Our cardiovascular system is composed of the heart (the pump); blood vessels consisting of arteries, veins, and capillaries (the pipes); and blood containing red and white blood cells, and plasma (the fluid). Cardiovascular disease (CVD) relates to diseases that affect the heart and blood vessels. These can include stroke, heart attack, coronary heart disease (CHD), angina, congenital heart disease etc. According to the British Heart Foundation there are around 7.4 million people living with heart and circulatory disease in the UK, with CHD being the most common. Heart and circulatory disease cause more than a quarter of all deaths in the UK.1
Perhaps of particular relevance today is that pre-existing cardiovascular diseases and their risk factors, such as diabetes, obesity, and high blood pressure, have emerged as some of the most important reasons for severe complications from Covid-19.2
Our cardiovascular system carries out many functions. It transports blood around the body, delivering oxygen, nutrients, and hormones to our cells. It also carries waste products out of the cell for detoxification and excretion and is a crucial part of our defence against infection and illness, as it carries immune system components to where they are needed. It also helps to regulate our body temperature and stabilise pH and ionic concentration of our bodily fluids. Damage to our CV system can subsequently have an immense impact on our health.
Factors that can play a part in the development of CVD include inflammation, obesity, lack of exercise, insulin resistance, oxidative stress, smoking and chronic stress. The likelihood of developing CVD is therefore largely linked to our diet and lifestyle choices. The World Health Organization, for instance, have estimated that most heart attacks and strokes are preventable, and that a healthy diet and other lifestyle factors are central to this prevention. Poor diet combined with a sedentary lifestyle and chronic stress is the perfect recipe for developing CVD. However, it also means that we have great capacity to safeguard our CV health by optimising our nutrient intake, exercising, and taking steps to manage our stress. Furthermore, there are certain nutrients, botanicals and natural phyto-antioxidants that can specifically help to support our CV health. In this blog we will be discussing some of these specific nutrients.
Nitric oxide (NO) plays a crucial role in the protection against the development and progression of CVD. L-citrulline is an amino acid and the natural precursor to L-arginine. While l-arginine is the precursor for the synthesis of NO, supplementation is mostly ineffective at increasing NO synthesis. Unlike l-arginine, l-citrulline is not quantitatively extracted from the gastrointestinal tract or liver and its supplementation is therefore more effective at increasing l-arginine levels and NO synthesis.3
The cardioprotective roles of NO include regulation of blood pressure and vascular tone, (helps blood vessels dilate to promote proper blood flow), inhibition of platelet aggregation and leukocyte adhesion, and prevention of smooth muscle cell proliferation.4
Beets and leafy green vegetables are a good source of dietary nitrates, which the body can convert to NO. Including vitamin C-rich foods in the diet such as citrus fruits and vegetables can also be beneficial. Vitamin C can help to increase levels of NO by increasing its bioavailability and absorption in the body.
Horse Chestnut Extract
In traditional medicine, Horse chestnut (Aesculus hippocastanum) has a long history of use in addressing symptoms such as swelling and inflammation, and in supporting the strength of blood vessel walls. Most of its beneficial effects comes from its biologically active compound, aescin.
Chronic venous insufficiency (CVI) is a condition where veins do not effectively return blood from the legs to the heart. It is associated with problems such as varicose veins, ankle swelling, and leg cramping. Research suggests that horse chestnut seed extract may be useful for CVI and can help to support the health of capillaries and veins. For instance, several randomised controlled trials have shown an improvement in CVI related signs and symptoms, such as leg pain, with horse chestnut extract compared with placebo.5
There is an increasing body of evidence that demonstrates that oxidative stress plays a fundamental role in the development of many diseases, including CVD. Oxidative damage to heart tissue can lead to heart disease, stroke, heart attack and other CV conditions. N-Acetyl-l-Cysteine (NAC) comes from the amino acid L-cysteine. Through its capacity to synthesize glutathione, a potent antioxidant, NAC has displayed many health-promoting properties with regards to CV health. Research also demonstrates it can help to increase NO production, which supports the dilation of veins, improving blood flow. This speeds up blood transportation back to the heart.6
Eating a diet rich in cysteine foods, including chicken, turkey, garlic, yoghurt, and eggs, has shown a decreased risk for strokes.7
Epidemiological research indicates that a diet abundant in fruit and vegetables offers protection against CVD, and this may be attributed, in part, to the flavonoid content.8 Studies have shown that flavonoids have several anti-atherosclerotic activities including anti-inflammatory, antioxidant, antiproliferative, antiplatelet, and provessel function activities9 and have been shown to be active against hypertension, inflammation, diabetes and vascular diseases.10
Quercetin is a flavonoid found in many plants and foods, such as onions, green tea, apples, berries, and red wine. In research, it has displayed considerable benefits in relation to the health of the heart, such as the inhibition of LDL oxidation; vasodilator effects; reduction of inflammatory markers, the protective effect on NO and endothelial function; prevention of oxidative and inflammatory damage; and helps to prevent the aggregation of platelets.10
Rutin is a flavanol, found abundantly in many plants including buckwheat, asparagus, apples, figs, and tea. It has also exhibited several pharmacological activities, including antioxidant, cytoprotective, vasoprotective, and cardioprotective activities.11
Grape Seed Extract
The oxidation of LDL cholesterol considerably increases this risk of atherosclerosis (accumulation of fatty plaque in the arteries), which is a well-known risk factor for CVD. Grape seeds are high in antioxidants, including phenolic acids, anthocyanins, and flavonoids. In human studies, grape seed extract has been found to exert reducing effects on oxidized LDL.12 Furthermore, a systematic review showed that grape seed extract appeared to significantly lower systolic blood pressure and heart rate.13
Acerola is a shrub or tree that is native to Central America, Mexico, and the Caribbean. The fruit is similar to a cherry and is a rich source of vitamin C . Vitamin C is a powerful antioxidant that has received considerable interest for its possible role in heart health. There are many observational studies that show an inverse relationship between vitamin C intake and major CV events and CVD risk factors. Hypertension is regarded as a major and independent risk factor of CVD. A systematic review last year showed that people with hypertension have a relatively low serum vitamin C, and vitamin C is inversely associated with both systolic blood pressure and diastolic blood pressure.14
Maritime Pine Bark Extract
Maritime pine trees grow in countries on the Mediterranean Sea and contain several bioflavonoids that exert anti-inflammatory and antioxidant effects.
Maritime pine bark extract has been used for respiratory conditions such as asthma, poor circulation and CVI.
Elevated total homocysteine has been identified as a risk factor for CVD. Homocysteine is an intermediary in the methylation cycle. Throughout the cycle it is recycled back to methionine if there is adequate B6, B12 and folate. Without sufficient B vitamins, homocysteine can build up and bring about damage to arteries. Over time, this can lead to atherosclerosis and CVD. Good sources of B vitamins include dark green leafy vegetables, nuts/seeds, eggs, meat/fish, and wholegrains.
Physical exercise is linked to longevity and can significantly reduce the risk of CVD, diabetes, high blood pressure, and obesity. It can also help to reduce stress, anxiety, and depression, and improve lipid profile.15 It is estimated that physical inactivity increases the risk of CVD by more than 20%.16
We are all currently experiencing unprecedented times, and stress levels are perhaps heightened for many of us. Whether it be loss of employment, adapting to a new way of working, or feeling socially isolated, stress can be detrimental to our CV health. The ‘fight or flight’ response is a primal evolutionary response to help us to survive. It is, however, largely unsuitable in today’s world of chronic stress. Modern stressors can be frequent and long-lasting, meaning the survival traits of the stress response (i.e., increased heart rate) are not effective in resolving the threat, and overtime can affect health. Chronic stress can contribute to high blood sugar, high blood pressure (which can damage artery walls), insulin resistance, decreased absorption of nutrients etc, all of which are bad news for our CV health.
Exercising, and enjoying a nutrient dense diet is a good place to start when dealing with stress. When we are stressed, the metabolism of our cells increases, and we burn through a lot more of the nutrients than we normally need. The adrenal glands will be working hard to produce stress hormones, so including plenty of foods to support the adrenal glands can be beneficial. These include vitamin C, magnesium, and the B vitamins. Limiting alcohol and caffeine and maintaining a healthy weight can also be beneficial.
- CVD relates to diseases that affect the heart and blood vessels
- Pre-existing cardiovascular diseases have emerged as some of the most important reasons for severe complications from Covid-19
- CV system transports blood around the body, delivering oxygen, nutrients, and hormones to our cells and is a crucial part of our defence against infection and illness
- Factors that can play a part in the development of CVD include inflammation, obesity, lack of exercise, insulin resistance, oxidative stress, smoking and chronic stress
- NO plays a crucial role in the protection against CVD. L-citrulline is an amino acid and precursor to L-arginine. l-arginine is the precursor for the synthesis of NO
- Horse chestnut has a long history of use in addressing symptoms such as swelling, inflammation, and in supporting blood vessel walls
- Through its capacity to synthesize glutathione, NAC has displayed many health-promoting properties with regards to CV health
- Epidemiological research indicates that a diet abundant in fruit and vegetables offers protection against CVD, and this may be attributed, in part, to the flavonoid content
- Grape seeds are high in antioxidants, including phenolic acids, anthocyanins, and flavonoids
- Vitamin C is a powerful antioxidant that has received considerable interest for its possible role in heart health
- Maritime pine bark extract has been used for respiratory conditions such as asthma, poor circulation and CVI
- Without sufficient B vitamins, homocysteine can build up and bring about damage to arteries
- Physical exercise is linked to longevity and can significantly reduce the risk of CVD, diabetes, high blood pressure, and obesity
- Chronic stress can contribute to high blood sugar, high blood pressure, insulin resistance, decreased absorption of nutrients, all of which are bad news for our CV health
If you have questions regarding the topics that have been raised, or any other health matters, please do contact me (Amanda) by phone or email at any time.
Amanda Williams and the Cytoplan Editorial Team
- British Heart Foundation. [online] Available at: https://www.bhf.org.uk/what-we-do/news-from-the-bhf/contact-the-press-office/facts-and-figures#:~:text=There%20are%20around%207.4%20million,the%20single%20biggest%20killer%20worldwide. [Accessed17th December 2020]
- Covid-19 and cardiovascular health | BHF (2020). Available at: https://www.bhf.org.uk/for-professionals/information-for-researchers/covid-19-and-cardiovascular-health (Accessed: January 5, 2021).
- Allerton, T. D. et al. (2018) “L-citrulline supplementation: Impact on cardiometabolic health,” Nutrients. MDPI AG.
- Naseem, K. M. (2005) “The role of nitric oxide in cardiovascular diseases,” Molecular Aspects of Medicine. Elsevier Ltd, pp. 33–65.
- Bielanski, T. E. and Piotrowski, Z. H. (1999) “Horse-chestnut seed extract for chronic venous insufficiency.,” The Journal of family practice. Cochrane Database Syst Rev, 48(3), pp. 171–172.
- Anfossi, G. et al. (2001) “N-acetyl-L-cysteine exerts direct anti-aggregating effect on human platelets,” European Journal of Clinical Investigation. Eur J Clin Invest, 31(5), pp. 452–461.
- Larsson, S. C., Håkansson, N. and Wolk, A. (2015) “Dietary Cysteine and Other Amino Acids and Stroke Incidence in Women,” Stroke. Lippincott Williams and Wilkins, 46(4), pp. 922–926.
- Bondonno, N. P. et al. (2015) “The Efficacy of Quercetin in Cardiovascular Health,” Current Nutrition Reports. Current Science Inc., pp. 290–303.
- Ciumărnean, L. et al. (2020) “The effects of flavonoids in cardiovascular diseases,” Molecules.
- Patel, R. v. et al. (2018) “Therapeutic potential of quercetin as a cardiovascular agent,” European Journal of Medicinal Chemistry. Elsevier Masson SAS, pp. 889–904.
- Ganeshpurkar, A. and Saluja, A. K. (2017) “The Pharmacological Potential of Rutin,” Saudi Pharmaceutical Journal. Elsevier B.V., pp. 149–164.
- Sano, A. et al. (2007) “Beneficial effects of grape seed extract on malondialdehyde-modified LDL,” Journal of Nutritional Science and Vitaminology. J Nutr Sci Vitaminol (Tokyo), 53(2), pp. 174–182.
- Feringa, H. H. H., Laskey, D. A., Dickson, J. E., & Coleman, C. I. (2011). The Effect of Grape Seed Extract on Cardiovascular Risk Markers: A Meta-Analysis of Randomized Controlled Trials. Journal of the American Dietetic Association, 111(8), 1173–1181.
- Ran, L. et al. (2020) “Association between Serum Vitamin C and the Blood Pressure: A Systematic Review and Meta-Analysis of Observational Studies,” Cardiovascular Therapeutics. Hindawi Limited, 2020.
- World Health Organisation. [online] Available at: https://www.who.int/cardiovascular_diseases/en/cvd_atlas_08_physical_inactivity.pdf?ua=1#:~:text=Doing%20more%20than%20150%20minutes,heart%20disease%20by%20approximately%2030%25.[Accessed 27th December, 2020]
- Physical Activity Policies for Cardiovascular Health (2020). Available at: http://www.ehnheart.org/publications-and-papers/publications/1243:physical-activity-policies-for-cardiovascular-health.html (Accessed: December 27, 2020).