Nicolantonio D’Orazio

Fucoxantin: a treasure from the sea.

The World Health Organization (WHO) estimates that 2.3 billion people will be overweight and 700 million obese in 2015. The reasons for this disastrous trend are attributed to the global tendency toward the reduced magnitude of exercise and physical activity and the increased dietary intake of fats, sugars and calories with reduced amount of vitamins and minerals. To prevent life-style-related diseases, like Metabolic Syndrome (MS), researchers’ attention is increasingly focusing on some of the so called “functional foods” which may be useful for their prevention and treatment. One of these functional ingredients is fucoxanthin (FX), a characteristic carotenoid present in edible brown seaweeds, such as Undaria pinnatifida (Wakame), Hijikia fusiformis (Hijiki), Laminaria japonica (Ma-Kombu) and Sargassum fulvellum. The increasing popularity of this molecule is certainly due to its anti-obesity effect, primarily detected by murine studies. These works revealed FX mediated induction of uncoupling protein-1 (UCP-1) in abdominal white adipose tissue (WAT) mitochondria, leading to the oxidation of fatty acids and heat production in WAT. Beyond this important role, in recent studies FX has shown a great antioxidant activity, anti-cancer, anti-diabetic and anti-photoaging properties. The aim of this review is to highlight the main effects of FX on human health.

The role of the antioxidant vitamin supplementation in the prevention of cardiovascular diseases

Industrial and technological revolutions have resulted in dramatic shifts in the diseases that are responsible for illness and death. In particular, cardiovascular disease (CVD) has emerged as the dominant chronic disease in many parts of the world. Diet, tobacco smoking, physical inactivity, obesity, lipid levels, hypertension and diabetes mellitus have contributed to their wide diffusion. Oxidative damage and the production of free radicals in the endothelium are two of the main factors involved in the pathogenesis of the atherosclerotic process that causes CVD. One of the more important results of basic research on dietetic regimes has shown that people who consume large amounts of fruits and vegetables have a lower incidence of CVD, stroke and tumours, but the specific mechanisms of these foods (which have an apparently protective effect) are still not completely clear. Possible reasons could include a greater consumption of fruit and vegetables, and an increased consumption of dietetic fibres. Recently, it been proposed that micronourishments with an antioxidant activity could be responsible for the reduction of chronic diseases. Research supplies a hypothetical mechanism by which antioxidant substances may be reducing the risk of atherosclerosis through the inhibition of oxidative damage. Appropriate nutritional practices are of central importance in managing risk and treatment of CVD; in fact, many current guidelines for a healthy general population contain nutritional recommendations to reduce the risk of these diseases. A large number of descriptive and case-control studies suggests that the consumption of many antioxidant vitamins (A, C and E) reduces the risk of CVD. Such data raises the following problem of whether supplementation of vitamins A, C and E emerges as being useful in the primary prevention of CVD. Many important studies involving a great number of participants have not confirmed this hypothesis and the results are often contradictory. This review examines the studies published in the literature that document the effect of supplementation with antioxidant vitamins (A, C and E) in the primary and secondary prevention of CVD due to an atherosclerosis process.

Novel phytonutrient contributors to antioxidant protection against cardiovascular disease

The associations linking endothelial inflammation, endothelial oxidative stress, and atherogenesis and the potential for dietary phytonutrients to decrease the impact of these associations were assessed. A detailed literature review was conducted and summarized. A large body of scientific evidence describes the interactions among endothelial inflammation, endothelial oxidative stress, and atherogenesis. A growing body of research indicates that several dietary phytonutrients (astaxanthin, lycopene, lutein, and glabridin) can decrease the risk for atherosclerosis by decreasing endothelial inflammation and oxidative stress. The consumption of foods or dietary supplements that provide astaxanthin, lycopene, lutein, and glabridin can ameliorate endothelial inflammation and oxidative stress, retard atherogenesis, and decrease the risk for atherogenic cardiovascular disease.

The role of selenium, zinc and antioxidant vitamin supplementation in the treatment of bronchial asthma: adjuvant therapy or not?

In the last few years, nutrition has represented an important conditioning factor of many cardiovascular, gastrointestinal and pulmonary chronic diseases. Many published works have documented specific inflammatory abnormalities in the airways of subjects with mild-to-moderate persistent bronchial asthma in which the inflammation state is often associated with an increased generation of reactive oxygen species and free radical-mediated reactions. This evidence has stimulated many researchers to suppose that the oxidative stress could be an important pathogenetic determining factor in the progression of chronic diseases, and the decrease of oxidant insults to the lung can be modified with antioxidant supplementary therapy. There are many studies regarding dietary interventions that confirm the relationship to oxidative stress, bronchial inflammation, the development of asthmatic symptoms and the lowered cellular reducing capacity. Simple dietary and environmental supplementations significantly reduce the oxidant stress, minimise the development of asthmatic symptoms, and should prove to be an effective new approach to asthma management in addition to current pharmacological strategies. Many randomised controlled trials with antioxidant vitamins and trace element supplements have not confirmed the results shown in other clinical trials. The aim of this review is to focus the attention on published works discussing the relationship between asthma and nutritional supplements (some trace elements and vitamins) and the effectiveness of these supplements in the treatment of bronchial asthma.

Plasma antioxidants and asymptomatic carotid atherosclerotic disease.

Background: Atherosclerosis remains clinically mute for a long time and frequently manifests itself with an acute cardiovascular event. The possibility of detecting this disease in a subclinical phase and reducing or reversing its progression is an issue of relevance. Published studies on the association between antioxidant vitamins and carotenoids and carotid intima-media thickness (CIMT) have been inconclusive. Methods: We enrolled 220 consecutive, asymptomatic participants. After carotid ultrasound investigation, a medical history was taken, a physical examination was performed and venous blood samples were collected. Venous blood samples were analyzed for concentrations of antioxidant vitamins and carotenoids. Results: Low concentrations of vitamin A (p < 0.01), vitamin E (p < 0.001), lycopene (p < 0.01) and β-carotene (p < 0.001) were significantly associated with carotid atherosclerosis (CIMT ≧0.8 mm). In addition, marginally higher body mass index, plasma haemoglobin and high-density lipoprotein cholesterol were also associated with carotid atherosclerosis, while other laboratory parameters considered in this study (total cholesterol, low-density lipoprotein cholesterol, triglycerides and C-reactive protein) were not significantly associated with carotid atherosclerosis. Conclusions: Low plasma concentrations of antioxidant vitamins (A, E, β-carotene) and lycopene were associated with early carotid atherosclerotic lesions as measured by CIMT. Regular intake of foods rich in lycopene and antioxidant vitamins may slow the progression of atherosclerosis.

Dietary Fibers and Cardiometabolic Diseases

The high prevalence of cardiovascular disease (CVD) is largely attributable to the contemporary lifestyle that is often sedentary and includes a diet high in saturated fats and sugars and low ingestion of polyunsaturated fatty acids (PUFAs), fruit, vegetables, and fiber. Experimental data from both animals and humans suggest an association between increased dietary fiber (DF) intakes and improved plasma lipid profiles, including reduced low density lipoprotein cholesterol (LDL-C) concentrations. These observations underline that the intake of DF may protect against heart disease and stroke.

Ivabradine: Beyond heart rate control

Chronic stable angina pectoris (CSAP) usually occurs in patients with coronary artery disease (CAD) that affects one or more large epicardial arteries. It results when myocardial perfusion is insufficient to meet cardiac metabolic demand. Elevated heart rate (HR) is an important factor in the development of myocardial ischemia and angina pectoris. The pharmacologic agents most commonly administered in the treatment of CSAP are β-blockers and calcium channel blockers (CCBs). However, the use of β-blockers is limited by poor compliance related to contraindications and comorbidities, especially in elderly patients. Ivabradine is a new selective HR-lowering agent that selectively inhibits the pacemaker current If in the sinus atrial node. In several randomized controlled trials, ivabradine 5–10 mg twice daily has demonstrated equivalent anti-ischemic and anti-anginal activity to β-blockers and CCBs, with a good safety and tolerability profile. Although ivabradine has been shown not to improve cardiac outcomes in patients with stable CAD and left ventricular systolic dysfunction, it may be used to reduce the incidence of CAD outcomes in a subgroup of patients with HR ≥70 bpm. The aim of this short review is to summarize the use of ivabradine in the treatment of CSAP, and its potential utility in atherosclerosis, primitive and dilatative cardiomyopathy, and arrhythmias, such as postural tachycardia syndrome and inappropriate sinus tachycardia, where exclusive lowering of elevated HR may prove beneficial.

Aliskiren, the First Approved Renin Inhibitor: Clinical Application and Safety in the Treatment of Hypertension

Hypertension is one of the most important risk factors for, and causes of, cardiovascular disease. The difficulty in achieving a normal blood pressure range in some patients makes the rate of cardiovascular disease high. For some years renin-angiotensin system inhibitors such as angiotensin-converting enzyme (ACE) and angiotensin receptor blockade have been objects of interest for treatment of cardiovascular disease. Aliskiren, the first approved renin inhibitor to reach the market, is a low molecular weight, orally active, hydrophilic nonpeptide molecule, which blocks angiotensin I generation. However it might also become a reasonable therapeutic choice in a broad number of clinical conditions, as stable coronary artery disease, cerebrovascular and cardiorenal disease, diabetes, and peripheral arterial disease. The aim of this review is to describe the effectiveness and safety of aliskerin in the treatment of hypertension.

Bronchial Hyperresponsiveness and Quality of Life in Asthmatics

Background: Quality of Life (QoL) measurements are more responsive to clinically significant changes that are not evaluated by conventional clinical measures. Objective: The objective of this study is to examine the relationship between bronchial hyperresponsiveness (BHR) and QoL in asthmatic patients. Patients and Methods: 394 patients underwent clinical follow-up, pulmonary function tests and the methacholine challenge test (MCHt), and completed the Asthma Quality of Life Questionnaire (AQLQ). Results: 200 patients had a positive MCHt and in 194 it was negative. For all 32 items, asthmatic patients had a median value of 4.7 (4.2–5.9) compared to 5.6 (4.7–6.3) in patients with negative MCHt (p < 0.01). For physical activities, patients with positive MCHt showed a median value of 5.0 (4.5–6.0) compared to 5.7 (4.8–6.3) in patients with negative MCHt (p < 0.05). Median scores of 12 items of symptoms and 5 items of emotions were significantly lower in patients with positive MCHt [4.5 (3.7–5.8) and 5.1 (4.2–6.1)] than in patients with negative MCHt [5.5 (4.4–6.1) and 6.3 (5.2–6.9), respectively, (p < 0.01)]. For items of environmental stimuli the median score was 4.7 (3.7–5.9) in patients with positive MCHt, being significantly lower than in patients with negative MCHt [5.4 (4.2–6.4), p < 0.05]. Patients with positive MCHt had lower values of QoL than patients with negative MCHt. Conclusions: QoL changes may be more sensitive than evaluation of BHR. The measurement of Qol may be important because it enables us to characterize patients who could be candidates eventually to a pharmacological treatment for BHR because they have an impaired QoL.

One-Year Treatment with Rosuvastatin Reduces Intima-Media Thickness in 45 Hypercholesterolemic Subjects with Asymptomatic Carotid Artery Disease

Aim: An increase in carotid intima-media thickness (CIMT) represents an early phase of the atherosclerotic process. The aim of our study was to evaluate whether a reduction in CIMT could be seen with 1-year treatment with rosuvastatin (10 mg/day). Methods and Results: Forty-five patients with hypercholesterolemia and asymptomatic carotid atherosclerosis on baseline carotid ultrasound investigation (CUI) were examined with repeat CUI after 1 year of treatment (rosuvastatin 10 mg/day). Demographic and lifestyle data were collected. A physical examination was performed, and fasting venous blood samples were obtained. Total cholesterol, low-density lipoprotein cholesterol and triglycerides decreased significantly (p < 0.001), while high-density lipoprotein cholesterol increased significantly (p < 0.001) during the intervention. The mean decreases in the IMT of the right and left common carotid arteries (CCAs) were 0.29 and 0.26 mm, respectively (p < 0.05 for each). Age and lipid profile parameters were significant predictors of change in CIMT in linear regression analyses after adjustment for established atherosclerosis risk factors. Conclusions: One-year treatment with rosuvastatin in hypercholesterolemic adults with evidenceof subclinical atherosclerosis significantly reduced the CIMT of both CCAs and improved the lipid and lipoprotein levels.