Vitamin in cardiovascular disease

Jacobsen DW (1998) Homocysteine and vitamins in cardiovascular disease. Clinical Chemistry44,1833-43. 

Over the past two decades attention has focused on the potential use of B vitamins in cardiovascular disease (CVD) prevention. Although classic antioxidant vitamins have failed to prevent vascular events in clinical trials, interest in B vitamins arose due to their homocysteine (Hey) lowering properties. Strong epidemiological and mechanistic evidence suggests that Hey is an independent cardiovascular risk factor (Antoniades et al. 2009a). In addition, this hypothesis confirms the original observation that patients with homocystinuria develop premature atherosclerosis and thromboembolic events early in life. 

Folate and B Vitamins in Cardiovascular Disease Insights from Clinical Trials and Folate Fortification Programme... 

Pham DQ, Plakogiannis R (2005) Vitamin E supplementation in cardiovascular disease and cancer prevention Part 1. Ann Pharmacother 39 1870-1878... 

The observed associations between folate, antioxidant vitamins, and cardiovascular disease may be confounded by other substances in fruits and vegetables, as the following examples of studies show Flavonoids (see Chapter 31) are naturally occurring, water-soluble antioxidants found widely distributed in vegetables, fruits, tea, and wine. There is an inverse relationship between flavonoids and decreased risk of coronary heart disease. Lycopene, the key antioxidant in tomatoes, shows an inverse association with myocardial infarctions. There is an inverse association between folate and cardiovascular disease. 

Tfcble 8 Some of the most important clinical/epidemiological studies using vitamin C in cardiovascular disease... 

Stanger O, Herrmann W, Pietrzik K, Fowler B, Geisel J, Dierkes J, et al. D. A. CH.-Liga Homocystein (German, Austrian, and Swiss Homocysteine Society) consensus paper on the rational clinical use of homocysteine, folic acid, and B vitamins in cardiovascular and thrombotic diseases guidelines and recommendations. J Kardiol 2003 10 190-9. 

Nuclear receptors also play an important role as drug targets in cardiovascular diseases. Peter Kolkhof, Lars Barfacker, Alexander Hillisch, Helmut Haning and Stefan Schafer review the mineralocorticoid receptor, peroxisome proliferator-activated receptor / and thyroid hormone receptors in detail based upon their therapeutic value, and additionally vitamin D receptor, retinoic add receptors and retinoid X receptors as well as liver X receptors are covered with a special focus on their role in cardiovascular diseases. 

Oxidative stress is an imbalance in ROS levels. It has been implicated in some forms of cancer, in cardiovascular disease, and in Alzheimer s and Parkinson s diseases. One way that living systems respond to oxidative stress is by lowering ROS concentrations by scavenging free radicals with the aid of antioxidants, such as vitamins E and C. 

Key Facts about B Vitamins as Therapeutic Agents in Cardiovascular Disease... 

Vitamin E can also act as an antioxidant (qv) in animals and humans alone or in combination with vitamin C (qv). Both are good free-radical scavengers with the vitamin C acting to preserve the levels of vitamin E (35). Vitamin E in turn can preserve the levels of vitamin A in animals (13). It has been shown that vitamin E reduces the incidence of cardiovascular disease (36—39). This most likely results from the antioxidant property of the vitamin which inhibits the oxidation of low density Hpoproteins (LDLs) (40—42). The formation of the oxidized LDLs is considered important in decreasing the incidence of cardiovascular disease (43). 

Low levels of vitamin E have been associated with increased incidence of coronary artery disease. Observational studies have therefore suggested that supplemental a-tocopherol might have value in the treatment of cardiovascular disease. Clinical studies demonstrated contradicting results regarding the benefits of vitamin E in the prevention of cardiovascular disease. Four... 

Globally, undernutrition is widespread, leading to impaired growth, defective immune systems, and reduced work capacity. By contrast, in developed countries, there is often excessive food consumption (especially of fat), leading to obesity and to the development of cardiovascular disease and some forms of cancer. Deficiencies of vitamin A, iron, and iodine pose major health concerns in many countries, and deficiencies of other vitamins and minerals are a major cause of iU health. In developed countries, nutrient deficiency is rare, though there are vulnerable sections of the population at risk. Intakes of minerals and vitamins that are adequate to prevent deficiency may be inadequate to promote optimum health and longevity. 

The a-tocopherol, P-carotene (ATBC) Cancer Prevention study was a randomised-controlled trial that tested the effects of daily doses of either 50 mg (50 lU) vitamin E (all-racemic a-tocopherol acetate), or 20 mg of P-carotene, or both with that of a placebo, in a population of more than 29,000 male smokers for 5-8 years. No reduction in lung cancer or major coronary events was observed with any of the treatments. What was more startling was the unexpected increases in risk of death from lung cancer and ischemic heart disease with P-carotene supplementation (ATBC Cancer Prevention Study Group, 1994). Increases in the risk of both lung cancer and cardiovascular disease mortality were also observed in the P-carotene and Retinol Efficacy Trial (CARET), which tested the effects of combined treatment with 30 mg/d P-carotene and retinyl pahnitate (25,000 lU/d) in 18,000 men and women with a history of cigarette smoking or occupational exposure to asbestos (Hennekens et al, 1996). 

The above scientific information on rice bran phytochemicals indicates that a multitude of mechanisms are operating at the cellular level to bring about specific health effects. Several health benefits of rice bran appear to be the result of the synergistic function of the many phytochemicals, antioxidants, vitamins and minerals which operates through a specific immune response. Their role in the biochemical mechanisms at the cellular level which result in major health effects is shown in Fig. 17.1. A short overview summarizing the effect of the various phytochemicals on major health issues such as cancer, immune function, cardiovascular disease, diabetes, altered liver function and gastrointestinal and colon disease will be given below. 

In animals, the major function of carotenoids is as a precursor to the formation of vitamin A. Carotenoids with provitamin A activity are essential components of the human diet, and there is considerable evidence that they are absorbed through the diet and often metabohzed into other compounds. Beyond their important role as a source of vitamin A for humans, dietary carotenoids, including those that are not provitamin A carotenoids, have been implicated as protecting against certain forms of cancer and cardiovascular disease. ... 

Many epidemiological studies have analyzed the correlations between different carotenoids and the various forms of cancer and a lot of conclusions converge toward protective effects of carotenoids. Many studies were carried out with (i-carotene. The SUVIMAX study, a primary intervention trial of the health effects of antioxidant vitamins and minerals, revealed that a supplementation of p-carotene (6 mg/day) was inversely correlated with total cancer risk. Intervention studies investigating the association between carotenoids and different types of cancers and cardiovascular diseases are reported in Table 3.1.2 and Table 3.1.3. 

In the Unites States, the daily intake of 3-carotene is around 2 mg/day Several epidemiological studies have reported that consumption of carotenoid-rich foods is associated with reduced risks of certain chronic diseases such as cancers, cardiovascular disease, and age-related macular degeneration. These preventive effects of carotenoids may be related to their major function as vitamin A precursors and/or their actions as antioxidants, modulators of the immune response, and inducers of gap-junction communications. Not all carotenoids exert similar protective effects against specific diseases. By reason of the potential use of carotenoids as natural food colorants and/or for their health-promoting effects, research has focused on better understanding how they are absorbed by and metabolized in the human body. 

Vitamin E consists of a family of related compounds, the tocopherols. The most abundant in the American diet is 7-tocopherol and, although it is potentially superior in the detoxification of nitrogen dioxide, the biochemistry of a-tocopherol is considered more relevant to cardiovascular disease (Kayden and Traber, 1993). Vitamin E undoubtedly has several modes of action in vim. The most clearly understood of these, at the chemical level, is the role of a-tocopherol as an antioxidant. 

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