Therapeutic lifestyle changes for cardiovascular disease

Nutraceutical support in heart failure: a position paper of the International Lipid Expert Panel (ILEP)

Heart failure (HF) is a complex clinical syndrome that represents a major cause of morbidity and mortality in Western countries. Several nutraceuticals have shown interesting clinical results in HF prevention as well as in the treatment of the early stages of the disease, alone or in combination with pharmacological therapy. The aim of the present expert opinion position paper is to summarise the available clinical evidence on the role of phytochemicals in HF prevention and/or treatment that might be considered in those patients not treated optimally as well as in those with low therapy adherence. The level of evidence and the strength of recommendation of particular HF treatment options were weighed up and graded according to predefined scales. A systematic search strategy was developed to identify trials in PubMed (January 1970 to June 2019). The terms 'nutraceuticals', 'dietary supplements', 'herbal drug' and 'heart failure' or 'left verntricular dysfunction' were used in the literature search. The experts discussed and agreed on the recommendation levels. Available clinical trials reported that the intake of some nutraceuticals (hawthorn, coenzyme Q10, l-carnitine, d-ribose, carnosine, vitamin D, probiotics, n-3 PUFA and beet nitrates) might be associated with improvements in self-perceived quality of life and/or functional parameters such as left ventricular ejection fraction, stroke volume and cardiac output in HF patients, with minimal or no side effects. Those benefits tended to be greater in earlier HF stages. Available clinical evidence supports the usefulness of supplementation with some nutraceuticals to improve HF management in addition to evidence-based pharmacological therapy.

No short-term effects of calorie-controlled Mediterranean or fast food dietary interventions on established biomarkers of vascular or metabolic risk in healthy individuals

BACKGROUND/OBJECTIVES

This study addressed the question whether the composition of supposedly 'healthy' or 'unhealthy' dietary regimes has a calorie-independent short-term effect on biomarkers of metabolic stress and vascular risk in healthy individuals.

SUBJECTS/METHODS

Healthy male volunteers (age 29.5 ± 5.9 years, n = 39) were given a standardized baseline diet for two weeks before randomization into three groups of different dietary regimes: fast food, Mediterranean and German cooking style. Importantly, the amount of calories consumed per day was identical in all three groups. Blood samples were analyzed for biomarkers of cardiovascular risk and metabolic stress after two weeks of the baseline diet and after two weeks of the assigned dietary regime.

RESULTS

No dietary intervention affected the metabolic or cardiovascular risk profile when compared in-between groups or compared to baseline. Subjects applied to the Mediterranean diet showed a statistically significant increase of uric acid compared to baseline and compared to the German diet group. Plasma concentrations of urea were significantly higher in both the fast food group and the Mediterranean group, when compared to baseline and compared to the German diet group. No significant differences were detected for the levels of vitamins, trace elements or metabolic stress markers (8-hydroxy-2-deoxyguanosine, malondialdehyde and methylglyoxal, a potent glycating agent). Established parameters of vascular risk (e.g. LDL-cholesterol, lipoprotein(a), homocysteine) were not significantly changed in-between groups or compared to baseline during the intervention period.

CONCLUSIONS

The calorie-controlled dietary intervention caused neither protective nor harmful short-term effects regarding established biomarkers of vascular or metabolic risk. When avoiding the noxious effects of overfeeding, healthy individuals can possess the metabolic capacity to compensate for a potentially disadvantageous composition of a certain diet.

Intra-operative grading of coronary artery atherosclerosis associated with homocysteine levels in postmenopausal women undergoing elective off-pump CABG surgery

Background:

Atherosclerosis is one of the common causes of morbidity and mortality, in postmenopausal women. Homocysteine, a sulfur-containing amino acid product of methionine metabolism, may play an important role in the development of cardiovascular diseases. This study was designed to evaluate the relationship between intra-operative grading of coronary artery atherosclerosis and homocysteine level in postmenopausal women who were candidates for off-pump coronary bypass graft surgery (CABG).

Materials and Methods:

In this cross-sectional study, 136 postmenopausal women (with the mean age of 54.9±4 years) were enrolled as candidates for elective off-pump CABG. For each patient the extent and severity of atherosclerosis was assessed by intra-operative grading (IOG) and Gensini score system. Total homocysteine was determined with ELISA method after 12 hours of fasting. The patients were classified into two groups (diffuse vs. discrete) based on intra-operative findings. Finally the relation between age, IOG, and Gensini score with homocysteine level was assessed by ANOVA, T-test, and Tukey HSD test.

Results:

There was a positive correlation between intra-operative grading and homocysteine level in both groups (P=0.005). The association between Gensini score and homocysteine was significant in higher levels of hyperhomocysteinemia (P<0.05). The homocysteine level also increased with age; therefore, patients were classified into two categories (<54 years and ≥54 years) by Levene test. Statistical analysis indicated no relationship between IOG, Gensini score, and homocysteine level in the patients who were younger than 54 years (P=0.3, P=0.2), but significant relation was detected between IOG, Gensini score, and homocysteine in the patients who were older than 54 years with diffuse or discrete lesions in coronary arteries (P=0.001, P=0.001).

Conclusion:

According to our findings, homocysteine level increases in post-menopausal women that can be an important risk factor for atherosclerosis and cardiovascular diseases.