The current trends regarding significance of vitamins in

The current trends regarding significance of vitamins in cardiovascular disease Prof. Asma Shaukat

NIACIN (B 3) qdirect and noncompetitive inhibition hepatocyte diacylglycerol acyltransferase-2, a key enzyme for TG synthesis. q 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(8 A): 20 B-26 B.

q. Decreased HDL-apo A-I catabolism q 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(8 A): 20 B-26 B.

NIACIN AS ANTIHYPERLIPIDEMIC q 1 -3 g/day niacin increases HDL level by 10 -30 % making it most powerful agent to increase HDL cholesterol. q. 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 -15 mmol/L in serum • Classification of severity of high homocysteine. Mild-----15 -30 mmol/L Moderate----30 -100 mmol/L Severe--->100 mmol/L • CHD pt with Hcy >15 mmol/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 q. Folic acid is itself not biologically active, q. Biological importance is due to tetrahydrofolate

FUNCTIONS q. The human body needs folate to: ü Synthesize DNA üRepair DNA üMethylate DNA üCofactor in biological reactions involving folate. üAiding rapid cell division and growth (infancy and pregnancy). üProduction 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 Xanthurenic Acid 3 -OH-KYNURENINE Kynureninase (PLP) 3 -OH ANTHRANILIC ACID QUINOLINIC ACID NIACIN acetyl Co. A acetoacetyl Co. A

B 6 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 B 12 AND HOMOCYSTEINE

VITAMIN B 12 AND HOMOCYSTEINE

Ascorbic Acid It was found out that serum ascorbic acid levels were independently associated with prevalence of coronary heart disease and stroke; ü 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

q. Vitamin C • Reduces oxidation, • Increase collagen for healing and • Improve the health and strength of arteries, q High dose Lysine destroys Lp(a) plaques. REFERENCE How to Live Longer and Feel Better Linus Pauling

ROLE OF VIT C DEFICIENCY IN CHD: q initiation of atherosclerotic plaque formation. q. Vitamin C and amino acid lysine (LP(a) binding inhibitors), prevent this molecule from binding to the walls of damaged arteries. q. 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 25 OHD 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, Jo. Ann E. Manson, et al. Calcium/Vitamin D Supplementation and Cardiovascular Events. Circulation 2007, 115: 846 -854

DIET FOR HEALTHY HEART q. Vitamin E - 800 to 3200 iu q. Vitamin A - 20, 000 to 40, 000 iu q. Super B-Complex, esp. Vitamins B 6 and B 3 q. Magnesium (300 to 1500 mg) and avoid Manganese q. Avoid refined carbohydrates q. Amino acids Taurine, Arginine and Carnitine (1 to 3 g). q. Add a good mineral/multivitamin. REFERENCE How to Live Longer and Feel Better Linus Pauling

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