Commentary to “The Possible Role of Nutraceuticals in the Prevention of Cardiovascular Disease”

Abstract

The treatment of metabolic cardiovascular (CV) risk factors through lifestyle modifications and pharmacotherapy is one of the pivotal points of CV prevention. Although current preventive strategies have resulted in a decline in mortality in the past few decades, CV diseases still represent the main cause of deaths worldwide [1]. Therefore, the improvement of current therapeutic approaches and possibly the proposal of new, safe, effective and largely applicable intervention strategies are warranted in order to reduce the impact of metabolic risk factors on CV mortality and morbidity. In recent years, great attention has been paid to dietary supplementation with natural compounds, mainly derived from plants, with variable evidence of a beneficial impact on health: these are the so-called nutraceuticals. The demand for these products has grown in the last years due to their theoretical good tolerability, patients’ propensity to use products of “natural origin”, and last but not least for the documented efficacy of some of them. The impact of different nutraceuticals on various traditional CV risk factors has been studied extensively along with their anti-inflammatory and antioxidant properties [2–4]. In addition, the protean impact of specific nutraceutical combinations on cardio-metabolic risk has been the object of intense research in the recent years. In this issue of High Blood Pressure and Cardiovascular Prevention, Rivellese et al. [5] reviewed and discussed evidence arising from controlled intervention studies on the effects of a number of nutraceuticals on different cardiovascular risk factors, such as body weight excess, high blood pressure, hyperglycemia and dyslipidemia. As underlined by the Authors [5], a growing body of evidence supports the beneficial effects of some nutraceuticals on the aforementioned metabolic alterations. Promising results about the effect of fibers on the atherosclerosis progression come from epidemiological and preclinical studies [4, 6]. Several randomized studies and some meta-analyses have shown the effects of supplementation with different types of fibers, such as glucomannan, betaglucan, guar gum, pectin psyllium and methylcellulose, on insulin sensitivity, lipids, blood pressure and body weight [7, 8]. Some studies, albeit with some inconsistency, have highlighted a possible beneficial role of fibers on vascular function [6]. Although the magnitude of the effect on individual risk factors is generally modest, good tolerability and low cost make these products generally highly valued by patients and physicians. A number of polyphenol-rich foods, such as soy, green tea, cocoa, grapes and red fruits, have produced beneficial effects on CV risk factors [2]. The effectiveness of different polyphenols in reducing cholesterol, triglyceride, glucose levels and blood pressure has been confirmed in randomized controlled trials (RCTs) and some meta-analyses [2, 3]. Epidemiological studies have examined the health benefits of omega-3 polyunsaturated fatty acids (PUFA n-3) consumed as part of the diet, and significant CV relative risk reduction has been confirmed repeatedly. PUFA n-3 supplementation showed beneficial effects on triglyceride levels and blood pressure control in intervention studies and some evidence suggests their potential role in weight control [9]. The effect of PUFA n-3 supplementation on the occurrence of clinical CV endpoints has been evaluated in multiple RCTs with conflicting results [10]. A recent study in patients at high CV risk and with elevated triglyceride levels found that supplementation with icosapent ethyl reduced the risk of ischemic events, including CV death [11]. Hence, the triglyceride-lowering impact of a high dose of PUFA n-3 appears to be of clinical value in patients with high CV risk and baseline high triglyceride levels. This article is part of the topical collection on Nutraceuticals in Hypertension & Cardiovascular Prevention.