Re: Chokeberry Flavonoids Reduce Inflammation in Medicated Patients with a History of Myocardial Infarction
Naruszeqicz M, Laniewska I, Millo B, Dluzniewski M. Combination therapy of statin with flavonoids rich extract from chokeberry fruit enhanced reduction in cardiovascular risk markers in patients after myocardial infraction [sic] (MI). Atherosclerosis. 2007;194: e179-e184.
Oxidative
stress is one of the most important causative factors in the development of
atherosclerosis in all of its stages, and it may contribute to the
destabilization of arterial wall plaque. Oxidative stress in the vascular wall causes
the formation of oxygenated forms of low-density-lipoproteins (LDLs), which
contribute to the formation of foam cells and subsequently to the development
of atherosclerosis. Recent clinical trials have shown a reduction in the
incidence of mortality in patients with coronary artery disease (CAD) after
treatment with statins, which was related not only to an LDL-cholesterol-lowering
effect but also to a reduction of less than 2 mg/l in the concentration of
C-reactive protein (CRP)—an indicator of inflammation. However, such reductions
in CRP are only possible with rather high doses of statins, which can have
adverse health effects. It has been postulated that a moderate dose of statins
in combination with natural polyphenols may provide an alternative therapeutic
approach. The objective of the present study was to determine whether a
reduction in oxidative stress through the consumption of flavonoids from black chokeberry
(Aronia melanocarpa var. elata) fruit in combination with statins
provides an additional reduction in biomarkers of cardiovascular disease risk
in patients with a history of myocardial infarction.
Forty-four
patients (n = 11 postmenopausal women and 33 men) with a mean age of 65 years
were recruited from a cardiology clinic associated with the Medical University
of Warsaw in Poland and enrolled in this double-blind, placebo-controlled,
parallel trial. All patients had a history of myocardial infarction and had
been taking statin drugs for at least 6 months (84% using a dose of 40 mg simvastatin/day
and 16% taking 20 mg atorvastatin/day), which continued throughout this study.
In addition, 77% were taking aspirin and 52% were using angiotensin
I-converting enzyme (ACE) inhibitors. The subjects were randomly assigned to
receive 3 capsules of either a flavonoid extract of black chokeberry or placebo
(maltodextrin) daily for 6 weeks. Each black chokeberry capsule (Aronox; Agropharm SA; Tuszyn,
Poland)
contained approximately 25% anthocyanins (cyanidin glycosides), 9% phenolic
acids (chlorogenic and neochlorogenic acids), and 50% monomeric (epicatechin)
and oligomeric procyanidins. Fasting blood samples were collected in the
morning at baseline and at 6 weeks for the measurement of glucose,
homocysteine, lipids (triglyceride, total cholesterol, LDL cholesterol, and
high-density-lipoprotein cholesterol), and markers of oxidative stress and
inflammation (interleukin-6, adiponectin, vascular adhesion molecule,
intercellular adhesion molecule, high-sensitivity CRP, F2-isoprostanes,
oxidized LDL, and monocyte chemoattractant protein-1). ACE activity (measured
in 10 subjects in the supplemented group and in 9 subjects in the placebo group
who were not taking ACE inhibitors), arterial blood pressure, and body mass
index were also measured at baseline and at 6 weeks.
Consumption
of the black chokeberry extract for 6 weeks had no significant effect on
lipids, homocysteine, glucose, or body mass index. Systolic and diastolic blood
pressure decreased significantly (P < 0.000) by 11.0 and 7.2 mm Hg after 6 weeks
of black chokeberry extract consumption but not after placebo. ACE activity
decreased by 20-57% (P < 0.009) in 7 of 10 subjects from the supplemented
subgroup but in none of the placebo subgroup. Compared with placebo, the black chokeberry
supplement resulted in a significant decrease in F2-isoprostanes and
oxidized LDL (by 38% and 29%, respectively; P < 0.000 for both), in
interleukin-6 by 30% (P < 0.003) and in CRP by 23% (P < 0.007), and in
the adhesion molecules including vascular adhesion molecule, intercellular
adhesion molecule, and monocyte chemoattractant protein-1 (P < 0.009, P <
0.05, and P < 0.001, respectively). Adiponectin concentrations increased
significantly after black chokeberry extract consumption (P < 0.034).
According
to the authors, the most "spectacular" findings of this study were
the significant decreases in systolic and diastolic blood pressure and in CRP
levels. The decrease in CRP concentrations indicates a reduction in
inflammation levels. These beneficial effects were attributed to a reduction in
oxidative stress resulting from the flavonoids in the black chokeberry extract,
as evidenced by the observed decreases in serum isoprostanes, adhesion
molecules, and oxidized LDL and the significant increase in serum adiponectin,
which plays an important role in vascular wall repair. Despite some limitations
of the study (e.g., relatively small sample size and short duration), the
authors conclude that the findings of this study indicate "a new
opportunity for using flavonoids of a high antioxidant potential for further
reduction in the risk of atheromatous progression in patients with CAD treated
with moderate doses of statins."
Unfortunately,
this article is marred by numerous grammatical and spelling errors as
exemplified in the title itself.