Transcript Document
The current trends regarding significance of
vitamins in cardiovascular disease
Prof. Asma Shaukat
NIACIN (B3)
direct and noncompetitive inhibition hepatocyte
diacylglycerol acyltransferase-2, a key enzyme for
TG synthesis.
accelerated intracellular hepatic apo B
degradation and the decreased secretion of VLDL
and LDL particles.
REFERENCE
Kamanna VS, Kashyap ML. Atherosclerosis Research Center, Department of Veterans Affairs Healthcare System, Long Beach,
California. Am J Cardiol. 2008 Apr 17;101(8A):20B-26B.
Decreased HDL-apo A-I catabolism
inhibits the hepatocyte surface expression of betachain adenosine triphosphate synthase (a recently
reported HDL-apo A-I holoparticle receptor), inhibits the
removal of HDL-apo A-I.
REFERENCE
Kamanna VS, Kashyap ML. Atherosclerosis Research Center, Department of Veterans Affairs Healthcare
System, Long Beach, California. Am J Cardiol. 2008 Apr 17;101(8A):20B-26B.
NIACIN AS ANTIHYPERLIPIDEMIC
1-3 g/day niacin increases HDL level by 10-30 %
making it most powerful agent to increase HDL
cholesterol.
Recommended form of niacin for raising HDL is
sustained release preparations.
REFERENCES
36:Rader, Daniel J. (2004). "Raising HDL in Clinical Practice". Raising HDL in Clinical Practice: Clinical Strategies to Elevate HDL.
http://cme.medscape.com/viewarticle/479499_5. Retrieved October 8, 2009.
Chapman, M. John; Assmann, Gerd; Fruchart, Jean-Charles; Shepherd, James; Sirtori, Cesare; European Consensus
Panel on HDL-C (2004). "Raising high-density lipoprotein cholesterol with reduction of cardiovascular risk: the role of
nicotinic acid – a position paper developed by the European Consensus Panel on HDL-C". Current medical research and
opinion 20 (8): 1253–68
Meyers, C. Daniel; Carr, Molly C.; Park, Sang; Brunzell, John D. (2003). "Varying Cost and Free Nicotinic Acid Content in
Over-the-Counter Niacin Preparations for Dyslipidemia". Annals of Internal Medicine 139 (12): 996
Homocysteine
• Normal level is 10-15mmol/L in serum
• Classification of severity of high homocysteine.
Mild-----15-30mmol/L
Moderate----30-100mmol/L
Severe--->100mmol/L
• CHD pt with Hcy >15mmol/L belongs
to high risk group.
Path-physiological role of homocysteine in CHD
Atherogenic
• Induces vascular inflammation via expression of TNF
• Increased.oxidative stress.
• Promote oxidation of LDL.
• Increased uptake of modified LDL by macrophages.
Direct toxic injury to endothelial.
Path-physiological role of homocysteine in CHD
Thrombogenic.
• Enhances binding of lipoprotein (a) to fibrin
•
decreases cell surface thrombomodulin and protein-C activation
• Increases platelet aggregation.
• Impairs inactivation of factor Va by activated protein C
FOLIC ACID
Folic acid is itself not biologically active,
Biological importance is due to tetrahydrofolate
FUNCTIONS
The human body needs folate to:
Synthesize DNA
Repair DNA
Methylate DNA
Cofactor in biological reactions involving folate.
Aiding rapid cell division and growth (infancy
and pregnancy).
Production of healthy red blood cells and to
prevent anemia.
The FDA’s implementation of mandatory fortification of
grains and cereals with folic acid on January 1, 1998 is a
direct result of research studies confirming
folate’s HCY-lowering effects,
References:
Tucker KL, Selhub K, et.al. Dietary intake pattern related to plasma folate and HCY concentrations in the Framingham Heart Study. J Nutr
1996;126:3025-3031.
Food and Drug Administration. Food Standards: amendment of standards of identity for enriched grain products to require addition of
folic acid. Federal Register. 1996;61(44):8781-97.
Riddell, LJ, Chisholm A, et.al. Dietary strategies for lowering HCY concentrations. Am J Clin Nutr. 2000; 71(6): 1448-54.
TRYPTOPHAN
N-FORMYLKYNURENINE
KYNURENINE
Xanthurenic
Acid
3-OH-KYNURENINE
Kynureninase (PLP)
3-OH ANTHRANILIC ACID
QUINOLINIC ACID
NIACIN
acetyl
CoA
acetoacetyl
CoA
B6 AND CHD
C-reactive proteins:
Low concentrations of pyridoxal-5'-phosphate
(PLP) are associated with high C-reactive protein
(CRP) levels.
Low PLP and elevated inflammatory markers, such
as high:sensitivity CRP (hs-CRP) and fibrinogen, are
related to a higher risk of CAD.
References:
Waldmann A, Koschizke JW, et.al. HCY and cobalamin status in German
vegans. Public Health Nutr. 2004 May;7(3):467-72
VITAMIN B12 AND HOMOCYSTEINE
VITAMIN B12 AND HOMOCYSTEINE
Ascorbic Acid
It was found out that serum ascorbic acid
levels were independently associated with
prevalence of coronary heart disease and
stroke;
A 0.5-mg per dl increase in serum
ascorbic acid level was associated with
an 11% reduction in coronary heart
disease and stroke prevalence.
REFERENCE
Joel A. Simon, Esther S. Hudes and Warren S. Browner
Epidemiology Vol. 9, No. 3 (May, 1998), pp. 316-321
Vitamin C
•Reduces oxidation,
•Increase collagen for healing and
•Improve the health and strength of arteries,
High dose Lysine destroys Lp(a) plaques.
REFERENCE
How to Live Longer and Feel Better
Linus Pauling
ROLE OF VIT C DEFICIENCY IN CHD:
initiation of atherosclerotic plaque formation.
Vitamin C and amino acid lysine (LP(a) binding
inhibitors), prevent this molecule from binding to
the walls of damaged arteries.
These substances at high dosages are patented to
prevent and to destroy existing atherosclerotic
plaques.
REFERENCE
Joel A. Simon, Esther S. Hudes and Warren S. Browner
Epidemiology Vol. 9, No. 3 (May, 1998), pp. 316-321
VITAMIN D
•Vit D inhibits Renin Angiotensin System
• Vit D regulates vascular smooth muscle (VSMC) function.
– Presence of 25OHD 1-alphahydroxylase in smooth muscle.
• Vit D improves endothelial cell-dependent vasodilation.
• Vit D inversely associated with coronary artery calcification.
• Vit D inhibits myocardial cell hypertrophy.
• Vit D exhibits anticoagulant activity.
• Vit D exhibits anti-inflammatory properties.
Reference
Greenland, Susan R. Heckbert, Karen C. Johnson, JoAnn E. Manson,et al.
Calcium/Vitamin D Supplementation and Cardiovascular Events. Circulation 2007, 115:846-854
DIET FOR HEALTHY HEART
Vitamin E - 800 to 3200 iu
Vitamin A - 20,000 to 40,000 iu
Super B-Complex, esp. Vitamins B6 and B3
Magnesium (300 to 1500 mg) and avoid Manganese
Avoid refined carbohydrates
Amino acids Taurine, Arginine and Carnitine (1 to 3 g).
Add a good mineral/multivitamin.
REFERENCE
How to Live Longer and Feel Better
Linus Pauling
Thank You