Patients were randomly assigned to drink one cup of Hibiscus or black tea two times per day for one month. Each infusion contained one tea sachet weighing 2 gm, placed in a tea pot with 240 ml boiling water and steeped for 20-30 minutes and then added one cube of sugar.

The average systolic blood pressure (SBP) in the hibiscus group decreased from 134.4 +/- 11.8 mm Hg at the start of the study to 112.7 +/- 5.7 mm Hg after 1 month. The average SBP changed from 118.6 +/-14.9 to 127.3 +/- 8.7 mm Hg in the black tea group during the same time period. There were no statistically significant effects on the mean diastolic blood pressure in either group.

Commentary:

It’s always gratifying to see a simple, safe, inexpensive herb studied for such a common problem. Hibiscus has been used historically for high blood pressure and contains several important ingredients including alkaloids, anthocyanins and quercetin. It is thought that the antioxidant and diuretic effects are the most important mechanisms.

References

Mozaffari-Khosravi H, Jalali-Khanabadi B, Afkhami-Ardekani M, et al. The effects of sour tea (Hibiscus sabdariffa) on hypertension in patients with type II diabetes. J Human Hypertension 2009;23:48-54.

Commentary: We know that elevated homocysteine levels are associated with the risk for AMD and B vitamins lower homocysteine levels. The current study suggests that supplementation with these three B vitamins can lower the risk for AMD, although it is not clear if this result is indeed related to homocysteine lowering or some other mechanism.

References

Christen W,et al. Folic acid, pyridoxine, and cyanocobalamin combination treatment and age-related macular degeneration in women: The women’s antioxidant and folic acid cardiovascular study. Arch Intern Med 2009. Feb 23;169:335

If you’ve not already been alarmed by the push for statins as primary heart disease prevention you will want to know that in 2006, 1.3 million coronary angioplasty procedures were done in the U.S., at a cost of $48,399.00 and 448,000 coronary bypass operations at a cost of $99,743.00. That’s a total of over 104 billion dollars. For those two procedures alone, we spent more than 100 billion dollars in 2006. If these procedures accomplished as much as they cost, that would be one thing, but even the New England Journal of Medicine reported in 2007 that angioplasties and stents do not prolong life or prevent heart attacks in stable patients; stable patients are 95% of those who undergo those procedures. And…. coronary bypass surgery sadly prolongs life in less than 3% of patients. We have good scientific evidence that diet and lifestyle changes can prevent at least 90% of all heart disease. 90%!!!!!! In yet another recent study proving this point, an intervention diet of either low-fat or Mediterranean diet significantly improved cardiovascular event free survival in those who had a previous heart attack.[1]

The well known Lyon Diet Heart Study also demonstrated a survival advantage with the Mediterranean diet.[2]

For both primary and secondary heart disease prevention, we have to step up our game in helping our patients “get religion” about rigorously changing their eating habits, losing weight, exercising a minimum of 30 minutes every day (and for overweight 40 and over women, likely 60 + minutes daily), and of course stopping smoking.

In addition to using nutritional and botanical supplementation to address any lipid or hypertension issues, a diverse approach attending to arterial health and inflammation deserves our attention as well. While questioning statins, we might also want to question our own use of nutraceuticals in treating hyperlipidemia with items such as soluble fibers, soy, red yeast rice, niacin, phytosterols, pantethine, tocotrienols, resveratrol, policosanol, gugulipids or garlic. I have as of yet not abandoned this thinking of improving lipid profiles, but a broader perspective is in order. While of course attending to normalizing blood pressure, (magnesium, potassium, bonito protein, marine omega 3 fatty acids, vitamin D, lycopene, pycnogenol, hawthorne, L-arginine, carnitine, NAC and more) I have also expanded my attention to arterial health with attention to dilatation, anti-inflammation, reduction of LDL oxidation, platelet function and reducing vascular calcification.

I look more to combination ingredients and product formulations that approach cardiovascular health from the multi-mechanism perspective. While not an exhaustive list, items to consider beyond lipid therapies:

Dilatation: L-arginine, quercitin/flavonoids, vitamin C and E, magnesium, co-enzyme Q-10, taurine, garlic, soy

Anti-inflammation: marine omega 3 fatty acids, flax oil, isoquercitin, quercitin/rutin/ flavonoids, resveratrol

Reduce LDL oxidation: niacin, green tea, garlic, pantethine, resveratrol, policosanol, Co-enzyme Q-10

Anti-thrombotic: marine omega 3 fatty acids, garlic, pomegranate, nattokinase, ginger, resveratrol

Reduce vascular calcification: Vitamin K2, marine omega 3 fatty acids

More than 500,000 women die of cardiovascular-related causes annually in the U.S., with approximately 100,000 prematurely, before the age of 65. Starting at age 50, more women die of cardiovascular diseases than of any other condition and women younger than 55 who have a heart attack have a worse prognosis and higher incidence of heart attack-related death than do men of the same age who have a heart attack, as well as a greater chance of having another heart attack. Disability due to cardiovascular disease is also a major concern, especially in older women. And for African-American women, the risk of heart-related death is even greater- it is twice as high as for Caucasian women.

To be successful with our mission of preventing and treating heart disease, and helping women with the difficult challenges of weight loss and lifestyle changes, we must enhance patient education, expand strategies for motivation, improve and broaden plant/nutrient based supplementation prescribing, and continue wise and considered selective/judicious use of pharmaceutical/conventional interventions.

References

[2] De Lorgeril M, Salen P, Martin J, et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999;99:779-785.

The results of this study suggest that a moderate to severe vitamin D deficiency is a risk factor for developing cardiovascular disease.  One would hope that treatment of vitamin D deficiency with vitamin D supplementation or adequate exposure to sunlight could reduce that risk.  While a randomized intervention trial would be needed to assess vitamin D supplementation as a treatment strategy, we do have other positive evidence showing vitamin D supplementation reducing blood pressure, ventricular hypertrophy and inflammatory cytokines.
References

Want T, Pencina M, Booth S, et al.  Vitamin D deficiency and risk of cardiovascular disease.  Circulation. 2008; 117: 503-511.

Isoflavones derived from Trifolium pratense had a beneficial effect on the lipid profile of postmenopausal women with a BMI > 25. There was also a significant decrease in TC ( 4.6%) LDL-C (15.6%) and LpA levels  (63.8%) in those that received the red clover isoflavones.

Commentary

At least five previously published reports of T. pratense isoflavones on lipid profiles in men and premenopausal and postmenopausal women have been positive, and at least two have shown no effect. This is the first published report on postmenopausal women with an increased BMI using T. pratense isoflavones to lower lipids. These decreases in TC, LDL-C and LpA correlate with findings that support a meaningful reduction in cardiovascular risk, and even more so in postmenopausal women with high lipid values. This study is promising and provides another important lifestyle supplemental tool for women who do not want to use or may not be good candidates for hormonal or statin therapies to lower their risk of cardiovascular disease.

References

• Chedraui P, San Miguel G, Hidalgo L, et al. Effect of Trifolium pratense-derived isoflavones on the lipid profile of postmenopausal women with increased body mass index. Gynecological Endocrinology 2008;24(11):620-624.

Bolland M, Barber P, Doughty R, et al. Vascular events in healthy older women receiving calcium supplementation: Randomised controlled trial. BMJ 2008;Feb 2; 336:262-266

[Click here to download fulltext PDF from BMJ]

Commentary: It is interesting and important to point out that the Women’s Health Initiative ( Circulation 2007;115:846) showed no statistically significant increase in cardiovascular events in postmenopausal women receiving calcium supplements and another study showed a non-significant but yet a trend in increased risk for ischemic heart disease. (Arch Intern Med 2006;166:869). These three studies all point to the fact that there is no definite statement or conclusion that can be made regarding calcium and cardiovascular events. That said, I am concerned that the importance of calcium supplementation in postmenopausal women, especially younger postmenopausal women, is very overplayed. And, most individuals do not estimate their dietary calcium sources, and then use a pill to supplement in addition to dietary sources to meet a total of 1,200mg-1,500 mg per day. Rather, they often take 1,000 mg to 1,500 mg per day, in addition to their dietary sources. A result of this misinterpretation of calcium guidelines might be excessive calcium and depletion of other nutrients such as copper, silicon and magnesium, all of which have cardioprotective benefits. In addition, these total daily calcium guidelines turn out to be most important to young girls and postmenopausal women 65 and older. These are the times in life when lack of bone architecture/density growth (young girls) and bone loss (elderly women) is most crucial in the prevention of osteoporosis and risk for fractures. For women in their 30’s, 40’s, 50’s and early 60’s, our bones seem to do just fine with average dietary intake.