ABSTRACT:
Cardiovascular disease has traditionally been treated with a magnitude of pharmaceuticals that have had somewhat modest benefits however, a move back to more natural therapeutics is becoming popular amongst doctors. The identification of omega-3 fats as a significant health requirement, especially for cardiovascular health, has changed the way many practitioners treat their patients. Nutrition can have a considerable influence in the maintenance of cardiovascular health.
Keywords: cardiovascular health, neurocard, omega-3, bacopa, magnesium, calcium, heart
A Shift in the Paradigm of Cardiovascular Health
Cardiovascular disease is the biggest killer in most populations around the world. Tackling cardiovascular disease by conventional pharmaceuticals has not brought the significant improvements that would be expected from decades of medical research. Instead, the identification of the major risk factors of cardiovascular disease has led to more preventative measures to maintain and improve cardiovascular health before the onset of symptoms. Not only can preventative treatment delay the onset of disease, but it remains significantly more cost effective than expensive drug regimens and surgery in progressive cardiovascular disease. Therefore, it is no wonder that a large proportion of the worldwide population has increasingly been seeking alternative medicines for preventing cardiovascular diseases. The apparent rise in the utilization of complementary and alternative medicines and therapies, has forced the medical community to consider the currently available evidence supporting complementary medicines, and the possible synergistic benefits with pharmaceuticals.
In the early stages of cardiovascular disease, it is usually investigations carried out by a doctor that reveal underlying risk factors. These risk factors are categorized into modifiable and non-modifiable. Most commonly, increased blood pressure and/or elevation in cholesterol and “bad” fats within the blood are identified as primary risk factors for cardiovascular disease. Monitoring these variables is essential in the maintenance of health and the avoidance of cardiovascular diseases from presenting earlier than they should. When blood pressure and cholesterol levels rise into an unacceptable category, as determined by health guidelines and recommendations, the decision to begin drug therapy is inevitable. However, before it reaches this point, there is plenty that can be done. Often doctors will delay the implementation of pharmaceuticals and encourage lifestyle changes, in the effort to reduce these cardiovascular disease markers. Complementary and alternative medicines has a significant role here, in the prevention of cardiovascular disease, such as nutrition.
Nutrition and Cardiovascular Disease
One of the largest modifiable risk factors for cardiovascular disease is nutrition. Dietary fats come in a range of different forms, some healthy and some unhealthy. High cholesterol diets can result in elevated blood cholesterol, which is a major contributor to the development of atherosclerosis and heart disease. Body weight, blood glucose and blood pressure are all associated with atherosclerosis and vascular disease. Nutrition can modulate these surrogate markers of cardiovascular disease, and delay the development and progression of disease.
There have been many studies showing the benefits of foods and nutrients for cardiovascular disease, stemming from observations of diets around the world and prevalence of cardiovascular illnesses. Most recently, the discovery of the potential benefits of fish oils for cardiovascular disease was found when someone correlated the fact that Northern Greenland Eskimos had particularly low rates of cardiovascular disease. As the Eskimos are known to have a diet rich in fish, the constituents of fish oils were identified as potential targets for research. Since this pivotal observation, fish oils have been extensively studied for their beneficial effects on cardiovascular health, as well as brain health, with very encouraging results.
Blood pressure
One of the major risk factors for cardiovascular disease is high blood pressure. Not only does high blood pressure put extra strain on the heart, but it can cause problems in the peripheral vessels that supply the body. High blood pressure, or hypertension, is caused by a range of different factors, most of which are usually unable to be distinguished in a particular patient. The resistance of blood vessels contributes to blood pressure, and many foods and other substances can affect this system. For example, the polyphenols within red wine have shown to decrease blood pressure by causing a relaxation of the muscle of arteries [1]. More importantly, essential nutrients such as omega-3 fats and minerals can improve blood pressure.
Omega-3
Several studies have shown that particular nutrients have a beneficial effect on reducing blood pressure. As described already, omega-3 has many known favorable effects on cardiovascular health. In a large study involving over 4,500 patients, it was found that omega-3 significantly reduces blood pressure [2]. It is thought that omega-3 increases the level of nitric oxide within arteries, which causes a significant relaxation of the arterial wall pressure or vasodilation. The most significant effects of omega-3 on lowering blood pressure have been observed in those aged over 45 and people with hypertension.
Magnesium
Another nutrient that has been known to improve blood pressure outcomes is magnesium. Several large epidemiological studies have shown that diets high in magnesium have a protective effect on cardiovascular health by reducing blood pressure [3-5]. One study of more than 30,000 men conducted over 4 years found an inverse relationship between dietary magnesium and hypertension [3]. Unfortunately, foods high in magnesium are also usually high in potassium, which is undesirable for cardiovascular health in large amounts. Therefore, supplements containing magnesium are a good way to support cardiovascular health.
Calcium
Calcium is well known for its critical role in bone health, but calcium also plays a role in blood pressure maintenance. Studies show that calcium reduces systolic blood pressure, particularly in the elderly when calcium levels are often low. A systematic review of 42 randomized controlled trials showed an overall reduction in systolic and diastolic blood pressure measurements attributable to calcium supplementation [6]. Not only is calcium good for your bones, but it improves your blood pressure as well.
Folate
Several studies have been conducted on the beneficial effects of folate on cardiovascular health including blood pressure [7, 8]. Most of the studies involved people with pre-diagnosed hypertension, showing significant improvements in lowering blood pressure. The mechanism by which folate reduces blood pressure is associated with its effects on lowering blood levels of homocysteine.
Bacopa Monniera
In a study examining the effects of bacopa on anxiety, it was serendipitously found that bacopa may also lower blood pressure. In a study involving 35 patients with anxiety, the treatment of bacopa resulted in a decrease in average diastolic blood pressure of 117mmhg to 112mmhg [9].
Homocysteine
The discovery of homocysteine as an indicator of cardiovascular disease was found when assessing the link between congenital elevations of homocysteine in children and an increased risk of premature vascular disease [10]. Since then, much research into homocysteine has revealed its significance as a cardiovascular risk factor. It was suggested that levels of homocysteine may be an even better indicator of cardiovascular disease progression than blood pressure and cholesterol [11]. Chemically, homocysteine is an amino acid synthesized from methionine.
Folate is directly involved in the metabolism of homocysteine, resulting in its conversion into methionine. The effect of folate in lowering levels of homocysteine significantly improves endothelial function of arteries, reducing the impact of hypertension and atherosclerosis [12]. Supplementation with folate has shown long term benefits in homocysteine levels and arterial function [13]. It is thought that via this action, folate also improves blood pressure measurements. Therefore folate is essential for the maintenance of cardiovascular health.
Atherosclerosis
The development of atherosclerosis can begin in the early 20s, when the initial stages of arterial damage lead to “fatty streaks” present on the walls of the artery. It is thought that atherosclerosis occurs when there is an initial injury to the inside of the blood vessel, called the intima. Oxidative stress and inflammatory substances contribute to the early damage to the intima. Macrophages, a component of the innate immune system, invade the vessel wall and result in a further inflammatory response. Circulating fats and cholesterol adhere to the growing plaque and are incorporated into the intima. The amount of cholesterol circulating in the blood is dependent on the ratio of micro-packages of fats called lipoproteins; HDL and LDL. LDL is associated with unhealthy saturated fats and higher levels of cholesterol. Once the cholesterol and fats accumulate in the wall of the artery, additional factors such as fibrosis and smooth muscle incorporation occur and the plaque develops into a mature thrombus.
There are two ways the rapidly growing thrombus can result in illness. Firstly, the thrombus may obstruct normal blood flow within the artery and starve tissue of essential oxygen and nutrients such as glucose. Most commonly in terms of cardiovascular illness, the coronary arteries that supply the heart are affected and the heart is starved of oxygen. All tissues rely on oxygen and cannot last long without it, particularly the heart. If an area of the heart is deprived of its blood supply for too long, it can become irreversibly damaged, known as an acute myocardial infarction or heart attack. Depending on the severity, this may be fatal if urgent medical attention is not available. Secondly, if the thrombus becomes unstable and dislodges into the bloodstream (embolism), it may lodge in another artery and cause localized damage. This is the mechanism behind stroke which results in the deprivation of blood supply including critical oxygen to the brain. Unlike the heart, the brain is significantly more fragile to loss of oxygen and usually becomes irreversibly damaged in a matter of minutes.
Polyunsaturated fats such as omega-3 reduce the amount of circulating LDL and cholesterol, and reduce the attachment of LDL to the vessel walls, delaying the progression of atherosclerosis. Fatty acid and cholesterol intake is important in health and disease, of the blood vessels and the heart. Fish oils contain a high concentration of omega-3 fatty acids, which are polyunsaturated fats with multiple double bonds. This means that these omega-3 fats are more fluid and mobile within the body, than other fats, which have a positive effect on fat metabolism within the body. Omega-3 reduces the amount of triglycerides within the blood, also limiting the amount of cholesterol being deposited in the tissues, preventing the development of atherosclerosis. Once established, omega-3 also stabilizes the thrombosis from rupture. Omega-3 also has anti-inflammatory properties that may decrease the likelihood of the initial injury to arteries in the early stages of atherosclerosis.
Modifiable Risk Factors of Cardiovascular Disease
The development of cardiovascular disease is affected by a range of risk factors, many of which that are deemed “modifiable”. Nutrition is a significant part of the prevention of arterial and heart problems. Other modifiable risk factors include physical inactivity and smoking, which remain significant health problems in the community. Attention should be given to reduce these risk factors also in the prevention of cardiovascular disease.
The Big Picture
So what does this all mean in terms of your cardiovascular health? Again, cardiovascular disease is the largest cause of mortality in the world. Congestive heart failure, coronary artery disease, cerebrovascular disease (stroke), and peripheral arterial disease are among the leading causes of death.
It is becoming increasingly evident to the public and health professionals that complementary medicines including specific nutrients can significantly improve cardiovascular health. Recommendations for the incorporation of natural medicines in the prevention and treatment of cardiovascular disease should be considered, as there is sufficient evidence to show a benefit of specific nutrients on cardiovascular outcomes.
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