Natural Products and Healthy Heart

Heart disease remains the number one cause of death in men and women and, according to the latest estimates by the American Heart Association, more than 64 million Americans suffer from some kind of cardiovascular disease. Although the actual death rate due to heart attack has not increased significantly over those of past years, there is an increasing incidence of pathologies associated with heart problems such as hypertension, atherosclerosis, and cardiomyopathy leading to congestive heart failure.1,2 The risk factors for heart diseases are on the rise due to metabolic disorders, specifically because of a tremendous increase in the number of obese subjects.3 The continuous increase in incidences of cardiovascular disease is a manifestation of chronic poor diet and lifestyle choices, which lead to diabetes and obesity.4 A large population is on constant medication for some form of heart problem.5 The most commonly used daily medications include drugs to treat hypertension, atherosclerosis, and diabetes. Although medications are necessary to cope with heart problems, daily use of these drugs is not only likely to make the patients drug dependent but also puts them at risk for drug-induced side effects.6 Unfortunately, these drugs are expected to overcome the poor diet and lifestyle choices that many patients continue to make despite their conditions. Most common heart problems can be easily dealt with by adopting a healthier lifestyle and opting for a wiser selection of foods. A healthy lifestyle includes, among other things, daily exercise and a healthy diet consisting of fruits, vegetables, and fish, with less fat and meat products.7 In addition, a large number of natural products exist that can perform the same tasks for the pathologic heart as those performed by prescription drugs. Table 1 shows examples of a few common heart problems, a selected group of drugs that can treat the specific problems, some side effects that are likely to occur in some patients during prolonged use of the drugs, and the natural products that can perform the same tasks as these drugs. This table is certainly not exhaustive, as there are many more drugs available in the market and side effects may occur only in a selected subset of patients. However, the natural products listed in the Table 1 have been used from time immemorial, and they can indeed successfully treat many heart problems and help maintain a healthy heart.TABLE 1: Selective Natural Product Alternatives That Can Be Used to Replace Prescription DrugsThe importance of natural products in combating heart diseases and maintaining healthy hearts will be addressed in a series of 6 selected review articles, published in this issue of the Journal and the issue immediately following it (November and December 2009). These reviews have been written by a group of renowned scientists. The first issue contains 3 articles documenting the heart health benefits of flaxseed, fish oil, and green/black tea. Dr. Kailash Prasad, from the University of Saskatchewan, Canada, is an authority on flaxseed research. In his review, Dr. Prasad discusses the cardioprotective properties of flaxseed and flax meal, which can suppress atherosclerosis by virtue of its antioxidant properties due to the presence of lignan. Lignan reduces serum triglycerides and low-density lipoprotein (LDL) and raises high-density lipoprotein. Flaxseed oil possesses anti-inflammatory properties and reduces platelet aggregation as well. Dr. Joel de Leiris and his coworkers from the Coeur & Nutrition, La Tronche, France, write of the importance of balancing n-3 and n-6 fatty acids in maintaining cardiac health. They discuss the results of clinical trials indicating that fish oil (marine n-3 fatty acids, eicosapentaenoic acid, and docosahexaenoic acid), whether from dietary sources or fish oil supplements, exhibit cardioprotective effects and reduce mortality due to cardiovascular diseases. They also provide convincing evidence that fish oil results in cell membrane stabilization and suppression of cardiac arrhythmias. N-3 fatty acids also possess anti-inflammatory and antiatherogenic effects and reduce blood pressure. Patients with coronary heart disease should be advised to consume n-3 fatty acid supplements and to eat oily fish at least 2-3 meals per week, as part of a healthy diet. Dr. Yuji Naito and Dr. Toshikazu Yoshikawa, from the Kyoto Prefectural University of Medicine, Kyoto, Japan, write of the importance of drinking tea in maintaining a healthy heart. Studies from different laboratories, including their own, document that tea catechin-especially (−)-epigallocatechin-3-gallate-inhibits the expression of soluble adhesion molecules including vascular adhesion molecule-1 and intercellular adhesion molecule-1, endothelial cell inflammatory markers, in response to stimulation with oxidized LDL, or other cytokines and CD11b by monocytes. They show that in in vivo studies using apolipoprotein E-deficient mice, tea catechin prevents the development of atherosclerosis and that (−)-epigallocatechin-3-gallate effectively reduces the progression of accelerated atherosclerotic plaque formation. The next series of reviews demonstrate the importance of a Mediterranean diet to the maintenance of the healthy heart. The first article in this series, written by Dr. Dipak K. Das of the University of Connecticut, Farmington, CT, and Dr. Alberto Bertelli of the University of Milan, Italy, discusses the importance of the grape skin- and red wine-derived polyphenolic antioxidant, resveratrol as protection for the heart from diverse degenerative diseases including cardiovascular, cerebrovascular, and cancer. Wines, grapes, and resveratrol can all attenuate cardiac diseases such as atherosclerosis and ischemic heart disease.8 Several recent studies have also confirmed that resveratrol and wine could increase the life span by stimulating longevity genes such as SIRTs.9 It is worthy to note that the resveratrol content of red wine varies considerably, ranging from a few milligrams per liter in Swiss wines up to more than 13 mg/L in Australian Pinot Noir or even 18 mg/L in Brazilian red wine. The bioavailability of resveratrol is low, and the maximal bioavailability is achieved if it is taken with wine. The other important factor to be considered is the pharmacokinetics of resveratrol. Resveratrol provides cellular protection only at low doses. At relatively higher doses, it exerts the opposite action on cells10 and at higher doses has been shown to be effective in killing cancer cells.11 The next review is written by Dr. Maria Isabel Covas, from the Cardiovascular Risk and Nutrition Center Group of the Institut Municipal d'Investigacio Medica de Barcelona, Barcelona, Spain. A recognized expert on the Mediterranean diet, she writes about the importance of olives/olive oil consumption in maintaining a healthy heart. Olive oil can reduce LDL and raise high-density lipoprotein cholesterol and increase insulin sensitivity and decrease lipid and DNA damage due to oxidative stress. In addition, olive oil reduces inflammatory and thrombogenic status, endothelial dysfunction, and blood pressure. The last article in the series addresses the role of cocoa and chocolate in cardiovascular disease. This article comes from a group of scientists at the University of Buenos Aires, Argentina, and the University of California at Davis, California. They discuss the importance of chocolate consumption in maintaining a healthy heart by documenting that cocoa as a plant and chocolate as food contain a series of phytochemicals that can interact with cell and tissue components, providing protection against the development of cardiac diseases. Although the mechanisms of action are not completely understood, the maintenance/restoration of vascular nitric oxide and bioavailability and antioxidant action seem to be among the important factors that are responsible for cocoa and chocolate's role in maintaining a healthy heart. I am indeed honored to have been asked to serve as a guest editor for this exciting review series and I wish to express my sincere gratitude to these outstanding authors who have kindly contributed to this venture. I also wish to congratulate them for their outstanding contributions to expanding our understanding of the role of natural products in maintaining a healthy heart.

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