Cardiovascular health and phytonutrients

In this blog, our expert Nutritional Therapist, Ruth, looks at the causes of cardiovascular disease and examines the important role phytonutrients – plant-based bio-actives founds in a variety of fruits and vegetables – have in protecting our cardiovascular health.

Cardiovascular disease (CVD) is an umbrella term for all the diseases of the heart and blood vessels. CVDs can be caused by a combination of socio-economic, metabolic, behavioural and environmental risk factors, including:

• high blood pressure
• unhealthy diet
• high cholesterol
• diabetes
• air pollution
• obesity
• tobacco use
• physical inactivity
• harmful use of alcohol
• stress.

For decades, CVD has been the leading cause of death worldwide. The World Heart Federation, in their 2023 report, states that more than half a billion people around the world are affected by cardiovascular diseases, which accounted for 20.5 million deaths in 2021; a figure that accounts for around one third of all global deaths.[1]

An estimated 80% of cardiovascular disease, including heart disease and stroke, is preventable.

We know that the majority of CVD is due to dietary and lifestyle factors, many of which are modifiable through healthy diet, physical activity and avoiding tobacco.

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Drivers of cardiovascular disease

There has been conflicting research in the past­ over the direct causes of cardiovascular disease leading to the demonisation of saturated fat, particularly in the 1970s. This led to an enormous increase in low fat diets in the 80s and 90s, which are still popular today; however, the incidence of cardiovascular disease has continued to increase.

The idea of saturated fat directly increasing atherosclerosis and fatty deposits within the vascular wall is too simplistic, there are many mechanisms which become dysfunctional and lead to the progression of CV conditions.

Drivers of CVD include inflammation, oxidative stress, calcium dysregulation, endothelial dysfunction, mitochondrial dysfunction, insulin resistance and stress (high cortisol).[2] Therefore prevention needs to be all encompassing and diet, and lifestyle are central to this.

Oxidative stress

Oxidative stress is defined as a dysregulation between the production of reactive oxygen species (ROS) and the endogenous antioxidant defence mechanisms. Very low levels of free radical reactive species are normal by-products of cellular metabolic processes and participate in the physiological signal transduction taking place inside the cell.⁴ However, excess ROS can cause cellular dysfunction, protein and lipid peroxidation, DNA damage, and irreversible cell damage.

In the heart, ROS can directly impair the function of cardiac muscle cells, induce an energy deficit by affecting the function of proteins involved in energy metabolism and ultimately result in cardiac dysfunction and potential heart failure.[3] Several studies have demonstrated that ROS, via different mechanisms, can lead to endothelial cell dysfunction, a major player in the aetiology of several CVDs.[4]

The production of excess ROS contributes to the reduction of nitric oxide availability and vasoconstriction, initiating arterial hypertension (one of the main factors that increase the risk of cardiovascular diseases). ROS also has a negative effect on the calcium management in the myocardium, causing arrhythmia and enhancing the remodelling of the heart by inducing signal hypertrophy and apoptosis. Importantly, ROS also initiates the formation of atherosclerotic plaques.¹⁰

Inflammation

Inflammation is a normal biological response of the body to tissue damage, infections and chemical or physical agents, in which the production of inflammatory mediators such as cytokines, prostaglandins and ROS is triggered. It is also a normal part of cellular and tissue regeneration and repair, although for this the response is only weakly inflammatory.[5] If inflammation is not controlled, these inflammatory mediators are over-produced which can induce several pathological processes linked to CVD.[6]  

Phytonutrients are plant-based bioactive compounds produced by plants for their protection.

They can be derived from various sources such as whole grains, fruits, vegetables, nuts, and herbs, and more than a thousand phytonutrients have been discovered to date.[7]

As oxidative stress and inflammation are interrelated and contribute to the initial events of cardiovascular diseases, phytonutrients that modulate redox balance may be considered as important regulators of inflammatory responses.

Read on as we will explore this concept alongside the wide range of mechanisms by which some of these powerful plant nutrients are considered to be particularly protective for cardiovascular health.

Phytonutrients for cardiovascular health

Resveratrol

This is probably the best studied phytonutrient in relation to cardiovascular health, likely due to the French Paradox, a concept formulated in the 1980s as a result of the observation that the French confounded the hypothesis that diets rich in saturated fats cause cardiovascular disease; the French, whose diet is very high in saturated fat, had a low incidence of heart disease. This was thought to be due to their consumption of red wine, a rich source of resveratrol.[8]

Whilst resveratrol has been shown to have protective properties for CVD, it is unlikely to be the sole contributor to the French Paradox. Indeed, the French consume saturated fat from meat and butter, however they did not consume foods which are heavily processed and high in trans-fat, omega 6 oils, refined grains and sugar as well as (at that time) having a different lifestyle and approach to eating and drinking, all of which contribute to protection for health.

Even so, evidence continues to grow for the therapeutic benefits of resveratrol, also found in peanuts, soy and berries.

Research shows that resveratrol:[9]^,[10]

• Moderately diminishes systolic blood pressure in hypertensive patients, as well as blood glucose in patients with diabetes mellitus
• Suppresses oxidation of low-density lipoprotein (LDL) and reduces lipid peroxidation
• Exhibits anti-inflammatory effects, including the inhibition of the pro-inflammatory enzyme cyclooxygenase-1 (COX-1), leading to the suppression of synthesis of proinflammatory eicosanoids
• Inhibits the production of pro-inflammatory cytokines such as tumour necrosis factor alpha (TNF-alpha) and interleukin-1β (IL-1β) and IL-6
• Stimulates autophagy; the process of removing and recycling damaged cellular components, in endothelial cells. Dysfunctional autophagy is known to promote mitochondrial dysfunction and oxidative stress
• Beyond its scavenger effect, resveratrol also has antioxidant effects in other ways; it regulates the expression and activity of numerous antioxidant enzymes, thereby facilitating the elimination of free radicals
• Induces the phosphorylation of AMP-activated protein kinase (AMPK), thereby promoting mitochondrial biogenesis. AMPK activity declines with age and can provoke chronic low-grade inflammation, increase cellular stress, and raise the risk for age-associated CVDs
• Endothelial cells are key regulators of blood pressure, vascular tone, and haemostasis, and therefore play an essential and dynamic role in the cardiovascular system.  Resveratrol can improve endothelial and vascular function via decreasing cholesterol and triglyceride levels and hence increasing nitrogen oxide (NO) levels

Lycopene

Lycopene is an antioxidant found in red fruits and vegetables, particularly tomatoes, and its bioavailability is improved by cooking or heating, therefore it is especially high in products such as tomato puree and sauces. Lycopene is lipid soluble, therefore, eating cooked tomatoes with some olive oil will also increase bioavailability.

Lycopene is characterised by a high antioxidant potential, the highest among carotenoid pigments, and epidemiological studies show an association between the consumption of lycopene in the diet and a reduced risk of cardiovascular disease.[11]

Research demonstrates that lycopene, also found in watermelon, pink grapefruit, papaya, apricots, and guava:^10,[12]

• Is a highly effective antioxidant on a range of free radicals, as well as increasing the cellular antioxidant defence system by regenerating non-enzymatic antioxidants, such as vitamins E and C, from their radicals
• Demonstrates cardioprotective properties including protection against oxidative stress-induced myocardial hypertrophy, inhibition of stress-induced endoplasmic reticulum damage, inhibition of LDL oxidative damage, suppression of ventricular remodelling after myocardial infarction by inhibiting apoptosis, and improving endothelial function
• Suppresses inflammatory pathways (TNF-α, IL-6 and IL-1β)
• In addition to the strong antioxidant activity with potential health-promoting properties of lycopene, the cardiovascular system is also influenced by its anti-inflammatory, anti-atherosclerotic, and anti-platelet effects
• Improves endothelial function; blood flow and NO bioavailability
• Can bind to plasma LDL cholesterol and by this mechanism, provides protection against atherosclerosis by suppressing lipid peroxidation
• Plays an important role in inhibiting cardiovascular complications, including blood clots resulting from atherosclerotic changes
• Demonstrates an antihypertensive effect by inhibiting the angiotensin converting enzyme (ACE) and due to its antioxidant effect, reducing the oxidative stress induced by angiotensin II and indirectly increasing the production of nitric oxide in the endothelium
• Disturbed glucose metabolism and type 2 diabetes is inversely associated with lycopene intake. A decrease in plasma glucose and concentration of fasting glucose were observed with an increase in serum lycopene[13]

A recent meta-analysis showed that lycopene intake is associated with a 17% reduction in risk of CVD.[14]

Astaxanthin

Astaxanthin, a potent quencher of free radicals; reactive oxygen and nitrogen species is found in a variety of living organisms, mainly within the marine environment, in unicellular microalgae, plankton, krill and other seafood such as salmon, trout and crustaceans.

Astaxanthin is closely associated with other well-known carotenoids, such as beta-carotene, lutein and zeaxanthin, sharing various of the physiological and metabolic functions attributed to these compounds.[15]

Astaxanthin is being evaluated in clinical trials for its effects on several conditions, including osteoarthritis, Alzheimer’s disease, diabetic neuropathy, stroke, polycystic ovary syndrome, and exercise capacity.[16]

Research shows that astaxanthin demonstrates the following cardiovascular protective effects:[17]

• Protects the cell membrane from reactive oxygen and nitrogen species and oxidative damage, helping to maintain the membrane structure and decrease membrane fluidity, and acting as an antioxidant
• Inhibits low-density lipoprotein (LDL) oxidation and thus decreasing the risk of endothelial dysfunction
• Reduces systolic blood pressure and induces histological changes in the aorta associated with decreased vascular stiffness and blood pressure, due to the greater bioavailability of NO, as well as the remodelling of the arteries. These actions of astaxanthin against early events of atherosclerotic plaque formation and arterial dysfunction may delay the progression of cardiovascular diseases
• Inhibits the production of pro-inflammatory cytokines such as TNF-alpha and IL-1β and IL-6
• Increases reverse cholesterol transport by HDL, thereby attenuating the accumulation of cholesterol in foam cells and the formation of atherosclerotic plaques
• Exhibits antioxidant properties which protect against homocysteine induced endothelial dysfunction (homocysteine is an independent risk factor which contributes to the occurrence and development of human cardiovascular diseases. Induction of oxidative stress and apoptosis is considered the major mechanism in homocysteine induced cardiotoxicity)[18]
• Improves lipid profiles (total cholesterol and LDL levels were reduced, while HDL levels increased) and markers of CVD risk, including fetuin A, fibrinogen, and L-selectin in individuals with prediabetes and dyslipidemia¹⁵
  

Other phytonutrients important for cardiovascular health

A range of other phytonutrients: plant-derived bioactive compounds, play a significant role in cardiovascular health through various mechanisms:[19]

1.  Polyphenols

Polyphenols are a large group of compounds found in plants that have been linked to antioxidant, anti-inflammatory, and cardio-protective effects. They are grouped into flavonoids, non-flavonoids, and other classes of phytoalexins.

Flavonoids:

Quercetin

A flavonoid found in apples, onions, and berries, has been shown to decrease blood pressure, enhance endothelial function, and decrease LDL cholesterol oxidation, predominantly through its antioxidant effect and regulation of the inflammatory response.[20]

Catechins

These are found in green tea and, especially epigallocatechin gallate, have positive effects on cardiovascular health by modifying lipid profiles, lowering blood pressure, and improving endothelial function. They have also demonstrated potential advantages in the prevention of atherosclerosis.[21]

Anthocyanins

Anthocyanins are pigments found in berries and red cabbage, and their intake has been linked to a reduced risk of CVD. They positively affect endothelial function, decrease levels of oxidative stress, and have beneficial effects on lipid levels.[22]

Non-flavonoids, including resveratrol (discussed above) and curcumin

Curcumin

Cucumin is the bioactive compound in turmeric and is known to have numerous health benefits, including anti-inflammatory properties, which can help to decrease inflammation and oxidative stress, enhance endothelial function, and decrease the risks of CVD.[23]

2. Carotenoids

Carotenoids are brightly-coloured bioactive compounds that widely exist in natural fruits and vegetables and are also known to have antioxidant and anti-inflammatory properties that benefit the heart.[24] Lycopene is one carotenoid, but others include:

Beta-carotene

Beta-carotene is an antioxidant that is converted to vitamin A in the body, which helps to prevent cardiovascular diseases by lowering oxidative stress and enhancing the immune system. It has also been seen to impact lipid profiles and vascular health.[25]

Lutein

Lutein found in leafy green vegetables, has been found to alleviate oxidative stress, enhance the function of arteries and promote cardiovascular health.[26]

3. Glucosinolates            

Glucosinolates are bitter, sulphur-rich compounds, found in many cruciferous vegetables, such as cabbage, broccoli, and cauliflower. Their beneficial effects on cardiovascular health are attributed to their ability to modulate inflammation and oxidative stress.[27]

Sulforaphane

Sulforaphane is a compound obtained from broccoli and other cruciferous vegetables. Previous studies have shown that sulforaphane reduces oxidative stress, improves endothelium-dependent vasodilation, and inhibits the formation of atherosclerosis, through its ability to enhance the activity of detoxification enzymes and inhibit inflammation.[28]

Indole-3-Carbinol

Indole-3-Carbinol is also found in cruciferous vegetables and has been suggested to have beneficial effects on cardiovascular health because of its regulatory effects on oestrogen metabolism, inflammation, and oxidative stress.[29]

4. Saponins

Saponins are glycosides of various plant origins and are commonly associated with legumes and herbs. They support cardiovascular health due to their antioxidant and lipid-lowering properties.[30]

Saponins in soybeans are known to enhance cardiovascular health by regulating lipid status, lowering cholesterol, and their antioxidant activities.[31]

Ginseng saponins have been found to enhance the function of the endothelium, reduce blood pressure, and protect against oxidative stress.[32]

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References

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[18] Fan CD, Sun JY, Fu XT, Hou YJ, Li Y, Yang MF, Fu XY, Sun BL. Astaxanthin Attenuates Homocysteine-Induced Cardiotoxicity in Vitro and in Vivo by Inhibiting Mitochondrial Dysfunction and Oxidative Damage. Front Physiol. 2017 Dec 12;8:1041. doi: 10.3389/fphys.2017.01041. PMID: 29311972; PMCID: PMC5733103.

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Last updated on 12th February 2025 by cytoffice