Researched Heart Health Benefits

Steve Myers, Senior Editor

September 27, 2012

19 Min Read
Researched Heart Health Benefits

Of the many risk factors associated with heart health and cardiovascular disease (CVD), the primary targets of natural products are cholesterol, triglycerides, blood pressure, blood flow, endothelial function, atherosclerotic plaque formation and heart rate/rhythm. The broader view considers the effects of natural ingredients on various cardiac events, in preventing and limiting damage, as well as aiding recovery.

Cholesterol is one of the most common risk factors for heart disease and is the focus of many consumers. The body needs cholesterol for many important tasks, and naturally gets only the it needs from the liver. However, excess cholesterol from the diet can contribute to the formation of atherosclerotic plaque, which a deposit of cholesterol, fibrin, calcium and other substances in the blood. Under certain conditions, these plaques can narrow arteries and possibly break off to become a clot (thrombus), which can result in the heart (and other vital organs) not receiving enough blood and oxygen, causing a heart attack.

Consumers trying to lower levels of bad cholesterol, or LDL, have responded to studies showing intake of plant sterols, which are structurally similar to endogenous cholesterol, can reduce absorption of cholesterol, possibly by competing with LDL for absorption in the intestines.1 The evidence on plant sterols in cholesterol reduction convinced FDA to authorize a health claim that plant sterols may reduce the risk of heart disease when combined with a diet low in cholesterol and saturated fats.

Other compounds studied for LDL-lowering effects include aged garlic extract (AGE),2 olive oil phenols,3 phytoestrogens,4 cocoa5 and chromium.6 Supplementation with chromium nicotinate (as ChromeMate®, from InterHealth USA) can help maintain healthy cholesterol levels already in the normal range.7 When combined with regular exercise, the supplement can support healthy body weight8 and composition by maintaining lean body mass,9 thereby improving an important lifestyle factor in heart health.

Beta-glucans also have an FDA-approved health claim for lowering cholesterol, based on studies showing beta-glucan intake can lower LDL in cases of high cholesterol or mild hypercholestemia.10,11 A combination of beta-glucan and chitin-glucan (as ARTINIA) may reduce oxidized LDL by as much as 26 percent in people with normal cholesterol levels.12

Oxidized LDL contains free radicals that contribute to atherosclerosis plaque formation. Oxidized LDL can wreak havoc in the endothelium (blood vessel lining), triggering inflammation, increasing foam cell production (atheroma cells) and  reduced nitric oxide (NO) production. NO helps blood vessels relax and dilate, which improves blood flow.

A number of antioxidant ingredients have been studied for possible inhibition of the oxidation of LDL and other lipids. Green tea polyphenols have reduced oxidized LDL concentration and improved brachial artery blood flow in healthy women.13 Similarly, cocoa polyphenols have demonstrated a protective effect against LDL oxidation and may increase high-density lipoprotein (HDL) cholesterol, often called good cholesterol, because it shuttles LDL cholesterol back to the liver.14

The carotenoid lycopene has been shown to decrease foam cell formation triggered by oxidized LDL.15 Other research reported lycopene can preserve myocardial antioxidant status and significantly inhibit lipid peroxidation resulting from myocardial ischemia-reperfusion injury.16 Also, a trial in healthy men found lycopene supplementation improved endothelial function by increasing activity of superoxide dismutase (SOD) and endogenous antioxidants.17 The results  further linked lycopene to reduced high-sensitivity C-reactive protein (hs-CRP), a marker of inflammation, and reduced systolic blood pressure.

Coenzyme Q10 (CoQ10), as ubiquinol, inhibited lipid peroxidation in the arterial wall in one study.18 A 2012 report detailed how CoQ10 improved antioxidant status and controlled oxidation in human umbilical cord cells subjected to oxidized LDL.19 CoQ10 also limited oxidized LDL's enzymatic reduction of NO synthesisNO signals the endothelium to relax, triggering vasodilation and improved blood flow.

Lipoproteins contain cholesterol, triglycerides and protein. Very low-density lipoprotein (VLDL) has the highest concentration of triglycerides among the lipoproteins, and is also associated with heightened risk of atherosclerosis. Pterostilbene, a compound found in blueberries and grapes, can help regulate cholesterol and lower the body's production of VLDL and triglycerides by acting on transcription factor PPAR-alpha.20 This may also raise levels of HDL.21

People with controlled LDL levels may still have increased heart disease risks if their HDL levels are too low. A number of ingredients increase HDL levels. Recent research showed supplementation with whole grape extract (as Vincare, from Ethical Naturals) increased HDL and the ratio of HDL to total cholesterol.22

B vitamin niacin (nicotinic acid) improved HDL levels by limiting the breakdown of HDL; it also inhibited an enzyme required for synthesis of triglycerides, which resulted in decreased production of VLDL and LDL.23 Early studies showed niacin supplementation increased HDL levels and, when combined with statin drugs, inhibited atherosclerosis development.24,25 However, a recent National Institutes of Health (NIH) large clinical trial (AIM-HIGH) investigating combined high-dose niacin (extended release) and statin therapy on low HDL and high triglycerides in metabolic syndrome patients was halted early after researchers found no additional benefit from the high-dose niacin on cardiac events.26 The niacin treatment increased HDL by 20 percent and reduced triglycerides by 25 percent.

Long-chain omega-3 essential fatty acids (EFAs) from fish oil raised HDL and decreased triglycerides as part of a roster of benefits for heart health.27  Fish oil can help lower unhealthy levels of LDL cholesterol,28 and EPA (eicosapentaenoic acid) from fish oil taken with statins by patients with a history of coronary artery disease reduced major coronary events by 19 percent compared to stain treatment alone.29

Considering other sources, docosahexaenoic acid (DHA) from algae also reduced triglycerides and increased HDL.30 Protection from LDL oxidation is another finding associated with DHA supplementation.31 Likewise, krill oil reportedly improved the HDL:triglyceride ratio compared to fish oil.32 Krill has also shown a greater effect on lipid and glucose metabolism than has fish oil.33

The net effect of these fatty acids on heart health has been varied. EPA and DHA in tandem have been linked to lower risk of fatal cardiac events, as has the combination of DHA with docosapentaenoic acid (DPA).34 This research review further revealed DHA can positively impact atrial fibrillation, and EPA plus DPA correlated with lower risk of non-fatal CVD endpoints.

High doses of polyunsaturated fats may cause a slight decrease in blood pressure, especially systolic pressure.35 Chronic hypertension can weaken blood vessels by exerting damaging pressure on the vessel walls and can contribute to heart attacks and other CVD events related to thrombosis and blocked arteries. Several natural ingredients can help manage blood pressure.

Soy protein has lowered blood pressure in both normotensive and hypertensive women,36 and isoflavone-rich soy powder added to a high-fat diet can limit blood pressure increases and oxidative damage and improve endothelial health.37

Botanicals rich in phytonutrients such as flavonoids have turned in consistent results on blood pressure. Grapes can address inflammatory contributors to hypertension and endothelial dysfunction,38 while grape seed extract (GSE) can lower systolic and diastolic blood pressure in pre-hypertensive adults,39 and improve endothelial function.40 The key may be GSE's antioxidant phtyochemicals, including oliomeric proanthocyanidin complexes (OPCs).

Pine bark is also rich in OPCs and has shown promising results against hypertension. Pycnogenol, a branded French maritime pine bark extract from Horphag Research, reduced systolic, but not diastolic, pressure.41 A 2012 study found Pycnogenol taken by patients with stable coronary artery disease improved endothelial function and increased blood flow via arterial dilation.42

Other flavonoid-rich botanical ingredients found to offer blood pressure benefits include catechin-rich tea,43 anthocyanin-rich chokeberries44 and flavanoid-rich pomegranates.45

Vitamin C aids in collagen production and vascular flexibility, and supplementation with the nutrient has reduced both systolic and diastolic blood pressure in hypertension patients.46 Used in conjunction with hypertensive therapy, vitamin C lowered systolic pressure and oxidative stress.47 Vitamin C is a heart-health juggernaut, also lowering LDL and triglycerides,48 inhibiting platelet aggregation,49 and reducing potentially damaging inflammation (as marked by CRP levels).50Combined use of vitamins C and E by hypertensive men for eight weeks not only lowered systolic and diastolic pressure, but also increased antioxidant status.51 Another study in a similar population found this vitamin combo significantly improved arterial flexibility, flow-mediated dilation (FMD), vasodilation and oxidative stress.52 Nattokinase in fermented soy can inhibit thickening of the interior arterial wall, possibly by breaking down fibrin that contributes to clotting and plaque formation.53

Vasodilation, which expands the vessel and  improves blood flow, is a common benefit among ingredients that help attenuate blood pressure. In fact, research suggested vitamin E (as gamma-tocotrienols) may lower blood pressure by supporting endothelial nitric oxide synthase (eNOS),54 an enzyme involved in production of NO, which is needed for vasodilation. In patients with narrowing of the carotid artery (main vessel to the brain), supplementation with a complex of palm tocotrienolsmembers of the vitamin E familyreversed atherosclerosis progression.55 Palm tocotrienols also reduced aortic systolic pressure56 and, as Tocomin SupraBio (from Carotech Inc.), lowered total and LDL cholesterol in hypercholestemia57 and reduced arterial stiffness in healthy adults.58

NO-mediated vasodilation can be impaired in cases of high LDL cholesterol levels.59 A component of NO production is the amino acid L-arginine, which has been shown to reduce arterial pressure and improve endothelial function people with hypercholesterolemia and atherosclerosis.60

Ginkgo biloba supports vasodilation through the NO pathway and may also help in blood pressure management. In hypertensive subjects, ginkgo extract administration restored vasodilatory function and significantly improved systolic blood pressure.61 Standardized ginkgo extract (as EGb 761, from Schwabe Pharma) can suppress age-related increases in blood pressure, in addition to proving strong anti-thrombotic and antioxidant effects in stroke-prone hypertension.62

Other vasodilators that also limit blood pressure include Pycnogenol,63 garlic,64 magnesium65 and the natural polyphenol resveratrol.66 A 2011 review of magnesium in heart health noted the mineral is effective at blood pressure reduction, but is more effective in this regard when combined with potassium.67 The review further found magnesium is as effective as one antihypertensive drug and can increase the effectiveness of all antihypertensive medications. Overall, increased magnesium intake can improve insulin sensitivity, hyperglycemia, diabetes mellitus, left ventricular hypertrophy, dyslipidemia, NO production, endothelial function and vasodilation.

Resveratrol's actions in heart health were spelled out in a 2012 review article, which reported the polyphenol "reduces platelet aggregation, induces vasorelaxation, limits endothelial activation, and modulates lipid and lipoprotein metabolism."68 The underlying mechanisms behind these actions is not fully known, but reviewers noted pathways utilized by resveratrol include oxidative stress reduction and eNOS activation.

The NO pathway is just one of the targets of the lycopene-free Fruitfow tomato extract, which also interacts with cGMP signaling, Ca2+ flux and tissue factor (TF, pro-coagulant). A pair of studies demonstrated Fruitflow modulates platelet function to help limit aggregation and improve blood flow as soon as three hours after supplementation and lasting for at least 12 hours.69,70 A proprietary whey-derived bioactive peptide ingredient (as CVH47, from Glanbia Nutritionals) taken by men and women with impaired brachial artery flow-mediated dilation (FMD) improved FMD, but not via the NO pathway.71

The many approaches to heart health and the many ingredients in the heart health marketplace can be overwhelming, but scientific results and R&D progress can shine a light on the best products. Whether focusing on one specific aspect of heart health, such as NO-mediated vasodilation or oxidized LDL, or favoring ingredients or products that act on multiple risk factors, including obesity and diabetes, the growing heart health market appears to have room for new and improved formulations. Ability to work in the increasingly popular convenient functional food and beverage formats is a plus, although supplements are still a popular format in the United States and should not be ignored.

References listed on the next page.

For more on Heart Health ingredients and the market, visit INSIDER's Heart Health Content Library.


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29. IBID Yokoyama

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About the Author(s)

Steve Myers

Senior Editor

Steve Myers is a graduate of the English program at Arizona State University. He first entered the natural products industry and Virgo Publishing in 1997, right out of college, but escaped the searing Arizona heat by relocating to the East Coast. He left Informa Markets in 2022, after a formidable career focused on financial, regulatory and quality control issues, in addition to writing stories ranging research results to manufacturing. In his final years with the company, he spearheaded the editorial direction of Natural Products Insider.

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