Jitendra Singh Yadav¹, Sonia Pandey² and Arti Gupta^{1* *}Correspondence: Arti Gupta, Department of Pharmaceutical Sciences, Rama University, Uttar Pradesh, India, Email:

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Introduction

Diet and nutrition are important factors in the promotion and maintenance of good health throughout life and also play as a risk factor for chronic diseases (Matsudo V, et al., 2002). As per calculations, in 2001, chronic diseases contributed approximately 60% of the 56.5 million total reported deaths in the world contributed by chronic diseases and approximately 46% of the global burden of disease (WHO, 2002). The share of the NCD burden is expected to reach 57% by 2020. Nearly half of deaths from chronic diseases are caused by cardiovascular disease. The 2016 Heart Disease and Stroke Statistics update of the AHA reported that the overall death rate from CHD was 102.6 per 100,000 (Mozaffarian D, et al., 2016). There is a strong relationship between SCD and CHD (Montagnana M, et al., 2008). Clinical and post-mortem studies as well as data from death certificates revealed that 62%-85% of patients who suffer out-of-hospital SCD have evidence of prior CHD, 10% have other structural cardiac abnormalities, and 5% have no structural cardiac abnormality (Kannel WB and Thomas Jr HE, 1982; Zheng ZJ, et al., 2001). A surveillance study of SCD from Ireland concluded that the majority of cases occurred at home and that successful resuscitation of SCD was especially associated with ventricular fibrillation as presenting rhythm (Byrne R, et al., 2008). IHD was also the greatest single cause of death in 2000, accounting for an estimated 6.0 million deaths. Individual populations face different challenges and each population has unique health burdens, however, CVD remains one of the greatest health challenges both nationally and worldwide (McAloon CJ, et al., 2016). Obesity is associated with some of the major risk factors for CVD, such as hypertension and low concentrations of High-Density Lipoprotein-cholesterol (HDL-cholesterol) (WHO, 2002). Arterial blood pressure and Hypercholesterolemia are key factors in the development of CVD.

Literature Review

Extensive study has been done in order to derive the solution to the question at hand. The majority of the study conducted revolves around the usage of e-books, most of which focused exclusively on essential nutrients. Additionally, government websites provided more information regarding what types of medications are used on cardiovascular diseases, as well as the short-term and long-term effects of their use. Furthermore, a couple of case studies detailed some students in India, and how their health improved with a conversion to a essential nutrients. The sources that are being used are several academic, peer-reviewed research papers, books, journals, and case studies. The mode of methodology that will be used to carry out the research is mixed between data analysis and experiments given in the case studies.

There has been a boom in their sales as patients rush to self-medicate, either in the hope that these products will be effective in treating diseases unsatisfactorily treated with pharmaceuticals, or that the adverse effects of some pharmaceuticals may be avoided. On whole, ‘Nutraceuticals’ has led to the new era of medicine and health, in which the food industry has become a research-oriented sector and that is used for the improvement of health, by preventing or treating disease (Das L, et al., 2012). The relation between nutraceuticals and other health products for various diseases are presented in Figure 1.

Figure 1: The relationship between nutraceuticals and other health products

Nutraceuticals in the form of macronutrients, micronutrients algae, and herbs are recommended together with physical exercise for prevention and treatment of CVD (Muredzi ED, 2023). Table 1presents some of the more recognizable nutraceuticals substances grouped according to food-source providers (Wildman RE, 2016).

Table 1: Examples of nutraceutical substances grouped by food source

Discussion

Risk of cardiovascular disease

Cardiovascular disease is the leading cause of premature morbidity and mortality in industrialized countries. Serum cholesterol correlates with the risk of coronary artery disease, myocardial infarction, and coronary death (Anderson KM, et al., 1987). Several studies have addressed the relation between the intake of Polyunsaturated Fatty Acids (PUFAs) and cardiovascular disease and the effect of increased PUFA intake on cardiovascular events. The low mortality from cardiovascular disease among traditionally living Eskimos and Alaskan Natives has been attributed to less atherosclerosis in the coronary arteries (Middaugh JP, 1990). The factors affecting the risk of heart disease are summarized in Figure 2(Dominguez H, 2013).

Figure 2: Major dietary factors affecting Coronary Heart Disease (CHD) risk

Nutraceutical diet for better cardiovascular health

Several nutraceutical substances are found in higher concentrations in specific foods or food families. These include capsaicinoids, which are found primarily in pepper fruit, and allyl sulfur (organo sulfur) compounds, which are particularly concentrated in onions and garlic. The table provides a listing of certain nutraceuticals that are considered unique to certain foods or food families (Wildman RE, 2016). Major Dietary factors are known to influence cardiovascular risk (Table 2) (Dominguez H, 2013).

Table 2: Major dietary factors affecting Coronary Heart Disease (CHD) risk

Essential nutrition required to maintain the heart health is depicted in Figure 3. Minerals exert various effects on CVD. Diets with high zinc/copper ratios are hypercholesterolemia (Bastida S, et al., 2000). Some minerals play a central role in blood pressure regulation; however, apart from sodium or potassium, little is known about the effects of minerals on CVD. Increased intakes of magnesium and calcium decrease blood pressure and the risk of being hypertensive (Rodenas S, et al., 2011).

Figure 3: Essential nutrients for cardiovascular disease

Sodium: A modest reduction (9-12 to 5-6 g/day) in salt intake for four or more weeks causes significant falls in blood pressure in both hypertensive and normotensive individuals. Reduction in salt intake of 3 g/day would result in the reduction of incidence CHD (5.9%-9.6%), stroke (5.0%-7.8%) (Bibbins-Domingo K, et al., 2010).

Potassium: The risk of stroke varies greatly with potassium intake: The relative risk of stroke in the highest quintile of potassium intake (average of 110 mmol/day) is almost 40% lower (He FJ and MacGregor GA, 2001).

Vitamin A: It is a liposoluble compound derived from animal tissues. Retinal, retinoic acid and β-carotene have potential activity against atherosclerosis and inflammatory diseases also have antioxidant activity (Walden R and Tomlinson B, 2012). Consumption of carotenoid-rich vegetables has been linked to a reduced risk of coronary artery disease. An oxygenated carotenoid (Lycopene) whose antioxidant activity is two times higher than that of β-carotene. Tomatoes are the best source of lycopene (Sesso HD, et al., 2012).

Vitamin C: The population with vitamin C deficiency, found at high risk for coronary heart disease (Simon JA, 1992). Antioxidant properties of Vitamin C may synergistically act with vitamin E, this leads to a reduction in peroxyl radicals’ formation and lipid peroxidation blocking (Mikirova NA, et al., 2008). Citrus extract plus ascorbate strongly inhibited atherosclerosis (Vinson JA, et al., 1998). Plant flavonoids are powerful antioxidants for heart disease (Vinson JA, et al., 1995). Studies have shown a reverse relationship between plasma renin activity levels and vitamin D, coronary artery calcification, and hypertension, (Resnick LM, et al., 1986).

Vitamin E: Vitamin E antioxidant and anticoagulant properties stabilized plaque, platelet aggregation, reduced inflammation, enhancing vasodilation, expression of adhesion molecules on the arterial wall are the potential mechanisms of cardio-protection (MI and thrombotic stroke) with vitamin E (Meagher EA, et al., 2001). High fiber consumption reduces post prandial glucose responses after carbohydrate-rich meals and lowers total and LDL cholesterol levels (Weickert MO and Pfeiffer AF, 2008). The polyphenolic contentis used for CVD prevention (Ullah MF and Khan MW, 2008). Red wine (polyphenolic) taken before food increases serum antioxidant activity which activates the platelet NO synthase and inhibits the platelet activation and production of reactive oxygen species, for at least 4 hours (Maxwell S, et al., 1994). Sudden death and heart attack incidences decreased by consumption of flavonoids (luteolin, kaempferol, apigenin, myricetin, and quercetin) intake assessed by dietary history. Flavonoid rich apples, black tea and onions were considered the most suitable foods. Moderate consumption of wine was found beneficial on ischemic CVD (Gresele P, et al., 2008). Resveratrol, induces the expression of several longevity genes, and prevents aging-related decline in cardiovascular function (Das DK, et al., 2011).

Flavanol-rich cocoa: They are suggested to have anti-inflammatory properties, antioxidant properties, antihypertensive effects, and anti-platelet aggregation. Platelet reactivity reduces and coronary vasomotion improved by Dark chocolate. It was found a significant decrease in the risk of the combined outcome of first MI or stroke in people in the top quartile compared to those in the bottom quartile of chocolate consumption (Buijsse B, et al., 2010). It seemed to be partly due to a drop in blood pressure in people who consume more chocolate. Vitamin K deficiency in the diet has been linked to an increased risk of atherosclerosis and soft-tissue calcification (Erkkilä AT and Booth SL, 2008). High level of potassium, magnesium, and calcium can lead to lower blood pressure and lower CDA and stroke (Houston MC and Harper KJ, 2008). The multiple cardio-protective and physiological activities of magnesium include calcium channel-blocking effects, antiarrhythmic effects, inhibition of blood coagulation, and improvement in NO release from coronary endothelium (Shechter M, et al., 1999). However, potassium and magnesium need to be avoided in the event of kidney failure. The health significance of iron is well known, with increasing attention being paid to the identification and treatment of iron deficiency in heart failure. Anemic patients (Hb ≤ 12 g/dL) with stable CHF, intravenous injections of iron sucrose only for 12 days decreased symptoms, improved exercise capacity, and increased hemoglobin (Anker SD, et al., 2009).

Trace minerals

Chromium: Chromium is an essential mineral that appears to have a beneficial role in the regulation of insulin action, metabolic syndrome, and cardiovascular disease (Hummel M, et al., 2007). Chromium is important for the metabolism of glucose and lipids and can contribute to the regression of cholesterol-induced atherosclerosis. The deficiency of chromium may influence glucose and lipid metabolism and affect atherosclerosis (Schroeder HA, 1967). Insulin resistance can be an important factor in disrupting lipid metabolism, the favorable effect of chromium on glucose or insulin metabolism can be a key factor in improving lipid profile (Balk EM, et al., 2007). Insufficient selenium in the soil can cause cardiac arrhythmias, CHF, multifocal myocardial necrosis, with cardiomyopathy. Primary prevention trials and most secondary prevention studies suggest that supplementation does not significantly reduce ischemic CVD events (Hercberg S, et al., 2004). L-carnitine was used as a supplemental treatment for Percutaneous Coronary Intervention (PCI) for Non-ST Elevation Acute Coronary Syndrome (NSTEMI).

DHA and EPA can improve many CVD risk factors, including lowering of plasma triglycerides, blood pressure, platelet aggregation, and inflammation, and improvement of vascular reactivity at the dose of >3 g/day (Breslow JL, 2006). A link has been established between fish oil supplementation and a significant reduction in deaths due to heart causes (León H, et al., 2008). Coenzyme Q10 (ubiquinone) has been used in oral forms to treat various cardiovascular disorders including angina pectoris, hypertension, and CHF (Greenberg ER, et al., 1996).

Algae and cardiovascular health

The importance of algae as components of functional foods with special application to cardiovascular diseases, due to their high dietary fiber, mineral, vitamins, and phytochemical contents, and their polyunsaturated fatty acid. Effects of seaweeds and alga compounds on cholesterol metabolism, lipoprotein levels, and thrombosis/blood coagulation have presented in Table 3.

Table 3: Effect of seaweeds and alga compounds on cholesterol metabolism, lipoprotein levels, and thrombosis/blood coagulation

There has been a combined effort among scientists to explore and utilize varying food sources to develop functional foods to cater to the ever-increasing demand from the consumers, who seek health-promoting roles of dietary compounds (Mendis E and Kim SK, 2011). Marine organisms are considered safer alternatives to some existing synthetic drugs as they exhibit significant biological properties. Marine bioactive include peptides, fatty acids, carbohydrates especially Sulfated Polysaccharides (SPs). Time is useful in food industries and performs the healing junctions like anti-hyperlipidemic, antioxidant, anti-diabetic, and these all functions contribute towards cardiac protection (Tufail T, et al., 2018). Nutrient used to prevent the risk of heart diseases are summarized in Table 4. Interaction between essential nutrient and conventional cardiovascular drugs are briefly summarized in Table 5and graphically presented in Figure 4.

Table 4: Nutritional summary for prevention of heart disease risk

Table 5: Descriptive interaction between essential nutrients and cardiovascular drugs

Figure 4: Graphical representations of interaction between food, supplements and cardiovascular drugs

Conclusion

The findings of major clinical trials usually do not support the cardiovascular advantages of antioxidant vitamin or other EMN supplements, and recommendations typically prescribe improved ingestion of foods abundant in these ingredients, not particular additional supplements. Omega-3 PUFAs may be an exception and niacin has an effect on plasma lipids at pharmacological doses. In most cases, scientific test data is not adequate to support conclusive guidelines for nutrients used in CVD prevention or treatment. Concomitant use of nutrients, herbs, and conventional drugs may present with untoward events. The evidence available in the literature indicates various mechanisms through which this can occur. By interacting with conventional medication, nutrients may precipitate manifestations of toxicity or in the other extreme, therapeutic failure. Good knowledge of the potential of commonly consumed nutrients to interact with prescription medicines, irrespective of the nature of the evidence available, will equip health professionals in their practice. Apart from those demonstrated insignificant number of human subjects, not all reported interactions are clinically significant. As such, more clinically relevant research in this area is necessary. This review provides information on commonly used nutrients for cardiac health and their potentials for interactions within the levels of evidence currently available.

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