Cardiovascular Disease and Micronutrient Therapies Judith Anderson, ARNP, PhD, Cathy R. Kessenich, ARNP, DSN [Medscape Nursing 1(2), 2001. © 2001 Medscape, Inc.] Abstract Cardiovascular disease is a problem of epidemic proportions. Its prevalence, morbidity, and mortality have encouraged millions of Americans to seek prevention and treatment by ingesting micronutrients and antioxidants. Patients actively seek information about these complementary therapies in health food stores, via mail order catalogs, and through the Internet. Healthcare providers must acquire knowledge about these substances so they can impart reliable information to their patients. This article reviews the current scientific evidence on the use of garlic, coenzyme Q-10, fish oils, vitamins (B6, B12, C, and E), and folic acid in the treatment and prevention of coronary artery disease. Introduction A great deal of recent biomedical and nursing research has focused on the modification of known cardiovascular risk factors. Despite this attention, coronary artery disease (CAD) continues to be a chief cause of death in the United States. It has been estimated that more than half of the deaths due to cardiovascular disease are related to atherosclerotic pathology.[1] In the last several decades, great strides have been made in the diagnosis and treatment of CAD. New categories of pharmacologic agents have been developed, and intervention strategies to mitigate the progression of CAD have evolved. While these advances are promising, they have not substantially reduced the morbidity and mortality associated with CAD. Improved prevention and treatment strategies for CAD are public health issues of critical importance to all. Patients and providers are actively seeking alternative methods, such as the use of micronutrients and antioxidants, to prevent and treat CAD. Micronutrients are defined as essential nutrients that are needed for survival, but only in small amounts. The most common micronutrients are vitamins, which are vital organic dietary substances essential in very small amounts for particular metabolic functions or for prevention of disease due to deficiency. In treating CAD, the most important vitamins are C, E, B6, B12, and folic acid (the vitamin supplement for folate). Antioxidants are substances that interfere with the oxidation of low-density lipoprotein (LDL) and thus prevent formation of foam cells, which are pathogenic in atherosclerosis development. The antioxidant vitamins are C and E. Other alternative therapies for lowering cholesterol levels include garlic, fish oils, and coenzyme Q-10. The role of many micronutrients and antioxidants is undetermined. Even so, many CAD patients use these substances in large quantities. A study by Eisenberg and colleagues[2] published in 1998 estimated that Americans made 629 million visits annually to practitioners of alternative medicine -- a number that exceeds the total number of visits to primary care providers. Primary care providers must be knowledgeable about the scientific evidence that supports or refutes the use of complementary therapies. The purpose of this paper is to review the current evidence on the use of garlic, vitamin C, vitamin E, coenzyme Q-10, fish oils, vitamin B6, vitamin B12, and folate in the treatment and prevention of CAD. Garlic Garlic (Allium sativum) has been used since medieval times as a food, a magical substance to cast off evil spirits, and a miracle cure for disease. It may be taken in the form of fresh bulbs, bulk powder, granules, or oils. The proposed action of garlic is to lower blood pressure and lower LDL and triglycerides by several percentage points. Additionally, some reports indicate that garlic contains antiplatelet properties.[3] Many of the proposed beneficial effects of garlic are unsubstantiated. However, there are several meta-analyses that have supported the efficacy of garlic in lowering lipids in the blood[4] and reducing blood pressure.[5] The effect on blood pressure has mixed reviews, with a number of studies demonstrating no effect. Several small studies have found garlic to be effective in reducing atherosclerotic plaques[6] and inhibiting platelet aggregation.[7] Research shows that garlic might have some effect on the prevention and treatment of CAD. No harmful effects have been discovered, although it is noted that several types of garlic preparations cause malodorous breath and body odor. Therefore, patients who use garlic therapy are probably choosing a safe therapy that complements other lifestyle modifications. The proper use of garlic may deter even the most ardent supporter, however. According to Roberts,[3] the best way to attain the positive effects of garlic is to eat 5-20 raw cloves per day. This therapy may cause gastrointestinal difficulty, including flatulence and esophageal and abdominal pain. To avoid these side effects, manufacturers have developed extracts, powders, and tablets. Unfortunately, many of these preparations contain little or no active garlic ingredient and are no better than placebo for the prevention and treatment of CAD. Vitamin C,E,CoQ10, Fish oil, Folate, B6,B12 Medscape Nursing article, 2001 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.