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 Table of Contents  
REVIEW ARTICLE
Year : 2018  |  Volume : 9  |  Issue : 1  |  Page : 80

Dietary supplements and cardiovascular diseases


1 Universita Vita-Salute San Raffaele, Milan, Italy
2 UO Cardiologia, Ospedale Valduce, Como, Italy

Date of Submission13-Apr-2017
Date of Acceptance27-Oct-2017
Date of Web Publication17-Sep-2018

Correspondence Address:
Alessandro Durante
Ospedale Valduce, Via Dante 11, 22100 Como
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpvm.IJPVM_179_17

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  Abstract 


The market of nutritional supplements is expected to expand over 6%/year through 2018 due to growing interest in personal health, aging population, and promising personalized care products. The most used dietary supplements are fish oil, multivitamins, Vitamin D, and coenzyme Q10 (CoQ10) in this order, while probiotics is the fastest growing supplement. In the U.S., over 68% of the population use dietary supplements regularly. On the other hand, in the developed countries, cardiovascular diseases (CVDs) are the main cause of death and morbidity from the 1900s. The effects of most dietary supplements on cardiovascular risk and CVD have been studied for a long time. However, despite several studies explored the association of the various supplements to the cardiovascular risk, there is still a lack of consensus. Multivitamin supplementation has been advocated to reduce cardiovascular events; Vitamin D levels have been associated with the occurrence of coronary artery disease, heart failure, and atrial fibrillation; CoQ10 deficiency has been associated with myocardial dysfunction and with statin myopathy; probiotoics has been suggested to lower both blood pressure and circulating lipids. However, the study of the effects of dietary supplementations is not straightforward, since people assuming dietary supplements generally have a healthier diet and lifestyle, and randomized studies are rarely performed. In this review, we will summarize the findings linking dietary supplements to CVD with a special focus on novel insights.

Keywords: Cardiovascular disease, cardiovascular risk, dietary supplements, multivitamins, probiotics, Vitamin D


How to cite this article:
Bronzato S, Durante A. Dietary supplements and cardiovascular diseases. Int J Prev Med 2018;9:80

How to cite this URL:
Bronzato S, Durante A. Dietary supplements and cardiovascular diseases. Int J Prev Med [serial online] 2018 [cited 2018 Oct 17];9:80. Available from: http://www.ijpvmjournal.net/text.asp?2018/9/1/80/241413




  Introduction Top


The United States (U.S.) nutritional supplements market is going to expand over 6%/year through 2018 due to growing interest in personal health, aging population, and promising personalized care products. In 2011, a survey of 10,000 consumers showed that the most used dietary supplements in the U.S. were fish oil, multivitamins, Vitamin D, and coenzyme Q10 (CoQ10), in this order.[1] However, in 2013 and first part of 2014, omega-3 and bone supplements sales in the U.S. declined, while probiotics was the fastest growing supplements category and it would remain so untill 2015.[1] The 2013 Council for Responsible Nutrition Consumer Survey on Dietary Supplements on 2012 U.S. residents over 18 years of age reported that 68% used dietary supplements regularly. The use of these supplements raised with age, varying from 64% of regular users between 18 and 34 years to 66% in the 35–55 years age group to 74% in the 55+ age group.[2]

Cardiovascular diseases (CVD) are the main cause of death in the U.S. from the 1900s.[3] In 2013, an estimated 83.6 million American adults (>1 in 3) have ≥1 types of CVD. Of these, 42.2 million are estimated to be ≥60 years of age.[4]

The efficacy of dietary supplements on global health has been deeply studied, but there is generally a lack of randomized trials and the understanding of their role is complicated by the fact that people assuming them generally have a healthier diet and lifestyle.

In our review, we will summarize the findings linking major dietary supplements to CVD with a special focus on novel insights. We will not discuss the role of omega 3 supplementation, since this supplement has been used in pharmacologic trials in cardiovascular field.


  Multivitamins Top


In the U.S., multivitamins are defined as a dietary supplement including three or more vitamins and minerals where each of them is contained at a tolerable dose, as defined by the Food and Drug Board.[5] Data on the efficacy of the association of vitamins on cardiovascular risk are actually inconsistent. The U.S. Preventive Services Task Force (USPSTF) has recently revised the most recent evidence of the association between vitamin consumption and CVD and cancer risk.[6] In its report, the USPSTF assessed that there are no sufficient data to confirm the role of multivitamin on the prevention of cancer and cardiovascular events. The first issue is that observational studies on the association between vitamins and CVD are scant and unclear. In the Cancer Prevention Study II on >1 million U.S. adults, the death rates tended to be more elevated in nonvitamin consumers with no previous CVD rather than in regular or occasional users. However, the significance of this association decreased when the death risk was adjusted for cardiovascular risk factors.[7] In Sweden, where fruits and vegetables consumption is poor, one case–control study on the relationship between vitamin supplements and myocardial infarction (MI) showed an inverse association between a low intake of multivitamins and the incidence of MI.[8] By contrast, in 2011, one large multiethnic study on 182,099 participants showed no significant association between multivitamins intake for >10 years and CVD risk.[9] These different results can be partially explained by the intervention of modifiers such as dose and composition of vitamin complex, age group, ethnicity, baseline intake of nutrients, behavioral exercise, and drugs (e.g., statin treatment). Recently, a study examined the efficacy of multiple vitamins and minerals on the secondary prevention of 1708 post-MI patients (age ≥50 years, ≥6 weeks after MI of CVD).[6] The consumption of a high-dose multivitamin and multimineral did not significantly reduce even secondary cardiovascular events. This outcome can be influenced either by high frequency of withdrawals and noncompliance of the patients. Another issue is that most of studies examined the efficacy on heart just of single or small combination of vitamins. Moreover, most of these agents have shown no efficacy in reducing CVD.[10],[11],[12] Some of them have also been addressed to increase toxicity and adverse events.


  Vitamin D Top


Vitamin D is a prohormone synthetized in skin through ultraviolet radiation of 7-dehydrocholesterol. Its functioning depends first on its liver metabolism to 25-hydroxyvitamin D3 (25[OH]D3) and second to kidney conversion to 1α, 25-dihydroxyvitamin D3. The serum 25(OH)D level is the most commonly used assessment to establish total level of Vitamin D.[13] Vitamin D has a wide spectrum of effects in the body, varying from the role on calcium/phosphate homeostasis and muscle strength, to the action on cardiovascular, nervous, and immune systems. Vitamin D deficiency has been referred to rise the incidence of multiple chronic diseases such as CVD, cancer, multiple sclerosis, and diabetes.[14] The first hypothesis of the association between level of Vitamin D and CVD was made by Robert Scragg in 1981. He suggested that ultraviolet irradiation, by raising body levels of Vitamin D, lowered the risk of thrombosis, thus protecting from CVD. According to Scragg, this hypothesis provided possible reasons for seasonal and geographical variations in CVD mortality and morbidity.[15] Since then, many authors provided important information to the association between Vitamin D levels and cardiovascular risk. Most of the recent results support a direct association between Vitamin D deficiency and CVD. One of the strongest results comes from a meta-analysis of prospective studies from 1966 through February 2012 on 65,994 subjects. In this study, the authors found a significant graded inverse association between 25(OH)-Vitamin D, varying from 20 to 60 nmol/L, and cardiovascular risk (RR, 1.03; 95% CI: 1.00–1.06 for each 25 nmol/L decrease in Vitamin D).[15] However, these data should be confirmed by studies regarding the association of Vitamin D to the different manifestations of CVD. In fact, CVD refers to a spectrum of different diseases including heart disease, vascular diseases of the brain, and the kidney and peripheral artery disease.[16] Most of results derived from studies about the association between Vitamin D status and heart disease, such as coronary artery disease (CAD), heart failure (HF), and dysrhythmia.


  Coronary Artery Disease Top


A growing number of evidence supports the predictive role of low levels of Vitamin D for the development of CAD. Two recent studies on patients who underwent coronary angiography also showed significant association between low level of Vitamin D and angiographic severity of coronary artery stenoses in patients with CAD assessed with SYNTAX score (which combines several angiographic classifications of lesions based on functional impact, location, and complexity).[17],[18],[19] A larger cross-sectional study confirmed these results. In this study, Verdoia et al. supported the impact of hypovitaminosis D on the progress and extent of CAD, particularly when Vitamin D levels were <10 ng/ml.[20] The main issue is still he understanding of the precise molecular causal effect linking Vitamin D deficiency to the development of CAD. Low levels of Vitamin D are associated with increased insulin resistance (and thus can lead to diabetes), hyperlipidemia, and hypertension, which all together lead to CAD.[21],[22],[23] Several findings revealed a direct biological effect of Vitamin D on the endothelium and in angiogenesis.[24],[25] In fact, Vitamin D can influence the development of coronary collateral circulation [Figure 1]. Artery collateralization (arteriogenesis) is a preserving process for ischemic tissue. In this process, nonfunctional vascular anastomoses are modified into collateral arteries which can bypass obstruction sites.[26] The molecular action of Vitamin D on arteriogenesis has been completely understood. Recent studies focused on Vitamin D action bound to its receptor in the nucleus. This complex promotes the transcription of several genes through the binding to specific gene target sequences.
Figure 1: Vitamin D has been demonstrated to increase arterial collateralization, to increase the duration of the atrial action potential, and to lower the activation of the renin-angiotensin-aldosterone system

Click here to view



  Heart Failure Top


There is a lack of consensus about Vitamin D action on HF and its consequences. In 2012, Gotsman et al. reported a high prevalence of Vitamin D deficiency among patients affected by HF. Low levels of Vitamin D were also predictive of poor outcome in HF patients.[27] In contrast, in 2013, Boxer et al. examined the role of high dose of Vitamin D supplementation (50,000 IU) in a randomized controlled study. After Vitamin D supplementation in, no improvement was found in HF patients' physical performance.[28] Moreover, a recent prospective study of 3731 men of 60–79 years old reported that the risk of HF in older men with and without MI or stroke was associated with the elevation in parathyroid hormone, recently denied to be an independent cardiovascular risk factor, but not with the 25(OH) D status.[29] How Vitamin D acts in HF is unclear. In animal models, Vitamin D status has been reported to downregulate the renin-angiotensin-aldosterone system (RAAS). In humans, it seems to be an inverse relation between Vitamin D and RAAS activation and activity [Figure 1].[30] The RAAS is overactivated in patients with HF, possibly leading to cardiac remodeling and activation of the sympathetic system.[31] Explanation could be found in Vitamin D status. Recently, the supplementation of 2000 UI for 6 weeks has been reported to lower plasma renin activity in HF patients.[32] Moreover, one recent study revealed that Vitamin D supplementation in HF patients with baseline low plasma levels lowered aldosterone concentration.[33]


  Atrial Fibrillation Top


The association between Vitamin D and atrial fibrillation (AF) is controversial. The first study which examined the possible role of Vitamin D in developing AF was a large European community-based cohort of 2930 participants in 2011.[34] After a follow-up of 9.9 years, the authors found no relationship between the incidence of new episodes of AF and Vitamin D status. Furthermore, in 2012, Qayyum et al. showed no association between Vitamin D level and type and adverse events related to AF.[35] However, recent smaller studies provided different results. In a recent comparative study of Vitamin D status in patients with nonvalvular AF, valvular AF and in control, Vitamin D deficiency was significantly related to nonvalvular AF.[36] The mechanisms which explain the effect of Vitamin D on the atrium are uncertain. A direct electromechanical action on the left atrium has been recently derived from a study on HF rabbits atrial tissue [Figure 1].[37] In this study, rapid atrial pacing and acetylcholine atrial stimulation both induce lower number, duration, and rate of AF episodes in the presence of 1,25[OH]2 D.


  Supplementation Top


The benefits of Vitamin D supplementation have been largely studied. Recently, Vitamin D supplements have been found to protect against bone fractures, cancer mortality, and overall mortality in elderly people.[38],[39],[40] In contrast, the effects of dietary Vitamin D supplementation on cardiovascular system are still under discussion. Large trials' analyses reported that Vitamin D supplements could prevent HF in the elderly but showed no protection against MI and stroke.[41] A recent small randomized double-blind placebo-controlled trial confirmed these results. This study showed that after 6 months of Vitamin D supplementation, elderly patients with HF had significant improvement in ejection fraction (EF).[42]


  Probiotics Top


Probiotics refer to viable bacteria or yeasts present in fermented dairy products, but also contained in drugs. They exhibit a wide spectrum of health benefits after ingestion, starting from better lactose tolerance and digestion, immune system reinforcement, and cancer inhibition. Nevertheless, much of literature has studied their activity of improving lipid metabolism and blood pressure (BP) profile, which are two strong independent cardiovascular risk factors. The first hypothesis of probiotics efficacy in lowering serum cholesterol refers to a study on dietary habits and cholesterolemia in the African Masaai.[43] The tribesmen were reported to assume regularly high dose of fermented whole milk and meat. Despite their dietary intake, they had low rate of CVD and low level of blood cholesterol. Thus, this inspired further studies to examine the association between cholesterolemia and fermented milk consumption.

Unfortunately, most of past and current results of the effect of probiotics on cardiovascular risk derive from studies in vitro. Furthermore, the precise mechanisms that make probiotics lowering lipids and BP are still unclear. Probiotics have been suggested either to promote cholesterol assimilation by growing cells, to bind it to cellular surface, or to insert it into the cellular membrane.[44],[45] Gut microflora can also transform cholesterol into coprostanol, thus making it eliminable with defection. This reduces cholesterol absorption and total cholesterol level. Different species of bacteria have been tested for this effect. In one study,  Sterolibacterium denitrificans Scientific Name Search shown to synthetize the enzymes which lead to cholesterol conversion into fundamental cofactors for coprostanol production.[46] This result is consistent with the fact that some probiotics act on cholesterol according to bacterial genus, species or strain; thus, it makes even more difficult to confirm the power of probiotics on lowering blood lipids. In vivo studies on animals reported that this action is partly due to Lactobacilli with bile salt hydrolase (BSH) activity.[47] Bile acids synthesis and elimination are the most important sources of cholesterol excretion in the feces.[48] These BSH bacilli have been shown to provoke the deconjugation of bile acids [Figure 2]. On one side, deconjugated bile acids are easily eliminated with defecation, thus raising the necessity of cholesterol to produce bile acids de novo. On the other side, the deconjugation of bile salts makes cholesterol hardly absorbable. Probiotics have also been investigated in improving BP profile. Recently, the consumption of probiotics for >8 weeks has been reported to reduce both systolic and diastolic BP, especially in subjects with high baseline BP consuming different species of probiotics.[49]
Figure 2: Probiotics have been demonstrated to increase bile salts synthesis and bile acids deconjugation, and to lower circulating cholesterol, thus possibly protecting from cardiovascular diseases

Click here to view



  Coenzyme Q10 Top


CoQ10, or ubiquinone, is an organic molecule which is placed in the mitochondria, where it serves the electron reaction chain for cellular energy production, and in the plasma and subcellular elements where it is involved in other functions.[50] Some of these functions have been suggested to impact on CVD and cardiovascular risk factors. CoQ10 deficiency, in fact, was revealed in serum and myocardial biopsies of patients with different CVD, from cardiomyopathy to HF.[51],[52] According to some literature, CoQ10 supplementation improves different cardiovascular conditions in many ways. Some authors reported that CoQ10 supplementation enhance myocardial contractility, thus improving the EF of HF patients.[53] Other authors showed that the addition of CoQ10 could influence the endothelial function.[54] Both coronary arteries tone and peripheral perfusion are controlled by the endothelium. Impaired flow-dependent, endothelium-mediated vasodilation (flow-dependent dilatation) is a typical condition of chronic HF where vessels are not able to face the variability in blood supply, partly because of nitric oxide degeneration by reactive oxygen species (ROS).[55] In recent years, one study showed that CoQ10 attenuates the oxidized low-density lipoprotein (oxLDL)-induced production of ROS, the oxLDL-altered proapoptotic responses of the endothelial cells and increase the antioxidant activity.[56] Another recent study reported that long-term supplementation with CoQ10 in 420 HF failure patients improves both HF symptoms and New York Heart Association class and reduces all-cause mortality.[57] However, according to a 2014 Cochrane systematic review, the CoQ10 supplementation was not confirmed neither to improve nor to worsen the conditions of patients with HF; thus, further evidence are needed.[58] The protective effect of CoQ10 against lipid peroxidation has been recently studied in patients with atherosclerosis. Lee et al. showed that the supplementation of 150 mg/day of CoQ10 in 43 patients with CAD is associated with lower oxidative stress, can improve antioxidant enzyme functions, and diminishes the level of pro-inflammatory interleukin 6.[59] This anti-inflammatory activity has also been proved in synergy with the Mediterranean diet, showing that the addiction of CoQ10, especially in the elderly, reduces the expression of both pro-inflammatory and stress genes.[60],[61] Some studies also analyzed the association between CoQ10 supplementation and cholesterolemia. Hypercholesterolemia increases the risk of CVD, particularly of CAD. The synthesis of both cholesterol and CoQ10 is dependent on the activity of the enzyme 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. Statins are commonly used drugs in the treatment of hypercholesterolemia as they inhibit HMG-CoA reductase. Thus, statins act also by blocking the production of CoQ10. The deficiency in CoQ10 and its consequences on mythocondrial functions could partly explain the incidence of myopathies induced by the use of statins, particularly in patients with genetic susceptibility.[62] Therefore, the supplementation of CoQ10 could be necessary to avoid this adverse event. However, there is still no significant association between statins treatment, CoQ10 depletion and the incidence of statins-induced myophaties.[63] Furthermore, there is no consensus about the improvement of these myopathies with CoQ10 supplements.[64],[65]


  Conclusions Top


In our work, we reviewed the role of the most used dietary supplements in cardiovascular risk. The market of nutritional supplements has increased and is going to further due to growing interest in personal health, aging population, and promising personalized care products.

The effects of most dietary supplements on cardiovascular risk and CVD have been studied for a long time. However, despite several studies explored the association of the various supplements to the cardiovascular risk, analyzing the effects of dietary supplementations is not straightforward since patients assuming dietary supplements generally have a healthier diet and lifestyle, and randomized studies are rarely performed.

Low Vitamin D levels have been associated with CAD, HF and AF; CoQ10 deficiency has been associated with myocardial dysfunction and to statin myopathies; multivitamin supplementation has been advocated to reduce cardiovascular events; probiotoics has been suggested to lower both BP and circulating lipids.

The growing importance of these dietary supplements could lead to the opportunity to perform ad hoc studies to clarify their role and the exact importance of each one in the determination of cardiovascular risk and CVD.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Nutritional Supplements in the U.S. 6th ed. 2014.  Back to cited text no. 1
    
2.
Nutrition C for R. Consumer Confidence In Supplements Remains At Two-Year High. 2013.  Back to cited text no. 2
    
3.
Jones DS, Podolsky SH, Greene JA. The burden of disease and the changing task of medicine. N Engl J Med 2012;366:2333-8.  Back to cited text no. 3
    
4.
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics-2014 update: A report from the American Heart Association. Circulation 2014;129:e28-e292.  Back to cited text no. 4
    
5.
National Institutes of Health State-of-the-Science Panel. National Institutes of Health State-of-the-Science Conference Statement: Multivitamin/mineral supplements and chronic disease prevention. Am J Clin Nutr 2007;85:257S-264S.  Back to cited text no. 5
    
6.
Moyer VA, U.S. Preventive Services Task Force. Vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer: U.S. Preventive services Task Force recommendation statement. Ann Intern Med 2014;160:558-64.  Back to cited text no. 6
    
7.
Watkins ML, Erickson JD, Thun MJ, Mulinare J, Heath CW Jr. Multivitamin use and mortality in a large prospective study. Am J Epidemiol 2000;152:149-62.  Back to cited text no. 7
    
8.
Holmquist C, Larsson S, Wolk A, Faire U de. Multivitamin supplements are inversely associated with risk of myocardial infarction in men and women – Stockholm Heart Epidemiology Program (SHEEP). J Nutr2 003;133:2650–2654.  Back to cited text no. 8
    
9.
Park SY, Murphy SP, Wilkens LR, Henderson BE, Kolonel LN. Multivitamin use and the risk of mortality and cancer incidence: The multiethnic cohort study. Am J Epidemiol 2011;173:906-14.  Back to cited text no. 9
    
10.
Lee IM, Cook NR, Gaziano JM, Gordon D, Ridker PM, Manson JE, et al. Vitamin E in the primary prevention of cardiovascular disease and cancer: The Women's Health Study: A randomized controlled trial. JAMA 2005;294:56-65.  Back to cited text no. 10
    
11.
Leppälä JM, Virtamo J, Fogelholm R, Huttunen JK, Albanes D, Taylor PR, et al. Controlled trial of alpha-tocopherol and beta-carotene supplements on stroke incidence and mortality in male smokers. Arterioscler Thromb Vasc Biol 2000;20:230-5.  Back to cited text no. 11
    
12.
Hennekens CH, Buring JE, Manson JE, Stampfer M, Rosner B, Cook NR, et al. Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease. N Engl J Med 1996;334:1145-9.  Back to cited text no. 12
    
13.
DeLuca HF. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 2004;80:1689S-96S.  Back to cited text no. 13
    
14.
Zittermann A, Gummert JF. Nonclassical vitamin D action. Nutrients 2010;2:408-25.  Back to cited text no. 14
    
15.
Scragg R. Seasonality of cardiovascular disease mortality and the possible protective effect of ultra-violet radiation. Int J Epidemiol 1981;10:337-41.  Back to cited text no. 15
    
16.
Fuster V, Kelly BB. Institute of Medicine (US) Committee on Preventing the Global Epidemic of Cardiovascular Disease: Meeting the Challenges in Developing Countries. Promoting Cardiovascular Health in the Developing World. National Academies Press (US); 2010.  Back to cited text no. 16
    
17.
Seker T, Gür M, Yüksel Kalkan G, Kuloğlu O, Yıldız Koyunsever N, Yıldıray Şahin D, et al. Serum 25-hydroxyvitamin D level and extent and complexity of coronary artery disease. J Clin Lab Anal 2014;28:52-8.  Back to cited text no. 17
    
18.
Chen WR, Qian YA, Chen YD, Shi Y, Yin DW, Wang H, et al. The effects of low vitamin D on coronary artery disease. Heart Lung Circ 2014;23:314-9.  Back to cited text no. 18
    
19.
Capodanno D, Capranzano P, Di Salvo ME, Caggegi A, Tomasello D, Cincotta G, et al. Usefulness of SYNTAX score to select patients with left main coronary artery disease to be treated with coronary artery bypass graft. JACC Cardiovasc Interv 2009;2:731-8.  Back to cited text no. 19
    
20.
Verdoia M, Schaffer A, Sartori C, Barbieri L, Cassetti E, Marino P, et al. Vitamin D deficiency is independently associated with the extent of coronary artery disease. Eur J Clin Invest 2014;44:634-42.  Back to cited text no. 20
    
21.
Lavie CJ, Lee JH, Milani RV. Vitamin D and cardiovascular disease will it live up to its hype? J Am Coll Cardiol 2011;58:1547-56.  Back to cited text no. 21
    
22.
Forman JP, Giovannucci E, Holmes MD, Bischoff-Ferrari HA, Tworoger SS, Willett WC, et al. Plasma 25-hydroxyvitamin D levels and risk of incident hypertension. Hypertension 2007;49:1063-9.  Back to cited text no. 22
    
23.
Anderson JL, May HT, Horne BD, Bair TL, Hall NL, Carlquist JF, et al. Relation of vitamin D deficiency to cardiovascular risk factors, disease status, and incident events in a general healthcare population. Am J Cardiol 2010;106:963-8.  Back to cited text no. 23
    
24.
Dusso AS, Brown AJ, Slatopolsky E. Vitamin D. Am J Physiol Renal Physiol 2005;289:F8-28.  Back to cited text no. 24
    
25.
Chung I, Han G, Seshadri M, Gillard BM, Yu WD, Foster BA, et al. Role of vitamin D receptor in the antiproliferative effects of calcitriol in tumor-derived endothelial cells and tumor angiogenesis in vivo. Cancer Res 2009;69:967-75.  Back to cited text no. 25
    
26.
de Groot D, Pasterkamp G, Hoefer IE. Cardiovascular risk factors and collateral artery formation. Eur J Clin Invest 2009;39:1036-47.  Back to cited text no. 26
    
27.
Gotsman I, Shauer A, Zwas DR, Hellman Y, Keren A, Lotan C, et al. Vitamin D deficiency is a predictor of reduced survival in patients with heart failure; vitamin D supplementation improves outcome. Eur J Heart Fail 2012;14:357-66.  Back to cited text no. 27
    
28.
Boxer RS, Kenny AM, Schmotzer BJ, Vest M, Fiutem JJ, Piña IL, et al. A randomized controlled trial of high dose vitamin D3 in patients with heart failure. JACC Heart Fail 2013;1:84-90.  Back to cited text no. 28
    
29.
Wannamethee SG, Welsh P, Papacosta O, Lennon L, Whincup PH, Sattar N, et al. Elevated parathyroid hormone, but not vitamin D deficiency, is associated with increased risk of heart failure in older men with and without cardiovascular disease. Circ Heart Fail 2014;7:732-9.  Back to cited text no. 29
    
30.
Scragg R, Sowers M, Bell C. Serum 25-hydroxyvitamin D, ethnicity, and blood pressure in the third national health and nutrition examination survey. Am J Hypertens 2007;20:713-9.  Back to cited text no. 30
    
31.
Unger T, Li J. The role of the renin-angiotensin-aldosterone system in heart failure. J Renin Angiotensin Aldosterone Syst 2004;5 Suppl 1:S7-10.  Back to cited text no. 31
    
32.
Schroten NF, Ruifrok WP, Kleijn L, Dokter MM, Silljé HH, Lambers Heerspink HJ, et al. Short-term vitamin D3 supplementation lowers plasma renin activity in patients with stable chronic heart failure: An open-label, blinded end point, randomized prospective trial (VitD-CHF trial). Am Heart J 2013;166:357-6400.  Back to cited text no. 32
    
33.
Boxer RS, Hoit BD, Schmotzer BJ, Stefano GT, Gomes A, Negrea L, et al. The effect of vitamin d on aldosterone and health status in patients with heart failure. J Card Fail 2014;20:334-42.  Back to cited text no. 33
    
34.
Rienstra M, Cheng S, Larson MG, McCabe EL, Booth SL, Jacques PF, et al. Vitamin D status is not related to development of atrial fibrillation in the community. Am Heart J 2011;162:538-41.  Back to cited text no. 34
    
35.
Qayyum F, Landex NL, Agner BR, Rasmussen M, Jøns C, Dixen U, et al. Vitamin D deficiency is unrelated to type of atrial fibrillation and its complications. Dan Med J 2012;59:A4505.  Back to cited text no. 35
    
36.
Demir M, Uyan U, Melek M. The effects of vitamin D deficiency on atrial fibrillation. Clin Appl Thromb Hemost 2014;20:98-103.  Back to cited text no. 36
    
37.
Hanafy DA, Chang SL, Lu YY, Chen YC, Kao YH, Huang JH, et al. Electromechanical effects of 1,25-dihydroxyvitamin d with antiatrial fibrillation activities. J Cardiovasc Electrophysiol 2014;25:317-23.  Back to cited text no. 37
    
38.
van der Velde RY, Brouwers JR, Geusens PP, Lems WF, van den Bergh JP. Calcium and vitamin D supplementation: State of the art for daily practice. Food Nutr Res 2014;58:1, 21796.  Back to cited text no. 38
    
39.
Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev 2014;CD007470.  Back to cited text no. 39
    
40.
Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Krstic G, Wetterslev J, et al. Vitamin D supplementation for prevention of cancer in adults. Cochrane Database Syst Rev 2014;CD007469.  Back to cited text no. 40
    
41.
Ford JA, MacLennan GS, Avenell A, Bolland M, Grey A, Witham M, et al. Cardiovascular disease and vitamin D supplementation: Trial analysis, systematic review, and meta-analysis. Am J Clin Nutr 2014;100:746-55.  Back to cited text no. 41
    
42.
Dalbeni A, Scaturro G, Degan M, Minuz P, Delva P. Effects of six months of vitamin D supplementation in patients with heart failure: A randomized double-blind controlled trial. Nutr Metab Cardiovasc Dis 2014;24:861-8.  Back to cited text no. 42
    
43.
Mann GV. Studies of a surfactant and cholesteremia in the Maasai. Am J Clin Nutr 1974;27:464-9.  Back to cited text no. 43
    
44.
Usman, Hosono A. Bile tolerance, taurocholate deconjugation, and binding of cholesterol by Lactobacillus gasseri strains. J Dairy Sci 1999;82:243-8.  Back to cited text no. 44
    
45.
Kimoto H, Ohmomo S, Okamoto T. Cholesterol removal from media by lactococci. J Dairy Sci 2002;85:3182-8.  Back to cited text no. 45
    
46.
Chiang YR, Ismail W, Heintz D, Schaeffer C, Van Dorsselaer A, Fuchs G, et al. Study of anoxic and oxic cholesterol metabolism by Sterolibacterium denitrificans. J Bacteriol 2008;190:905-14.  Back to cited text no. 46
    
47.
De Smet I, De Boever P, Verstraete W. Cholesterol lowering in pigs through enhanced bacterial bile salt hydrolase activity. Br J Nutr 1998;79:185-94.  Back to cited text no. 47
    
48.
Hofmann AF. The continuing importance of bile acids in liver and intestinal disease. Arch Intern Med 1999;159:2647-58.  Back to cited text no. 48
    
49.
Khalesi S, Sun J, Buys N, Jayasinghe R. Effect of probiotics on blood pressure: A systematic review and meta-analysis of randomized, controlled trials. Hypertension 2014;64:897-903.  Back to cited text no. 49
    
50.
Bentinger M, Tekle M, Dallner G. Coenzyme Q – Biosynthesis and functions. Biochem Biophys Res Commun 2010;396:74-9.  Back to cited text no. 50
    
51.
Folkers K, Vadhanavikit S, Mortensen SA. Biochemical rationale and myocardial tissue data on the effective therapy of cardiomyopathy with coenzyme Q10. Proc Natl Acad Sci U S A 1985;82:901-4.  Back to cited text no. 51
    
52.
Folkers K, Littarru GP, Ho L, Runge TM, Havanonda S, Cooley D, et al. Evidence for a deficiency of coenzyme Q10 in human heart disease. Int Z Vitaminforsch 1970;40:380-90.  Back to cited text no. 52
    
53.
Sander S, Coleman CI, Patel AA, Kluger J, White CM. The impact of coenzyme Q10 on systolic function in patients with chronic heart failure. J Card Fail 2006;12:464-72.  Back to cited text no. 53
    
54.
Littarru GP, Tiano L. Bioenergetic and antioxidant properties of coenzyme Q10: Recent developments. Mol Biotechnol 2007;37:31-7.  Back to cited text no. 54
    
55.
Landmesser U, Spiekermann S, Dikalov S, Tatge H, Wilke R, Kohler C, et al. Vascular oxidative stress and endothelial dysfunction in patients with chronic heart failure: Role of xanthine-oxidase and extracellular superoxide dismutase. Circulation 2002;106:3073-8.  Back to cited text no. 55
    
56.
Tsai KL, Huang YH, Kao CL, Yang DM, Lee HC, Chou HY, et al. A novel mechanism of coenzyme Q10 protects against human endothelial cells from oxidative stress-induced injury by modulating NO-related pathways. J Nutr Biochem 2012;23:458-68.  Back to cited text no. 56
    
57.
Mortensen SA, Rosenfeldt F, Kumar A, Dolliner P, Filipiak KJ, Pella D, et al. The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: Results from Q-SYMBIO: A randomized double-blind trial. JACC Heart Fail 2014;2:641-9.  Back to cited text no. 57
    
58.
Madmani ME, Yusuf Solaiman A, Tamr Agha K, Madmani Y, Shahrour Y, Essali A, et al. Coenzyme Q10 for heart failure. Cochrane Database Syst Rev 2014;CD008684.  Back to cited text no. 58
    
59.
Lee BJ, Huang YC, Chen SJ, Lin PT. Coenzyme Q10 supplementation reduces oxidative stress and increases antioxidant enzyme activity in patients with coronary artery disease. Nutrition 2012;28:250-5.  Back to cited text no. 59
    
60.
González-Guardia L, Yubero-Serrano EM, Delgado-Lista J, Perez-Martinez P, Garcia-Rios A, Marin C, et al. Effects of the mediterranean diet supplemented with coenzyme q10 on metabolomic profiles in elderly men and women. J Gerontol A Biol Sci Med Sci 2015;70:78-84.  Back to cited text no. 60
    
61.
Yubero-Serrano EM, Gonzalez-Guardia L, Rangel-Zuñiga O, Delgado-Lista J, Gutierrez-Mariscal FM, Perez-Martinez P, et al. Mediterranean diet supplemented with coenzyme Q10 modifies the expression of proinflammatory and endoplasmic reticulum stress-related genes in elderly men and women. J Gerontol A Biol Sci Med Sci 2012;67:3-10.  Back to cited text no. 61
    
62.
Thomas JE, Lee N, Thompson PD. Statins provoking MELAS syndrome. A case report. Eur Neurol 2007;57:232-5.  Back to cited text no. 62
    
63.
Marcoff L, Thompson PD. The role of coenzyme Q10 in statin-associated myopathy: A systematic review. J Am Coll Cardiol 2007;49:2231-7.  Back to cited text no. 63
    
64.
Caso G, Kelly P, McNurlan MA, Lawson WE. Effect of coenzyme q10 on myopathic symptoms in patients treated with statins. Am J Cardiol 2007;99:1409-12.  Back to cited text no. 64
    
65.
Young JM, Florkowski CM, Molyneux SL, McEwan RG, Frampton CM, George PM, et al. Effect of coenzyme Q(10) supplementation on simvastatin-induced myalgia. Am J Cardiol 2007;100:1400-3.  Back to cited text no. 65
    


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  In this article
Abstract
Introduction
Multivitamins
Vitamin D
Coronary Artery ...
Heart Failure
Atrial Fibrillation
Supplementation
Probiotics
Coenzyme Q10
Conclusions
References
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