, antioxidants were the third mostpopular supplement in 2001, earning a following from 16.4 percent of consumerspolled. In addition, antioxidant supplements were 64 percent more popular in2001 than they were in 2000.

One antioxidant, vitamin C, was the second most popular supplement in 2001according to NMI figures--with almost half (45.4 percent) of poll respondentsadmitting to taking it. Vitamin C was second only to its fat-soluble cousin, vitaminE, which earned a following from 45.7 percent of NMI respondents in 2001.

A review done by researchers at the Mayo Clinic in Rochester, Minn. (MayoClin Proc, 76,11: 1131-36, 2001) (www.mayo.edu),suggested that basic science and animal studies have supported thecardioprotective role of vitamin E--consisting of tocopherols and tocotrienols--whichis suspected to slow the progression of atherosclerosis by reducing LDLcholesterol. However, the authors stated that observational studiesdemonstrating this protective role have primarily used subjects with noestablished CHD. Early primary and secondary prevention trials have showed mixedresults, according to the Mayo Clinic review, and three large randomizedclinical trials (Gruppo Italiano per lo Studio della Sopravvivenza nell'InfartoMiocardico, Heart Oucomes Prevention Evaluation, and Primary Prevention Project)with a combined total of more than 25,000 patients did not show significantbenefit with supplemental vitamin E for the prevention of CHD.

Another large, ambiguous study involving vitamin E is the SECURE trial (Studyto Evaluate Carotid Ultrasound changes in patients treated with Ramipril andvitamin E), which was set up to evaluate the effects of long-term use oframipril--an angiotensin-converting enzyme (ACE) inhibitor--with vitamin E onatherosclerosis progression in high risk patients. A total of 732 patients--55years or older with vascular disease or diabetes and at least one othercardiovascular risk factor--were enrolled in this study. Patients were randomlyassigned to receive one of five treatments: 1) placebo; 2) ramipril (2.5 mg/d)and placebo; 3) ramipril (2.5 mg/d) and vitamin E (400 IU/d); 4) ramipril (10mg/d) and placebo; or 5) ramipril (10 mg/d) and vitamin E (400 IU/d).Researchers concluded that ACE inhibition slowed atherosclerosis progression butthe administration of vitamin E had no impact. Rather, vitamin E demonstrated aneutral effect on the ultrasound measurements of atherosclerosis progression inthe trial (Int J Clin Pract Suppl, Jan,117: 13-18, 2001).

According to scientists at The Heart Research Institute in Camperdown,Australia, vitamin E may be more effective in combination with the antioxidant coenzymeQ10 (CoQ10), which was ninth on NMI's popularity list, earning a 6 percentfollowing from the 2,000 plus respondents. In an animal study (ArterioslcerThromb Vasc Biol, 21: 582, 2001) (http://atvb.ahajournals.org), researchersfound that vitamin E plus CoQ10 were more effective than either antioxidantalone at inhibiting heart disease.

Administered alone, CoQ10 also has beneficial effects on heart health,according to researchers at the Virginia Commonwealth University, Richmond. In areview of CoQ10 research and chronic heart failure, angina and hypertension,researchers discovered that CoQ10 administered orally demonstrated beneficialeffects on cardiovascular health and was well tolerated among adult subjects.Researchers stated that CoQ10 could be recommended as adjuvant therapy inpatients with heart disease, although it should not be recommended as the onlyline of treatment for disease (Pharmacotherapy, 21,7: 797-806, 2001) (www.accp.com).

Grape seed extract is another antioxidant compound thought to haveprotective effects on heart health. "Grape seeds are one of the richestsources of proanthocyanidins, a class of biologically active flavonoids foundthroughout the plant kingdom," according to the National Nutritional FoodsAssociation (NNFA) (www.nnfa.org), whichorganized a Grape Seed Methods Evaluation Committee to create recommendationsfor manufacturers and distributors for the labeling of grape seed extractsupplements. Studies have found that grape seed extract works as an antioxidanton cholesterol levels.

Researchers at Georgetown University Medical Center in Washington assignedfour groups of ten subjects to take placebo, 200 mcg of chromium polynicotinate(Cr), 100 mg grape seed extract, or a combination of Cr and grape seed extract.After two months, the combination group demonstrated the largest decrease intotal cholesterol concentration. However, both groups taking grape seed extractdemonstrated decreases in oxidized LDL cholesterol levels as compared to Cralone or placebo (J Med, 31,5-6: 227-46, 2000). (The grape seed extractused in this study was Activin, from InterHealth USA, which is now supplied byDry Creek Nutrition.)

By studying rats who were administered 100 mg/kg/d of grape seedproanthocyanidin extract (GSPE) as compared to a control diet, researchers atthe University of Connecticut School of Medicine, Farmington, Conn., discoveredthat GSPE demonstrated beneficial effects on heart health by functioning as anantioxidant (Free Radic Biol Med, 31,6: 729-37, 2001). In another animalstudy, scientists at Georgetown University Medical School concluded thatprolonged supplementation with a combination of agents with antioxidant effects(chromium polynicotinate, grape seed extract--as Activin--and zincmonomethionine) can significantly lower systolic blood pressure (Mol CellBiochem, 223,1-2: 95-102, 2001).

Pine bark extract is another compound with antioxidant properties thatis thought to positively affect the cardiovascular system. A research reviewcompiled by I. Jialal and submitted to Free Radical Research (www.tandf.co.uk)in August 2001 indicated that French maritime pine bark (as Pycnogenol,distributed by Natural Health Science) prevents platelets from clogging bloodvessels, improves blood circulation and normalizes blood pressure.

One study in particular compared the cardiovascular effects of 200 mg/d ofFrench maritime pine bark extract (as Pycnogenol) to placebo for reducinghypertension. Researchers at the University of Arizona noted a significantdecrease in systolic blood pressure during supplementation as compared toplacebo, although supplementation did not significantly affect diastolic bloodpressure (Nutrition Research, 21: 1251-60, 2001).

Carotenoids may also prove to be beneficial in heart health. Lycopene,for example, has been featured in recent research for its ability to reduce therisk of cardiovascular events. Conducted by Finnish researchers, the KuopioIschaemic Heart Disease Risk Factor Study involved 725 men (aged 46 to 64 years)who were free of CHD and stroke. At the end of the trial, researchers discoveredthat low serum levels of lycopene were associated with an increased risk ofatherosclerotic vascular events (Br J Nutr, 85,6: 749-54) (www.cabi-publishing.org).

Similarly, a review compiled by researchers at the University of Torontodemonstrated that serum and tissue lycopene levels were inversely related withchronic disease risk. Researchers noted that dietary intakes of tomatoes andtomato products that contain lycopene were associated with a decreased risk ofchronic diseases such as cancer and cardiovascular disease (J Am Coll Nutr,19,5: 563-9, 2000).

The Mediterranean diet, specifically omega-3 fatty acid intake, hasbeen studied recently because of its seeming connection with healthier hearts.The American Heart Association (AHA) and the American College of Cardiologyreleased a 2001 update of its 1995 guidelines to reduce heart attacks (http://circ.ahajournals.org).Among the recommendations was a suggestion that a diet high in omega-3 fattyacids could reduce the incidence of heart attacks. Also, the NationalCholesterol Education Program (NCEP) recently released new guidelines forpreventing and treating atherosclerosis that include lowering triglycerides andincreasing HDL-cholesterol levels.

In 2001, omega-3 fatty acids doubled in popularity from 2000 to earn tenthplace on NMI's top ten supplements of 2001 list. According to NMI, of consumerspolled, 5.4 percent used omega-3 supplements in 2001.

A review compiled by researchers at Emory University in Atlanta stated,"Randomized clinical trials with fish oils--eicosapentaenoic acid (EPA) anddocosahexaenoic acid (DHA)--and alpha-linolenic acid (AA) have demonstratedreductions in risk that compare favorably with those seen in landmark secondaryprevention trials with lipid-lowering drugs." Researchers also noted thatthe cardioprotective effects of omega-3 fatty acids may include anti-arrhythmic,hypolipidemic and antithrombotic roles (Arch Intern Med, 161,18: 2185-92,2001).

B vitamins, including folic acid, have also been indicated forcardiovascular wellness. In fact, in January 1998, FDA required that allenriched grain products contain 140 mcg of folic acid per 100 g, which wasconsidered to be able to reduce homocysteine levels--a risk factor for CHD.Researchers at the University of California, San Francisco, approved this methodfor improving general heart health in a cost-effective manner through a reviewof the Coronary Heart Disease Policy Model. They hypothesized that supplementinggrains with folic acid decreased CHD events by 8 percent in women and 13 percentin men, with comparable reductions in CHD mortality (JAMA, 286,8: 936-43,2001) (www.jama.com).

On Sept. 5, 2000, FDA authorized the use of labeling health claims about therole of plant sterol/stanol esters in reducing the risk of CHD for foodscontaining these substances. The comment period was reopened in 2001, closing inNovember, although FDA had not issued a final rule as of press time. FDA did,however, offer an example of a health claim for foods that contain plant sterol/stanolesters: "Foods containing at least 0.65 grams per serving of plant sterolesters, eaten twice a day with meals for a daily total intake of at least 1.3grams, as part of a diet low in saturated fat and cholesterol, may reduce therisk of heart disease. A serving of [name of the food] supplies ___ grams ofplant sterol esters." Details of the interim rule are available on theCenters for Food Safety and Applied Nutrition (CFSAN) Web site (www.cfsan.fda.gov),and comments sent in to FDA regarding the final rule are available on the FDAWeb site (www.fda.gov) under docket numbers00P1275 and 00P1276.

In recent research, plant sterol/stanol esters have been shown in animalmodels to reduce cholesterol. In a Netherlands study, researchers compared fivegroups of mice that received specialized diets for nine weeks. Compared to thecontrol diet, the plant stanol ester treatment (consisting of 88 percentsitostanol, 10 percent campestanol) reduced serum cholesterol levels by 10percent to 33 percent. Scientists concluded that plant stanol ester feedingdose-dependently lowered serum cholesterol levels as a result of a reducedsecretion of very low density lipoprotein cholesterol (Arterioscler ThrombVasc Biol, 21: 1046, 2001).

Garlic (Allium sativum) was listed by NMI as the fourth mostpopular supplement of 2001, with 15.4 percent of study respondents admitting tousing it. Garlic has grown 64 percent in popularity since 2000.

According to research, garlic has been found to protect heart health bylowering blood pressure. In a Pakistani pilot trial, researchers studied 101subjects' diets to determine if dietary garlic intake affected blood pressure.They found a positive correlation in systolic blood pressure and high dietarygarlic intake, concluding that individuals who have lower blood pressure arelikely to consume more garlic in their diets than those who have higher bloodpressure (J Pak Med Assoc, 50,6: 204-7, 2000).

Researchers at the University of Wolverhampton in the United Kingdom soughtto determine the effects of garlic oil capsules on healthy subjects to determineif they would demonstrate a decreased risk of coronary heart disease. Each of 27subjects took 12.3 mg/d of garlic oil (or placebo) capsules for 16 weeks.Subjects taking garlic oil supplements experienced a decreased risk of coronaryheart disease, specifically changes in blood pressure, plasma lipids, totalantioxidant status, LDL composition and blood clotting factors (Blood CoagulFibrinolysis, 12,1: 67-74, 2001).

Take Heed

While the numerous heart healthy ingredients in the natural products industryare proving themselves through clinical trials, there are additional trialslinking them to adverse events in specific populations. Soy, garlic andantioxidants are a few of the ingredients being scrutinized in recent research.

A 2001 study published in The Journal of Clinical Endocrinology &Metabolism (86,7: 3053-60) (http://jcem.endojournals.org)suggested that while soy protein isolate (40 g soy protein and 118 mgisoflavones) improved blood pressure and lipid levels in 213 subjects, malesubjects suffered a decline in endothelial (cells that line the heart) function.This study was, however, refuted in another study that suggested administeringgenistein, a soy isoflavone, could eliminate this effect (Free Radical Res,34,1: 101-12, 2001).

Antioxidants have received some negative press because they were shown toblock HDL levels in patients on simvastatin-niacin therapy for coronary arterydisease. According to a study at the University of Washington, Seattle, theremay be an adverse reaction in CAD patients on lipid therapy when they takeantioxidants. In the 12-month study (Aterioscler Thromb Vasc Biol, 21:1320, 2001), patients taking simvastatin-niacin therapy as well as vitamins Eand C, beta-carotene and selenium demonstrated blunted HDL levels, while otherpatients experienced an improved ratio of HDL to LDL levels.

While lycopene has been shown to decrease the risk of cardiovascular disease,it may not do so in smokers. A study conducted in the United Kingdom involved 34healthy women (18 nonsmokers, 16 smokers) who followed three diets for one weekeach after an eight-day depletion period. Each diet consisted of an intake of300 to 400 g/d of vegetables rich in beta-carotene, lutein or lycopene. Afterthe lycopene-rich diet, all subjects' serum lycopene concentrations wereincreased, but only the nonsmokers demonstrated a reduction in susceptibility ofLDL to oxidation (Clin Chem, 46,11: 1818-29, 2000) (www.clinchem.org).

According to researchers at the National Institute of Allergy and InfectiousDiseases, a division of the National Institutes of Health (NIH), garlicsupplements may reduce the efficacy of saquinavir, a pharmaceutical HIVmedication. The NIH study indicated garlic supplements reduced subjects' bloodlevels of saquinavir by more than half (Clinical Infectious Diseases) (www.journals.uchicago.edu)and resulted in a recommendation that HIV patients use caution with garlicsupplements.

This study was challenged by the American Institute of Biosocial and MedicalResearch (AIBMR) in mid-December. "The recent attention given to anine-subject pharmacokinetic study modeling the effect of garlic on saquinaviramong HIV patients is very disturbing," said Alexander Schauss, Ph.D.,director of natural and medicinal products research at AIBMR. "Saquinaviris not even approved by the FDA in the way it was used in the study."

Another trial involving garlic that had surprising results was a UnitedKingdom study that sought to determine whether enteric coating would increasethe efficacy of garlic supplements, but instead found that women showedfavorable effects in terms of a lowered risk of coronary heart disease, althoughthe men demonstrated "small adverse events" (J Nutr, 131,5:1471-8, 2001).

Diet and exercise play a large role in protecting heart health, fromchildhood through adulthood. According to a national survey conducted by OpinionResearch Corp., most Americans (78 percent) are not aware that heart diseasebegins developing during childhood. However, many children consume large amountsof foods that are high in saturated fat, leading to an adulthood troubled byhigh blood pressure and cardiovascular risks.

According to AHA, the number of deaths from cardiovascular diseases hasincreased since 1940--mainly because America has "aged," as thegeneral and the elderly populations increase. In addition, modern lifestyles,secondhand smoke, inactivity and poor diets are taking their toll oncardiovascular wellness. In a published paper, co-author Lyn Patrick, N.D.,estimated that by the year 2020, cardiovascular disease would be responsible for36 percent of all deaths and be the leading cause of death in the world (AlternMed Rev, 6,3: 248-71, 2001).

Consumers the world over are recognizing that heart health is the key to along, healthy life. Preventive measures such as controlling blood pressure,balancing cholesterol levels and taking heart-friendly supplements maypotentially protect heart health and ward off serious cardiovascular events.Retailers can be sure that consumers will ask about the latest research in thisfield, from soy to antioxidants, from garlic to plant sterol/stanol esters.These products will continue in their popularity as heart health continues to beon everyone's mind.

Editor's note: INSIDER is pleased to present Health ConditionFocus, a new column that will feature a different health topic in each issue,looking at the recent research and marketing opportunities available forsupplement companies. If you would like to submit research for a future HealthCondition Focus column, please contact Heather Granato, group editor, at [email protected]or (480) 990-1101 ext. 1305.

Cardio Fact Box

Cardiovascular Diseases

Stroke

Hypertension

*Source:2001 Heart and Stroke Statistical Update, American HeartAssociation