Coronary heart disease (CHD)
CHD is caused by atherosclerosis, in which cholesterol-filled atheromas or plaques form in the lining of the coronary arteries that supply nutrients and oxygen to the heart muscle. The atheroma process is believed to be initiated by inflammatory reactions in the artery wall in response to damage, mediated by inflammatory eicosanoids formed from the omega-6 fatty acid arachidonic acid.
EPA from fish oil is converted to pro- and anti-inflammatory eicosanoids in cell membranes, mainly prostaglandin I3 & E3, 3-series thromboxanes and 5-series leukotrienes. Prostaglandin I3 is strongly anti-inflammatory and the inflammatory eicosanoids produced from EPA are reliably weak, providing an overall anti-inflammatory effect.
Omega 3 fatty acids help prevent atherogenesis and thrombosis by reducing platelet aggregation and thromboxane production, inhibiting clotting, dilating blood vessels and reducing blood pressure. They also inhibit fatty acid and triglyceride synthesis and VLDL secretion in the liver, reducing serum triglyceride levels. Patients with cardiac arrhythmias given fish oil had a decrease in arrhythmias, serum triglycerides, total cholesterol, LDL cholesterol, plasma free fatty acids and thromboxane B2 and HDL cholesterol increased. A systematic review of studies on fish or fish oil and cardiovascular disease concluded that intake significantly reduced all-cause mortality, cardiac and sudden death and possibly stroke.
Coenzyme Q10 (CoQ10)
CoQ10 is an important antioxidant coenzyme naturally found in the body that transfers electrons in the electron transport chain in the mitochondria of cells, a vital step in energy production for all cells and especially the heart and muscles. It helps scavenge damage free radicals and can regenerate the body's main fat-soluble antioxidant vitamin E. Statin drugs have been found to reduce CoQ10 levels with adverse effects on mitochondrial and heart function. Supplemental CoQ10 is advised for patients with familial hypercholesterolaemia, heart failure and those over 65 years of age on statin therapy.
Supplemental CoQ10 has been shown to improve cardiovascular function. Patients with cardiovascular disease on CoQ10 had reduced chest pain, fatigue, breathlessness and palpitations and less need for medication.Myocardial infarction patients taking CoQ10 had significantly fewer cardiac events, heart attacks and cardiac deaths at twelve-month follow-up.A systematic review of high blood pressure trials found that, overall, CoQ10 lowered systolic blood pressure by 16mm Hg and diastolic by 10mm Hg. Patients with cardiomyopathy taking CoQ10 had improvements in ejection fraction and cardiac output. In a study of congestive heart failure patients given CoQ10 in addition to conventional treatment, 38% fewer patients required hospitalization for their heart condition and there was a 60% reduction in episodes of pulmonary oedema.
Folic acid & vitamin B12
Homocysteine is formed in the body as a toxic intermediate of methionine metabolism. A deficiency of folic acid and vitamin B12 can impair homocysteine metabolism and lead to an elevated blood concentration, which is a potent, independent risk factor for cardiovascular disease. Supplemental folic acid and vitamin B12 can lower homocysteine concentrations in populations by about 25% to 30% and by about 10% to 15% in populations with routine folate-fortification of foods.
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