Atherosclerosis and Heart Disease Prevention
Atherosclerosis, often known as hardening of the arteries, leads to cardiovascular disease, and is the leading cause of death in men over age 35 and all people over 45. Most
Current theories suggest that atherosclerosis begins with injury to the lining of the arteries. High blood pressure physically stresses this lining, while circulating substances such as low-density lipoprotein (LDL) cholesterol, homocysteine, free radicals, and nicotine chemically damage it. White blood cells then attach to the damaged wall and take up residence. Then, for reasons that are not entirely clear, the artery lining begins to accumulate cholesterol and other fats. Platelets also latch on, releasing substances that cause the formation of fibrous tissue. The overall effect is a thickening of the artery wall called a fibrous plaque.
Over time, the thickening increases, narrowing the bore of the artery. When blockage of the coronary arteries (the arteries supplying the heart) reaches 75% to 90%, symptoms of
Blood clots can develop on the irregular surfaces of arteries and may become detached and block downstream blood flow. Fragments of plaque can also detach. Heart attacks are generally caused by such blood clots, whereas strokes are more often caused by plaque fragments or gradual obstruction. Furthermore, atherosclerotic blood vessels are weak and can burst.
With a disease as serious and progressive as atherosclerosis, the best treatment is prevention. Conventional medical approaches focus on lifestyle changes, such as increasing
Principal Proposed Natural Treatments
This section presents some promising and not-so-promising natural approaches for preventing cardiovascular disease by fighting atherosclerosis. Note that we have left out two classes of treatments: those that reduce elevated cholesterol
Omega-3 Fatty Acids
Omega-3 fatty acids are healthy fats, found in certain foods such as cold-water fish. Some evidence suggests
A gigantic study (over 18,000 participants) published in 2007 was widely described in the media as finally proving beyond a shadow of a doubt that fish oil helps prevent heart problems.
If it does provide benefit for atherosclerosis, fish oil is thought to do so primarily by reducing serum
Similarly, some but not all studies also suggest that fish, fish oil, or EPA or DHA separately can modestly raise levels of HDL ("good") cholesterol.
For more information, including dosage and safety issues, see the full
Finally, while it is commonly stated that people require a certain optimum ratio of omega-3 to
There is no doubt that
However, while it may not be important to cut down on total fat, accumulating evidence hints that trans-fatty acids, a type of fatty acid found in margarine and other hydrogenated oils, increase risk of cardiovascular disease. In July 2002, the US Institute of Medicine concluded that there is no safe intake level of trans-fatty acids and recommended that overall consumption should be kept as low as possible.
The moderate use of alcohol is thought to help reduce cardiovascular risk, but the evidence regarding this subject is both inherently unreliable (because it is based on
Other Proposed Natural Treatments
Several natural products have shown some promise for helping to prevent atherosclerosis.
Garlic is generally said to produce several effects that together reduce atherosclerosis risk.
Although garlic is no longer believed to strongly reduce cholesterol levels, it may improve cholesterol profiles to a modest extent; in addition, it may mildly lower
Garlic preparations have been shown to slow the development of atherosclerosis in rats, rabbits, and human blood vessels, reducing the size of plaque deposits by nearly 50%.
Finally, in another study, 432 people who had suffered a heart attack were given either garlic oil extract or no treatment over a period of 3 years.
For more information, including dosage and safety issues, see the full
Other Potentially Beneficial Treatments
Mildly impaired responsiveness to insulin (short of outright diabetes) is a fairly common condition that appears to increase the risk of heart disease.
Some but not all observational studies suggest that
Many herbs and supplements appear to decrease platelet stickiness, including
Frequent consumption of nuts may reduce the risk of heart disease,
Wholegrain oats may help prevent heart disease, but the supporting evidence is almost entirely limited to studies conducted by manufacturers of wholegrain oat products.
For other natural substances that may help prevent atherosclerosis by lowering its major risk factors, see the articles on
Antioxidants: Probably Not Effective
The body is engaged in a constant battle against damaging chemicals called free radicals, or pro-oxidants. These highly reactive substances are believed to play a major role in atherosclerosis, cancer, and aging in general.
To counter the harmful effects of free radicals, the body manufactures antioxidants
Certain dietary nutrients augment the body's natural antioxidants and may be able to help out when the primary system is under stress. Vitamins E and C and beta-carotene are the best known, but many other substances found in fruits and vegetables are also strong antioxidants. For years we've been thinking that antioxidant supplements might offer considerable protection against heart disease, especially vitamin E. However, current evidence appears to dampen these high expectations.
Before presenting this disappointing information, it is necessary to explain the weaknesses of the observational studies that raised our hopes.
However, the results can be misleading. For example, if an observational study finds that people who take vitamin supplements live longer, it is not necessarily the vitamins that deserve the credit. Vitamin users also tend to exercise more and to eat more healthful foods, habits that may play a more important role than the vitamins. It is impossible to know for sure simply by evaluating the results of such a study.
Similarly, several observational studies have found that men who consume more foods that are rich in lycopene are less likely to develop prostate cancer. But does this mean that taking lycopene supplements will reduce prostate cancer risk? Not necessarily. Such foods contain many other nutrients as well, and they may be more important than lycopene.
A more reliable kind of study is the
Most but not all observational studies have found associations between high intake of vitamin E and reduced risk of cardiovascular disease.
The Heart Outcomes Prevention Evaluation (HOPE) trial found that natural vitamin E (d-alpha-tocopherol) at a dose of 400 IU daily did not reduce the number of heart attacks, strokes, or deaths from heart disease any more than placebo.
In addition, a large open trial compared the effectiveness of aspirin and vitamin E for the prevention of heart attacks, strokes, and other diseases related to atherosclerosis.
When the results of these studies began to come in, some antioxidant proponents suggested that the individuals enrolled in these trials already had too advanced disease for vitamin E to help. However, a large trial found vitamin E ineffective for slowing the progression of heart disease in healthy people, as well.
On balance, the evidence strongly suggests that vitamin E in the form used in these studies (alpha-tocopherol) is
helpful for preventing heart disease.
For more information, including dosage and safety issues, see the full
The study results involving
Many studies suggest that eating foods high in carotenoids can prevent atherosclerosis.
A huge, double-blind intervention trial involving 29,133 Finnish male smokers found 11%
deaths from heart disease and 15% to 20%
strokes in those participants taking beta-carotene supplements.
Similar poor results with beta-carotene were seen in another large, double-blind study in smokers.
What is happening here? Clearly, smoking presents a challenge to antioxidants. However, the question remains: Why should beta-carotene not only fail to help but actually worsen the situation?
One possible explanation is that beta-carotene in the diet always comes along with other naturally occurring carotenes. It is quite likely that other carotenoids in the diet are equally or more important than beta-carotene alone.
The moral of the story is that you should eat your vegetables but maybe not take beta-carotene supplements.
A single, double-blind study suggests that the antioxidant
Like other berries,
One large, double-blind study explored the potential benefit of
It has been suggested that the best approach is to use a combination of antioxidants. This makes sense theoretically because, for example, vitamin E fights free radicals that dissolve in fats while vitamin C fights those that dissolve in water. However, evidence for benefit with such combinations comes only from observational studies.
Herbs and Supplements to Use Only With Caution
Various herbs and supplements may interact adversely with drugs used to treat atherosclerosis. For more information on this potential risk, see the individual drug article in the Drug Interactions
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Last reviewed April 2009 by EBSCO CAM Medical Review Board
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