Heart disease doesn’t discriminate. It’s the leading cause of death for several populations, including white people, Hispanics, and black people. Ischaemic heart diseases remained as the major cause of death amongst the Malaysian population, 15.0 per cent of the 109,164 medically certified deaths in 20191. While heart disease can be fatal, it’s also avoidable in most people. The general lifestyle improvements, including quitting smoking, lowering cholesterol, controlling high blood pressure, maintaining a healthy weight, and exercising, greatly and positively impact our health. In this article, we look at the supplements that can scientifically enhance heart health and discuss in depth.
Ginkgo contains significant levels of flavonoids and terpenoids, which are compounds known for their strong antioxidant effects2. Antioxidants combat or neutralise the damaging effects of free radicals. Free radicals are highly reactive particles that are produced in the body during normal metabolic functions, such as converting food to energy or detoxification. The active constitutes extracted from ginkgo biloba such as flavonoids, terpene lactones and ginkgolic acids take part in increasing blood flow, prevent blood clots and reduce blood lipids through the mechanisms of antioxidation and prevent platelet aggregation3.
A study conducted in people with heart disease who supplemented with ginkgo revealed an instantaneous upsurge in blood flow to multiple parts of the body. This was attributed to a 12% increase in levels of circulating nitric oxide4. A 2-weeks study revealed that supplementation of ginkgo biloba promoted the blood flow of patients suffering from coronary artery disease by increasing the production of nitric oxide which helps to dilate the blood vessels for blood circulation and lowers blood pressure.
Ginkgo biloba extract taken at 240mg daily for 2 months was also found to diminish lipid peroxidation, minimise the formation and size of atherosclerotic plaque by 11.9% and 24.4 nm in high-risk cardiovascular patients. The atherosclerosis slowing effect is possibly due to an upregulation in the body's own radical scavenging enzymes and an attenuation of the risk factors including lessened lipoprotein (by 23.4%) and augmented vasodilating cAMP and cGMP (by 37.5% and 27.7% respectively) concentrations in subjects' blood5.
Ginseng contains the active ingredient ginsenoside (triterpene saponins), exhibiting anti-inflammatory, antioxidant, and anticancer effects6. It is traditionally used to support energy and overall wellbeing, by acting as an adaptogen and an overall wellness tonic. The term “adaptogen” represents an agent that purportedly “increases resistance to physical, chemical, and biological stress and builds up general vitality, including the physical and mental capacity for work6.
Both human and animal studies revealed the ability of ginseng in reducing total cholesterol, LDL cholesterol and triglyceride levels7-8. The improvement in lipid profile was associated with the increased antioxidant enzyme activity in subjects supplemented with ginseng. Besides, the anti-inflammatory effect of ginsenoside was also shown to play a role in the prevention of atherosclerosis by reducing the plaque formation in blood vessels, thereby improving the endothelial function9,10.
CoQ10 acts as an antioxidant, which protects cells from damage and plays an important part in the metabolism as an essential cofactor for energy production. CoQ10 deficiencies are due to autosomal recessive mutations, mitochondrial diseases, aging-related oxidative stress and carcinogenesis processes, and also statin (cholesterol-lowering drug) treatment. Many neurodegenerative disorders, diabetes, cancer, and muscular and cardiovascular diseases have been associated with low CoQ10 levels11. Coenzyme Q10 may benefit patients with certain cardiac diseases including atherosclerosis, heart failure, and coronary artery disease, according to a report in Pharmacology & Therapeutics12.
A low level of myocardial CoQ10 is related to the severity of heart failure. In a study of 420 people with heart failure, treatment with 100mg CoQ10 three times daily for two years improved their symptoms (based on New York Hospital Association functional classification, 6-min walk test, and levels of N-terminal pro-B type natriuretic peptide) and reduced their risk of dying from heart problems (cardiovascular mortality of 9% instead of 16% with placebo, all-cause mortality of 10% instead of 18% with placebo)13. Another study treated 641 people with 2mg/kg per day CoQ10 or a placebo for a year. At the end of the study, those in the CoQ10 group had been hospitalized less frequently for worsening heart failure and had fewer serious complications (the episodes of pulmonary oedema or cardiac asthma were reduced in the control group as compared to the placebo group)14.
Research suggests that coenzyme Q10 may lower oxidative stress, in addition to support the widening of the blood vessels—a major element in blood pressure control15.
It is a known event that the cholesterol-lowering medication, statin group, can cause adverse muscle effects after some time. In one small study, patients taking statin medications were given 100 mg of CoQ10 or a placebo for 30 days. Three-quarters of the CoQ10 group reported a reduction in statin-related muscle pain, while the placebo group saw no improvement16.
The aim of heart disease prevention is to diminish the occurrence of major cardiovascular events thereby lowering premature disability and morbidity whilst prolonging survival and quality of life. Whilst lifestyle advices remained generally throughout the years, the advancements and progresses in nutrition and pharmaceutical options continued to evolved to make cardiovascular events a preventable disease. In addition to the lifestyle advices mentioned in the beginning of this article, the extracts of ginkgo biloba, ginseng and coenzyme Q10 have demonstrated useful benefits in their antioxidant, lipid profile changing, blood vessels dilating and atherosclerotic plaque reducing properties.
- Statistics on Causes of Death, Malaysia, 2020. Department of Statistics Malaysia. Accessed on 23/10/2021. https://www.dosm.gov.my/v1/index.php?r=column/cthemeByCat&cat=401&bul_id=QTU5T0dKQ1g4MHYxd3ZpMzhEMzdRdz09&menu_id=L0pheU43NWJwRWVSZklWdzQ4TlhUUT09#:~:text=causes%20of%20death-,Ischaemic%20heart%20diseases%20remained%20as%20the%20principal%20causes%20of%20death,bronchus%20and%20lung%20(2.4%25).
- Pietta PG. Flavonoids as Antioxidants. J. Nat. Prod. 2000, 63, 1035-1042.
- Cho HJ, Nam KS. Inhibitory effect of ginkgolide B on platelet aggregation in a cAMP-and cGMP-dependent manner by activated MMP-9. Journal of Biochemistry and Molecular Biology. 2007;40(5):678-683.
- Wu YZ, Li SQ, Zu XG, Du J, Wang FF. Ginkgo biloba extract improves coronary artery circulation in patients with coronary artery disease: contribution of plasma nitric oxide and endothelin-1. Phytother Res. 2008 Jun;22(6):734-9.
- Rodriguez M, Ringstad L, Schafer P, Just S, Hofer HW, Malmsten M, et al. Reduction of atherosclerotic nanoplaque formation and size by ginkgo biloba (EGb 761) in cardiovascular high-risk patients. Atherosclerosis. 2007;192(2):438-444.
- Kiefer D, Pantuso T. Panax ginseng. Am Fam Physician. 2003;68(8):1539-1542.
- Ko CN, Park SU, Chang GT, Jung WS, Moon SK, Park JM, et al. Antihyperlipidemic and antioxidant effects of the mixture of ginseng radix and crataegi fructus: experimental study and preliminary clinical results. Ginseng Res. 2011;35(2):162-169.
- Kim JY, Park JY, Kang HJ, Kim OY, Lee JH. Beneficial effects of Korean red ginseng on lymphocyte DNA damage, antioxidant enzyme activity, and LDL oxidation in healthy participants: a randomized, double-blind, placebo-controlled trial. Nutrition Journal. 2012; 11:47.
- Im EJ, Yayeh T, Park SJ, Kim SH, Goo YK, Hong SB, et al. Antiatherosclerotic effect of Korean red ginseng extract involves regulator of g-protein signalling 5. Evidence-Based Complementary and Alternative Medicine. 2014; 985174: https://doi.org/10.1155/2014/985174
- Kho MC, Lee YJ, Park JH, Kim HY, Yoon JJ, Ahn YM. Fermented red ginseng potentiates improvement of metabolic dysfunction in metabolic syndrome rat models. Nutrients. 2016;8(369): https://doi:10.3390/nu8060369
- Garrido-Maraver J, Cordero MD, Oropesa-Ávila M, Vega AF, Mario de la Mata, Pavón AD, Manuel de Miguel, Calero CP, Paz MP, Cotán D, Sánchez-Alcázar JA. Coenzyme q10 therapy. Mol Syndromol. 2014 Jul;5(3-4):187-97.
- Kumar A, Kaur H, Devi P, Mohan V. Role of coenzyme Q10 (CoQ10) in cardiac disease, hypertension and Meniere-like syndrome. Pharmacology & Therapeutics. 2009;124(3):259-268. https://doi:10.1016/j.pharmthera.2009.07.003
- Mortensen SA, Rosenfeldt F, Kumar A, Dolliner P, Filipiak KJ, Pella D, Alehagen U, Steurer G, Littarru GP, Q-SYMBIO Study Investigators. The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial. JACC Heart Fail. 2014 Dec;2(6):641-9.
- Morisco C, Trimarco B, Condorelli M. Effect of coenzyme Q10 therapy in patients with congestive heart failure: a long-term multicenter randomized study. Clin Investig. 1993;71(8 Suppl):S134-6.
- Garrido-Maraver J, Cordero MD, Oropesa-Ávila M, et al. Coenzyme Q10 therapy. Mol Syndromol. 2014;5(3-4):187-197. https://doi:10.1159/000360101
- Šabovič, M. Coenzyme Q10 supplementation decreases statin-related mild-to-moderate muscle symptoms: a randomized clinical study. Med Sci Monit. 2014;20:2183-2188.