Cardiovascular benefit

Nickenig G, Ostergren J, Struijker-Boudier H (2006) Clinical evidence for the cardiovascular benefits of angiotensin receptor blockers. JRAAS 7 (Suppl 1) S1-S7... 

Resveratrol is another type of polyphenol, a stilbene derivative, that has assumed greater relevance in recent years as a constituent of grapes and wine, as well as other food products, with antioxidant, anti-inflammatory, anti-platelet, and cancer preventative properties. Coupled with the cardiovascular benefits of moderate amounts of alcohol, and the beneficial antioxidant effects of flavonoids, red wine has now emerged as an unlikely but most acceptable medicinal agent. 

Alcohol abuse and dependence, widely known as alcoholism, is a major cause of morbidity and mortality. Its acute and chronic toxicity spreads across multiple systems and organs, from child abuse to domestic or public violence to traffic accidents and from cirrhosis to hypertension. Mean life expectancy of alcohol abusers is around 55 years. Alcohol seems involved in several hundred thousand deaths each year in Europe, with considerable added social and health care costs. This is in clear contrast with the little attention paid to the treatment of alcohol dependence and abuse. On the other hand, much is made of the French Paradox , the J curve and the demonstrated cardiovascular benefits of regular moderate wine intake. 

Fresh garlic may have some cardiovascular benefits, but it is unclear whether it lowers blood lipids or blood pressure as much as originally thought. Aged preparations and cooked garlic are likely to be less effective despite being better tolerated. 

E. Saw palmetto reduces the symptoms of prostatic obstruction with long-term use and appears to be as effective as finasteride. Green tea is recommended as an antioxidant and for its reputed cardiovascular benefits. Bilberry is used for improving night vision, while cayenne pepper is appUed topically as a coun-... 

D. Kava is often recommended for anxiety, and it appears significantly more effective than placebo for this condition. Garlic is used for cardiovascular benefits, saw palmetto for prostatic hypertrophy, and ginkgo as a cerebral vasodilator. Echinacea is considered an immunomodulating herb with potential benefit in viral illnesses. 

C. Ginkgo would be the most likely herbal treatment to benefit this patient, since it would improve cerebrovascular blood flow and cognitive function. Vertigo and tinnitus may also respond, although there is more evidence for the former. GarUc is traditionally used for cardiovascular benefits (Upid, blood pressure reduction), but it would be unlikely to produce immediate results. Peppermint is used as an antispasmodic in irritable bowel syndrome, while ginger tea is a common carminative (gas reducer) and motion sickness treatment. Valerian is useful as a sedative. 

Fat is a key component in the human diet. Research shows that excessive consumption of saturated fat negatively impacts several biomarkers of health while monounsaturated and n-3 PUFAs are beneficial to human health. Moreover, research shows that imbalanced dietary ratios of n-6 n-3 may lead to various health complications as well as disease progression while increased n-3 levels impart prevention and health promoting effects (Burghardt et al., 2010 Goodstine et al., 2003 Simopoulos, 2002 Wan et al., 2010). The American Heart Association recommends eating fatty fish meals at least twice a week due to their promising health and especially cardiovascular benefits. Here, we review some of the health benefits of n-3 PUFAs, due in part to their anti-inflammatory effects in cancer, cardiovascular diseases (CVDs), obesity, and other metabolic disorders. 

The well-known French paradox was first noted by Irish physician Samuel Black in 1819. Back in the nineteenth century, he was the first to observe the fact that people in France suffer relatively low incidence of coronary heart disease, despite their diet being rich in saturated fats. It was proposed that France s profound red wine consumption is a primary factor contributing to the protective effect. The first scientific evidence, however, for the cardiovascular benefits of red wine was put forward by Renaud and his associates in 1992 [Renaud and Lorgeril, 1992]. In this study, popularly known as the French paradox, the researchers found that there had been a low mortality rate from, and incidence of, coronary heart disease among French men above the age of 40 years compared to men in the United Kingdom and the United States, despite their high consumption of saturated fats and the prevalence of other... 

Pendurthi UR, Williams JT, Rao LV. 1999. Resveratrol, a polyphenolic compound found in wine, inhibits tissue factor expression in vascular cells A possible mechanism for the cardiovascular benefits associated with moderate consumption of wine. 

The use of Coleus Forskohlii seems to have possible cardiovascular benefits by acting as a vasodilator (lowers blood pressure), inhibition of platelet aggregation (reduced blood clotting), and positive inotropic activity in the heart (increased contractile force). 

Williams GH. Cardiovascular benefits of aldosterone receptor antagonists. Climacteric. 2003 6(suppl 3) 29-35. 

In addition to its antihypertensive effects, the ARB losartan demonstrated cardiovascular benefits beyond lowering blood pressure in the Losartan Intervention for Endpoint (LIFE) Reduction in Hypertension Study [8]. Similarly, results from the Valsartan in Acute Myocardial Infarction Trial showed that valsartan improves survival after acute MI in high-risk patients [15]. Due to a lack of clinical studies involving populations with the same cardiovascular risk profile, it is not possible to extrapolate these findings to all ARBs, particularly since the dose of ARB used appears critically important [7]. Several ARBs carry additional indications, including treatment of hypertension with LVH, stroke prevention, CHF, and nephropathy in typ. 2 diabetes mellitus. 

There has been considerable discussion in the world s medical literature and at medical conferences as to whether physicians should actually advocate initiation of alcohol consumption for patients who currently do not drink. Certainly, there is unequivocal proof of the cardiovascular benefits, but there is also unequivocal proof of the potential downside of drinking, both for the individual and for society as a whole. The horrors of deaths to drunk drivers and their victims come vividly and dramatically to mind, as does the sociological impact of alcoholism on the individual and his or her family. 

One such study came from the University of L Aquila in Italy where researchers have been busily looking into the cardiovascular benefits of the fiavonols, a type of polyphenol, that are found in cocoa products. Dr. Claudio Ferri and his colleagues, in collaboration with investigators at Tufts University in Boston, learned that flavonol-rich dark chocolate reduces blood pressure during both the day and the night in patients with hypertension. 

More recently, it has been shown that hypokalemia and other dose-related adverse metabolic effects of thiazide diuretics increase the risk of sudden death and negate the cardiovascular benefit of blood pressure lowering when high doses these drugs are prescribed (21). Hence, another explanation for the apparent inability of antihypertensive therapy to lower mortality in patients with coronary heart disease is that high thiazide doses were used in many of the trials that were analyzed. As pointed out by Temple (2), this explanation is supported by the results of a trial of antihypertensive therapy in elderly patients with isolated systolic hypertension (22). In this study, only low doses of a thiazide diuretic were prescribed and a 4-mm Hg average decrease in diastolic blood pressure was associated with a 36% reduction in the... 

Schlienger et al. conducted a retrospective case control study from 1992-1997 to investigate if NSAIDs had the same cardiovascular benefit in prevention of AMIs.[154] A total of 3,319 cases with first time AMIs were determined and matched with 13, 139 controls based on age, gender, and practice and calendar time. After adjustment for other risk factors hke smoking, BMI, HRT and aspirin, there was a trend towards increased risk of AMI in NSAID users. The higher doses of NSAIDs were associated with significantly increased risk of MI as much as doubled. The authors concluded that NSAIDs was associated with an increased risk of AMI and no cardioprotection was observed with use of NSAIDs. 

Angiotensin II antagonists share the hemodynamic effects of ACE-I, and therefore have similar indications such as HTN, CHF, and diabetic nephropathy. However, ARBs have not been shown to be superior to ACE-I and are more expensive. In addition, there is an absence of data documenting comparable long-term cardiovascular benefits. Therefore, ARBs should be reserved principally for patients in whom ACE-I are indicated but who are unable to tolerate the medication. 

In patients with high cardiovascular risk, chronic ACE inhibition improves endothelial function (86, 88). This may explain why patients treated with ACE inhibitors experience a greater cardiovascular benefit than is attributable to the decrease in blood pressure. Indeed, ACE inhibitors improve endothelial function... 

Low-dose spironolactone has been shown to decrease cardiovascular mortality in patients with severe heart failure. However, since spironolactone contributes to hyperkalemia, this agent should not be used in patients with Stage 4 or 5 CKD. New studies will be required before concluding that spironolactone administration is safe in the chronic hemodialysis population to reap the potential cardiovascular benefits. 

Garlic Allium sativum) is thought to provide several cardiovascular benefits, such as blood pressure (BP) lowering, serum lipid lowering, and antithrombotic activity. Garhc oil has been reported to interrupt thromboxane synthesis, thereby inhibiting platelet function. 

Problem 19.56. What is the cardiovascular benefit of increasing the amount of unsaturated triacylglycerols relative to saturated triacylglycerols in the diet ... 

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