When you have coronary heart disease, however, the delivery of oxygen and nutrients is compromised as the arteries which supply heart muscle are narrowed or hardened. As a result, they are unable to dilate sufficiently when the heart’s oxygen needs increase. This can lead to heart muscle pain (angina) which typically feels like a tight discomfort, pressure or pain in the chest which comes on during exercise and improves with rest. Treatment is aimed at preventing the progression of coronary artery disease and promoting dilation of arteries so blood flow increases.
N.B. Chest pain or discomfort should always be taken seriously, and medical advice sought without delay.
How is coronary heart disease diagnosed?
Coronary heart disease may be diagnosed when you experience symptoms of angina, or as a result of medical screening tests such as an electrocardiogram (ECG). An exercise stress test on a treadmill can confirm if your heart muscle is lacking oxygen during physical activity, or you may have dye tests (coronary angiography) or radionuclide tests to outline the arteries and visualise any narrowing. A CT scan or cardiac MRI scan can also show if the coronary arteries are narrowed.
How is coronoary heart disease treated?
Coronary heart disease is treated with diet and lifestyle changes such as stopping smoking, adopting a healthy, low-salt diet, losing excess weight, cutting back on alcohol and avoiding stress. Medical treatment may include nitrate drugs which dilate arteries, low-dose aspirin or other antiplatelet drugs to reduce blood clots, and treatment to lower blood pressure and cholesterol levels. In some cases, surgery may be offered to widen the coronary arteries (angioplasty) or to reroute blood around a severe blockage using a by-pass graft.
Nutrients that support the heart
Nutrition is so important for heart health that a worldwide study, involving 52 countries, concluded that almost one in three heart attacks are linked with following a poor diet.1 If you eat a heart-friendly diet, however, you can reduce your future risk of a heart attack even if you have already experienced one. The DASH (Dietary Approach to Stopping Hypertension) diet is widely recommended and is based on the Mediterranean way of eating. This has been shown to improve many risk factors for heart disease, from blood pressure and type 2 diabetes to cholesterol levels and weight.
When it comes to supplements, the EU has authorised several health claims relating to heart health for key supplements.
Plant sterols reduce cholesterol levels by blocking its absorption within the intestines. A sterol rich diet can lower levels of harmful LDL-cholesterol by up to 15%2 to significantly reduce the risk of experiencing a heart attack or stroke. There are approved EU health claims that plant sterols contribute to the maintenance of normal blood cholesterol levels, and that plant sterols have been shown to lower blood cholesterol, with a further statement that high cholesterol is a risk factor in the development of coronary heart disease.3
Because statins work in a different way to plant sterols, the two can be used together to lower cholesterol levels even further.4 In fact, adding sterols to statin medication is more effective than doubling the statin dose.5 Some foods such as spreads and yoghurts are fortified with plant sterols, and tablets are also available to take with meals.
Low dose aspirin is sometimes prescribed to reduce the tendency for blood cell fragments (platelets) to clump together and form unwanted clots. Fruitflow, a tomato extract from the clear jelly surrounding tomato seeds achieves the same result in a different way and has an approved EU claim that it helps to 'maintain normal platelet aggregation, which contributes to a healthy blood flow'.6 Tomato Fruitflow works by keeping platelets smooth rather than spiky. This reduces clumping and protects against abnormal blood clotting and may help to prevent abnormal blood clotting as a complication of atherosclerosis.7
Omega-3 fish oil
Fish oil provides the long-chain omega-3 fatty acids, EPA and DHA which, according to authorised EU health claims, contribute to the maintenance of normal heart function, the maintenance of normal blood pressure and the maintenance of normal blood triglyceride levels.8 Some research suggests that fish oil has a protective effect against abnormal heart rhythms, especially in heart muscle receiving a poor blood supply.9 Diet should always come first, so aim to eat at least two portions of fish per week, of which one is oily (eg salmon, mackerel, herrings, sardines). If you don’t like eating fish, supplements are available.
Authorised EU health claims confirm that magnesium contributes to the normal functioning of the nervous system and normal muscle function. This makes it vital for heart muscle contraction, maintaining a normal heart rhythm and the regulation of blood pressure. Lack of magnesium has been linked with spasm of coronary arteries and abnormal heart rhythms. These effects seem to be more pronounced during times of stress.
Vitamin B1, also known as thiamine, is needed to produce energy, the transmission of electrical messages in nerve and muscle cells, including the heart, and to produce red blood cells. Vitamin B1 appears to have a protective effect against over proliferation of artery linings which is linked with hardening and furring up of the arteries (atherosclerosis). Cell studies have even suggested that good intakes of vitamin B1 may delay hardening and furring up of the arteries associated with elevated glucose levels in people with type 2 diabetes.10 Thiamine is found in whole grains, meat – especially pork and duck – seafood, nuts, pulses and yeast extracts. Thiamine is also found in multivitamins and B vitamin complex. There is an authorised EU health claim that thiamine, contributes to the normal function of the heart.11
Vitamin K is essential for normal blood clotting, for which there is an authorised EU health claim. Vitamin K comes in different forms, and vitamin K2 is involved in the synthesis and activation of a series of proteins which bind calcium and helps to protect against calcification of tissues. As a result, vitamin K2 may also reduce the risk of coronary heart disease in older people. Researchers looking at dietary intakes of over 16,000 women aged 49 – 70 years found that every 10mcg increase in dietary intakes of vitamin K2 reduced the risk of coronary heart disease by 9%.12 This may be related to a reduced build-up of calcification in artery walls. The diet mostly provides the form known as vitamin K1, which is found in plants such as cauliflower, broccoli and dark green leaves. Only around 10% of dietary vitamin K is in the form of K2, which is mostly obtained from liver, cheeses, egg yolk, meats and bacterial fermented foods such as probiotic yoghurt, cheese and natto. Supplements are also available.
New understandings about vitamin D show that it is not just about calcium absorption for healthy bones – it also helps to protect against heart disease by improving blood pressure control and helping to reduce the amount of calcium laid down in artery walls. There is now also an authorised EU claim that vitamin D contributes to the maintenance of normal muscle function. These functions are all important for a healthy heart and circulation. As we cannot synthesise vitamin D in the skin when the UV index is below 3, Public Health England recently recommended that everyone should take a vitamin D supplement during Autumn and Winter.
Nutrients without claims
Other supplements also have evidence of benefit in supporting heart health but do not yet have authorised health claims for this specific indication.
Coenzyme Q10 is needed for energy production in cells, especially muscles such as the heart. If you have coronary heart disease, your doctor is likely to offer a statin drug to lower cholesterol. Statins act on the liver to reduce the synthesis of cholesterol and also reduce the production of coenzyme Q10. Taking a statin can halve circulating levels of co-enzyme Q10 within 4 weeks13, 14 which may contribute to the muscle-related side effects some people experience when taking a statin. Taking co-enzyme Q10 supplements (eg ubiquinol 100mg or ubiquinone 200mg) helps to maintain blood levels of this important muscle nutrient15, 16, 17 without affecting the cholesterol-lowering action of statin drugs.18
Garlic is a source of powerful antioxidants which help to prevent cells from taking up cholesterol and discourages hardening and furring up of the arteries. Garlic also dilates small arteries and small veins to lower blood pressure and improve the circulation. In people at high risk of heart disease (due to a combination of central obesity, high blood pressure, raised cholesterol or poor glucose tolerance) taking 2.4g aged garlic extracts per day for one year was recently shown to slow the accumulation of coronary artery plaque by 80% compared to those taking placebo. In fact, the level of soft plaque present reduced by -1.5%, whereas in those taking placebo the level of plaque increased by +0.2%.19 The researchers believe these extracts can reverse the early stages of coronary heart disease.
For more information on how to keep your heart healthy, see our heart health hub.
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15Bargossi AM et al. (1994). Exogenous CoQ10 supplementation prevents plasma ubiquinone reduction induced by HMG-CoA reductase inhibitors, Molecular Aspects of Medicine
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18Bargossi AM et al. (1994). Exogenous CoQ10 supplementation prevents plasma ubiquinone reduction induced by HMG-CoA reductase inhibitors, Molecular Aspects of Medicine
19Matsumoto S et al. (2016). Aged Garlic Extract Reduces Low Attenuation Plaque in Coronary Arteries of Patients with Metabolic Syndrome in a Prospective Randomized Double-Blind Study, J Nutr