Cardiovascular disease vitamin

Antioxidants

Data from many sources, including laboratory experiments, epidemiology, animal studies and some clinical trials suggest that antioxidants may protect against the development of cardiovascular disease. The evidence is strongest for vitamin E and weakest for vitamin C.

Antioxidants may help prevent heart disease in a number of ways. They improve blood cholesterol levels and protect LDL cholesterol from oxidation. Oxidized LDL cholesterol is more likely to block arteries than unoxidized LDL cholesterol. Oxidized LDL cholesterol can also impair the action of nitric oxide, a chemical secreted by the blood vessel wall which dilates arteries. Levels of beneficial HDL cholesterol may be lowered by free radical activity. Antioxidants also help prevent the aggregation of blood platelets which can stick to blood vessel walls and cause blockages.

It is not yet clear what dose or in what combination, antioxidants provide the best protection. At the very least, it is important to consume the recommended dietary allowances for all antioxidants, especially from food which contains many other heart protective chemicals.

Cardiovascular disease vitaminCardiovascular disease vitamin: Carotenes

Many large population studies show that the risk of heart disease decreases with increasing beta carotene intake. Researchers involved in the Massachusetts Health Care Panel Study examined the links between consumption of carotene- containing fruits and vegetables, and death from cardiovascular disease among 1299 elderly people. The results of the study, which were published in the Annals of Epidemiology in 1995 showed that during the follow-up period of almost five years, there were 161 deaths from cardiovascular disease. The risk of death in the group who ate the most carotene-containing foods was almost half that of those people whose carotene consumption was low.

Results from the EURAMIC study suggest that antioxidants protect heart attacks. Researchers studied people from ten European countries and analyzed for levels of carotenes in those who had suffered heart attacks and those who had not. They found protective effects of alpha carotene, beta carotene, and lycopene. Lycopene was particularly protective, with those in the highest intake group having around half the risk of heart attack of those in the lowest intake group.

In a 1997 study, researchers in Italy investigated the relationship between nonfatal heart attacks and dietary intake of beta carotene. The study involved 433 heart attack patients and 869 women without cardiovascular disease. The results showed that women with high beta carotene intakes had around half the risk of heart attack of those with low intakes. The relationship between intake of dietary antioxidants and risk of stroke was investigated as part of the Chicago Western Electric Study. The researchers found a moderately reduced risk in those with high beta carotene intakes.

Supplements

Beta carotene supplements have been used in cancer and cardiovascular disease prevention trials including the Finnish Alpha Tocopherol Beta Carotene Cancer (ATBC) Prevention Study, the US Carotene and Retinol Efficacy Trial (CARET) and the US Physicians Health Study. In 1996 these studies reported results which received wide publicity. The ATBC Prevention group studied 29,000 men who smoked and drank alcohol. The results showed an 18 per cent increase in lung cancer deaths and an 11 per cent increase in ischemic heart disease deaths in men who took daily supplements of 20 mg beta carotene. The CARET study was stopped 21 months early. This study was examining the effect of beta carotene (30 mg daily) and retinol (7500 mcg RE daily) supplementation on the prevention of cancer and heart disease in over 18,000 smokers and people who had been exposed to asbestos. The trial was stopped when the results showed a 28 per cent increased risk of lung cancer, a 26 per cent increase in the risk of death from cardiovascular disease and a 17 per cent increase in overall deaths in the group receiving the supplements.

It seems likely that smoking and alcohol consumption contribute to the adverse effects of beta carotene supplements. The CARET results showed greater risk in current smokers than former smokers and also in those who drank alcohol. Recent laboratory research suggests that vitamin C protects against the harmful effects of beta carotene in smokers. Smokers tend to have low levels of vitamin C and this may allow a build-up of a harmful form of beta carotene called the carotene free radical which is formed when beta carotene acts to regenerate vitamin E. These results suggest that in smokers, dietary vitamin C supplementation should accompany beta carotene supplementation.

Cardiovascular disease vitaminCardiovascular disease vitamin: Vitamin C

Low vitamin C intake is linked to an increased risk of cardiovascular disease. As well as exerting beneficial effects on cholesterol levels, vitamin C also increases the production of prostacyclin, a prostaglandin which decreases the clumping of blood platelets and dilates blood vessels, therefore reducing the risk of heart disease, atherosclerosis and stroke.

In a study begun in 1981, USDA researchers assessed the health and nutrition status of 747 elderly people aged 60 years and over. Particular attention was paid to the foods the participants usually ate their blood levels of the antioxidant vitamins C, E and beta carotene. The researchers following up the subjects from nine to 12 years later found that among people who ate lots of dark green and orange vegetables, there were fewer deaths from heart disease and other causes. The results showed that a daily intake of more than 400 mgand higher blood levels of vitamin C were linked to reduced risk of death from heart disease.

In a study published in the British Medical Journal in 1995, UK researchers assessed the links between dietary intake and blood levels of vitamin C, and death from stroke and coronary heart disease in people aged 65 and over. The study involved 730 men and women who were followed up for a 20- year period. The results showed that those with the highest intakes had around half the risk of death from stroke when compared to those with the lowest intakes. However, in this study, no link was found between vitamin C status and risk of death from coronary heart disease.

Low vitamin C levels are also associated with an increased risk of heart attack. In a 1997 study, Finnish researchers examined this link in 1605 men aged between 42 and 60 who were free from heart disease when they entered the study. During the follow-up period there were 70 heart attacks. The results showed that men with vitamin C deficiency were three-and-a-half times more likely to have a heart attack than those who were not deficient. However, not all studies have shown protective effects of vitamin C. These include the large Nurses and Health Professionals Studies.

Researchers from Cambridge University in the UK examined the relationship between blood levels of vitamin C status and angina in women aged from 45 to 74. Forty-two women with previously undiagnosed angina were compared with 877 women with no disease. Those with higher vitamin C levels had a 66 per cent reduced risk of angina. The same researchers examined the link between blood levels of vitamin C and blood fat levels. Their results showed that a high intake of vitamin C from food raises beneficial HDL cholesterol and lowers serum triglyceride.

Supplements

Vitamin C supplements may help protect against the development of cardiovascular disease. The results of a 1996 study showed that those taking vitamin E supplements had a 47 per cent lower risk of death from heart disease and those taking both vitamin C and vitamin E had a 53 per cent reduced risk. High fat meals cause damage to artery linings, which may contribute to the development of atherosclerosis. Research suggests that taking the antioxidant vitamins C and E before a meal may help to prevent this damage. Vitamin C may also improve artery function in those with coronary artery disease, high cholesterol levels and chronic heart failure. When blood is re-supplied to an organ from which it was previously cut off, oxidative damage can occur. This has been found in many types of surgery; for example, in heart bypass operations. Vitamin C has been shown to protect against this reperfusion injury.

Vitamin C also seems to protect against smoking-related damage, possibly by decreasing the smoking-related build-up of atherosclerotic plaque and by improving artery function.

Cardiovascular disease vitamin: Vitamin E

High intakes of vitamin E may reduce the risk of heart disease. Some studies have only shown benefit from the amount of vitamin E that can be obtained in the diet, whereas others suggest that the amount of vitamin E needed to show protective effects is considerably more than a typical diet provides.

Results from the Iowa Women's Health Study suggest a link between low vitamin E intake and heart disease. Researchers studied 34,486 postmenopausal women with no cardiovascular disease who in early 1986 completed a questionnaire that assessed, among other factors, their intake of vitamins A, E, and C from food sources and supplements. During seven years of follow-up, 242 women died of coronary heart disease. The results showed that high vitamin E consumption reduced the risk of death from coronary heart disease. This association was particularly striking in the subgroup of 21,809 women who did not consume vitamin supplements.

Similar results have been seen in men. Harvard School of Public Health researchers have assessed the links between diet and heart disease in 39,910 US male health professionals aged between 40 to 75 years of age. Participants responded to a questionnaire in 1986 and were then followed up for four years, during which time there were 667 cases of coronary disease. The results showed a lower risk of disease among men with higher intakes of vitamin E. Men consuming more than 40 mg (60 IU) per day had a 36 per cent lower risk than those consuming less than 5 mg (7.5 IU) per day. Men who took at least 67 mg (100 IU) per day for at least two years had a 37 per cent lower risk than those who did not take supplements.

Vitamin E appears to play a part in decreasing the risk of angina. The results of a 1996 study done in Japan suggest that low vitamin E levels increase the risk of a variant angina, a form of the disease caused by coronary artery spasm. Results of the Finnish ATBC Prevention Study found a slightly reduced risk in those taking vitamin E supplements.

Cardiovascular disease vitaminSupplements

Results from the Nurses Health Study provide evidence for the protective effects of vitamin E supplements. Researchers assessed the links between vitamin E and heart disease in 87,245 female nurses aged from 34 to 59. During the follow-up period of eight years, there were 552 cases of major coronary disease

(437 nonfatal heart attacks and 115 deaths due to coronary disease). The results showed that women with the highest vitamin E intakes had 34 per cent less risk of major coronary disease compared to those with the lowest intakes. Most of the reduction in risk was attributable to vitamin E consumed as supplements, a finding which conflicts with some other studies which only show benefit from high dietary intakes. Women who took vitamin E supplements for short periods had little apparent benefit, but those who took them for more than two years had an even lower risk of disease.

Results from a British study known as the Cambridge Heart Antioxidant Study (CHAOS) which were published in The Lancet in 1996 provide further evidence of a link between vitamin E supplements and reduction in heart disease risk. In this double-blind, placebo-controlled study, 2002 patients with coronary atherosclerosis were enrolled and followed up for 510 days. 546 patients were given 536 mg (800 IU) daily; 589 patients were given 268 mg (400 IU) per day; and 967 received identical placebo capsules. The results showed that those who received vitamin E supplements had a 75 per cent reduction in the risk of non-fatal heart attacks. The beneficial effects were apparent after one year of treatment.

Cardiovascular disease vitamin: B vitamins

Thiamin

Marginal thiamin deficiency may contribute to heart disease as those with heart disease have been found to have lower than normal levels of thiamin in their heart muscle.

Niacin

Large doses of the nicotinic acid form of niacin are used to lower harmful LDL blood cholesterol and triglyceride levels, and raise levels of beneficial HDL cholesterol. Niacin also favorably influences other lipid levels including lipoprotein (a). Doses used range from 1500 to 2500 mg. The increase of HDL cholesterol seems to occur at a lower dose (1500 mg per day) than the reduction of LDL cholesterol. In general, it is usual to start taking lower doses (around 50 to 100 mg) and then gradually increase to the higher doses over a period of two to three weeks.

Researchers involved in a 1997 study done in Minneapolis compared blood lipid levels in 244 patients treated with niacin and 160 treated with lovastatin, a widely used cholesterol-lowering drug. The results showed that both lovastatin and niacin effectively reduced LDL cholesterol levels with a greater drop seen in those taking lovastatin. Niacin use was associated with a 16.3 per cent improvement in HDL cholesterol, while HDL cholesterol levels in the lovastatin group unproved 1.5 per cent. The improvement in triglyceride levels was also much greater in the niacin group.

Nicotinic acid can also enhance the effects of other cholesterol-lowering medications. This may mean that the doses of these drugs can be reduced, thus lessening the possibility of undesirable side effects. In a recent US study researchers found that combination therapy with niacin and low dose lovastatin was as effective as high dose lovastatin.

Nicotinic acid has also been shown to have favorable effects on the blood clotting system which can reduce the build-up of atherosclerotic plaque. It has also been used to treat peripheral vascular disease and circulatory disorders much as Raynaud's disease, as it dilates blood vessels thereby increasing blood flow to certain areas of the body.

Vitamin B6

Vitamin B6 deficiency seems to increase the risk of developing heart disease, most likely because of increased homocysteine levels. In a study published in 1998, researchers involved in a study done in several centers in Europe compared 750 patients with vascular disease and 800 control subjects of the same ages and sex. They measured blood levels of homocysteine, folate, vitamin B12, and vitamin B6. The results showed that those with high blood homocysteine concentrations had a high risk of vascular disease. In addition, low concentrations of folate and vitamin B6 were also associated with increased risk. In this study, the relationship between vitamin B6 and atherosclerosis did not appear to be solely due to increased homocysteine levels, suggesting that vitamin B6 may have other important roles in heart disease prevention.

Researchers involved in the Framingham Heart Study analyzed blood samples from the study participants to assess levels of homocysteine and the relationship between B vitamins and carotid artery narrowing, which increases the risk of heart attack. The results showed that low intakes of folate and vitamin B6 were associated with high homocysteine levels.

Intake of folate and vitamin B6 above the current recommended dietary allowance seems to be important in the prevention of coronary heart disease among women. Researchers from the Harvard School of Public Health investigated the links between intakes of folate and vitamin B6 and the incidence of heart attacks in 80,082 women taking part in the Nurses Health Study. The women had no previous history of cardiovascular disease, cancer, high cholesterol levels or diabetes when they entered the study. During the 14 years of follow-up, there were 658 nonfatal heart attacks and 281 fatal ones. The results showed that those with the highest intakes of vitamin B6 had just over 30 per cent less risk of heart attack than those in the low intake group. Women in the group with the highest intakes of both folate and vitamin B6 had just less than half the risk of women in the lowest intake group. Risk of coronary heart disease was reduced among women who regularly used multiple vitamins, the major source of folate and vitamin B6.

Supplements

In a study published in 1998, Irish researchers screened a group of clinically healthy working men aged 30 to 49 years and selected 132 with mildly raised homocysteine concentrations. They then assessed the effects of eight weeks of supplementation with B group vitamins and antioxidant vitamins on homocysteine concentrations. The men were randomly assigned to one of four groups: supplementation with B group vitamins alone (1 mg folic acid, 7.2 mg pyridoxine, and 0.02 mg vitamin B12); antioxidant vitamins alone; B-group vitamins with antioxidant vitamins; or placebo. The results showed significant decreases in both groups receiving B group vitamins either with or without antioxidants. The effect of the B group vitamins alone was a reduction in homocysteine concentrations of almost 30 per cent.

Vitamin B6 may also exert beneficial effects on the cardiovascular system by protecting against the aggregation of blood platelets. This prolongs clotting time and helps to reduce atherosclerotic plaque build-up. Vitamin B6 has also been shown to lower blood pressure and blood cholesterol levels. In a Swedish study published in 1990, researchers assessed the effect of 120 mg a day of vitamin B6 on seventeen 88 year-old men with low vitamin B6 levels. After supplementation for eight weeks, the average plasma total cholesterol and LDL cholesterol concentrations were decreased by 10 per cent and 17 per cent respectively.

Folic acid

Diets high in folic acid seem to reduce the risk of heart disease. As with vitamin B6, this is likely to be due to the relationship with homocysteine levels. In a study published in 1998, researchers at the Cleveland Clinic conducted a study to investigate the relationships between homocysteine, B vitamins, and vascular diseases. The study involved 750 patients with documented vascular disease and 800 control patients matched for age and sex. The results showed that those in the lowest 10 per cent of folate intakes had an increased risk of disease. A 1996 Canadian study of the relationship between fatal coronary heart disease and folic acid levels in 5000 men and women found thai the risk of ..... coronnarv heart disease increased as folic acid levels decreased Those in the lowest intake group were 69 per cent more likely to die of heart disease than those with the highest intakes.

Low blood folic acid levels also seem to increase heart attack risk in young women. In a 1997 study, researchers at the University of Washington measured the homocysteine, folic acid and vitamin B12 levels in 79 heart attack survivors under 45 and compared these with levels in 3 86 healthy control subjects. Those with the highest homocysteine levels had 2.3 times the risk of heart attack compared to those with the lowest levels. Those with the highest levels of folic acid had around half the risk of heart attack compared to those with the lowest levels.

Supplements

Several studies have examined the homocysteine-lowering effects of folate supplements. In a 1998 paper, researchers analyzed the results of randomized controlled trials that assessed the effects of folic acid-based supplements on blood homocysteine concentrations. The data included that from 1114 people in 12 trials. They found that 0.5 to 5 mg folic acid daily reduced blood homocysteine concentrations by 25 per cent.47 Those with the highest homocysteine levels may respond best to increases in folic acid intake; and above a certain level of intake, increasing folic acid may not affect homocysteine levels. In a 1997 Irish study, researchers assessed the effects of various doses of supplements on homocysteine levels. Of the three folic acid doses, 200 mcg appeared to be as effective as 400 mcg, while 100 did not lower levels sufficiently.

Vitamin B12

Vitamin B12 may also be important in maintaining normal levels of homocysteine.

Cardiovascular disease vitamin: Vitamin D

Low vitamin D levels may also increase the risk of atherosclerosis. Research suggests that a low level of vitamin D increases the risk of calcium build-up in atherosclerotic plaques, and that higher levels reduce the risk of build-up. Researchers at UCLA School of Medicine measured the vitamin D levels in the blood of 173 men and women at risk of heart disease and also measured the build-up of calcium in coronary arteries (a common finding in coronary artery disease). The results suggest that calcium may regulate calcium deposition in the arteries as well as in the bone.

 
 
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