Micronutrients and Heart Health - Pay Attention

Heart or cardiovascular health is the state of health of the heart, blood vessels, and organs that are critically dependent upon blood supply. It is essential for the body's overall health that the cardiovascular system functions smoothly, as every cell in the body depends on it to survive. Consequently, disorders of the cardiovascular system can have a wide range of consequences.??The term "cardiovascular disease" generally refers to conditions that involve narrowing or blocking of blood vessels that can lead to a heart attack (blood supply is cut off from a part of the heart), angina pectoris (chest pain caused by too little blood and oxygen supply of the heart) or stroke (disturbance in the blood supply to the brain).

Worldwide, cardiovascular diseases kill more people than anything else, with global healthcare costs exceeding USD 500 billion annualy

What we eat every day has a significant impact on our heart health. However, when talking about heart health and nutrition, major emphasis is placed on dietary fats and sodium and their outcomes. The role of saturated and unsaturated fats on cardiovascular health is well known and well studied. There is an increasing controversy surrounding sodium and its effects on heart health. In contrast, micronutrients are unpopular and poorly understood when it comes to heart health.

It is undeniable that a nutritious, balanced diet can reduce the risk of cardiovascular disease and help manage existing cardiovascular illnesses. Micronutrients are essential components of any heart-healthy diet for maintaining and improving cardiovascular function. Let's discuss.

Micronutrient Deficiencies and Heart Failure

Heart Failure (HF) is a common, disabling, and expensive condition. Deficits in micronutrients have been linked to the development and progression of heart failure.?According to observational studies, patients with heart failure tend to have low levels of a number of micronutrients. It may be associated with a poor prognosis. Several studies have also suggested that patients with heart failure may have reduced intake of micronutrients, a possible explanation for reduced status.

A 2009 review stated that despite major advances in medical therapy, morbidity and mortality remain high, partly because current pharmacological regimens may not fully address some unique requirements of the heart. Keeping the heart healthy requires a continuous supply of energy-producing substrates like micronutrients and amino acids. In a 2021 study, 79 patients with heart failure were assessed for dietary micronutrient intake and micronutrient status using a validated food frequency questionnaire.?The study revealed that over 20% of patients had low intakes of vitamin A, calcium, magnesium, selenium, and iodine, while up to 75% had low intakes of vitamin D.?In a multicenter prospective cohort study involving 274 patients with heart disease, dietary micronutrient deficiencies were evaluated on the basis of clinical outcomes. A four-day food diary was obtained from 246 patients to estimate the intake of 17 micronutrients, including 11 vitamins and 6 minerals.?Patients with deficiencies in seven micronutrients are considered to have a high micronutrient deficiency. There was a 44% rate of all-cause hospitalization or death in the high micronutrient deficiency group versus a 25% rate in the low micronutrient deficiency group, according to the study.?Patients with high micronutrient deficiencies had almost double the hazard of events after adjusting for race, comorbidity, body mass index, depression, estimated sodium intake, and HF severity.?

What do micronutrients do for our hearts?

HF patients often consume less than the recommended daily amount of several micronutrients, including iron (46%), zinc (65%), and vitamin D (97%). Cross-sectional studies indicate that up to 50% of patients are deficient in one or more micronutrients. Micronutrients such as coenzyme Q10, zinc, copper, selenium, and iron) are required to convert macronutrients into adenosine triphosphate (ATP), energy-carrying molecules. Supplementing with certain micronutrients along with evidence-based pharmacological therapy can improve HF management, according to available clinical evidence.?Optimizing nutritional status has already been outlined as a potential benefit for HF patients in the Scientific Statements Committee of the Heart Failure Society of America (HFSA).?

Cardiomyocytes (muscle cells of the heart) obtain their energy primarily from macronutrients like fatty acids, lactic acid, and carbohydrates. Vitamins, minerals, and essential amino acids are also necessary to convert macronutrients to adenosine triphosphate (ATP), but in very small amounts, which are found in a healthy diet. For efficient ATP production, coenzyme Q10, zinc, copper, selenium, and iron are required as illustrated in Figure 1.

Few Essential Micronutrients and Heart Health

One of the major groups of nutrients our body needs is micronutrients. These include vitamins and minerals. In comparison to macronutrients, micronutrients are needed in smaller amounts by our body. That's why they're called "micro." Micronutrients are crucial and all have distinctive functions in maintaining overall health. Some micronutrients - calcium, zinc, vitamin D, iron, and selenium are discussed in conjunction with heart health and potential heart diseases.

Calcium and cardiovascular health

Calcium is an imperative mineral in the biological system, especially in the bone and cardiovascular systems.?Numerous observational and clinical trial studies have reported mixed results regarding calcium and its supplements' role in cardiovascular health. All excitable tissues, especially the heart and nerves, are directly affected by the concentration of extracellular calcium. The heart muscles, require calcium to contract.?Hypocalcemia has been independently correlated with poor long-term cardiovascular outcomes in a study of patients admitted with acute coronary syndrome.? A cohort study on post-menopausal women found that calcium supplements reduced mortality rates.?An analysis by Lewis et al. (2015) demonstrated that calcium supplements did not significantly increase older women's risks for myocardial infarction, angina pectoris, and acute coronary syndrome.?However, several meta-analyses show that an increase in serum calcium levels can raise the risk of CVDs like hypertension, myocardial infarction (MI), etc. Hypercalcemia promotes vascular calcification, including coronary artery and aortic calcification, and increases coronary artery plaque formation.?

A daily calcium intake of 1,200-1,500 mg is recommended for both men and women. Calcium can be found in milk and milk products, green leafy vegetables such as spinach, kale, and fortified flour. Apart from the dietary sources, many people opt for calcium supplements, either independently or in conjunction with vitamin D, in order to achieve adequate serum levels and enhance bone health through diet alone.

The role of trace element zinc in cardiovascular disease

Zinc is an antioxidant that prevents the formation of free radicals, which can damage cells and cause degenerative diseases.?Zinc's role in nucleic acid metabolism and protein biosynthesis ensures that cells grow, divide, and function properly.?An impaired function of superoxide dismutase leads to oxidative stress, which increases the release of nitric oxide (NO), a powerful vasodilator that increases blood pressure. Atherosclerosis can also be caused by increased oxidative stress. By maintaining adequate functioning of superoxide dismutase, zinc helps reduce NO generation.?Despite some evidence showing zinc's role and benefits in cardiovascular health, supplementation of zinc is not justified. For a decision to be made, more research is needed, as well as steadfast and robust experimental data.?

Zinc intake for men and women should not exceed a maximum of 40 mg per day. Foods high in zinc include beef, veal, pork, lamb, cereals, grains, fish, vegetables, nuts, milk, and dairy products.

Low Vitamin D levels and cardiovascular diseases

Vitamin D3 or cholecalciferol is a steroid hormone found in nature, as well as in seafood such as salmon, tuna, eel, cow milk, and eggs. When exposed to ultraviolet B rays (UVB), the skin naturally synthesizes cholecalciferol.?Vitamin D deficiency is a global problem, and some of its causes are aging, hyperpigmentation, low dietary intake, limited sun exposure, pollution, smoking, and obesity.?

Numerous observational studies, epidemiological investigations, and laboratory studies have found a link between low blood vitamin D levels and higher cardiovascular risk. However, the findings were not very significant.?An investigation conducted in 2022 examined whether serum 25-hydroxyvitamin D or 25(OH)D, is associated with CVD risk. A total of 295,788 participants completed health questionnaires at baseline and provided blood samples for biomarker and genetic analyses.?There was a reduction in CVD occurrence with higher concentration levels of serum 25(OH)D, with individuals with serum concentrations of 25 nmol/l having an 11% higher CVD risk than those with concentrations of 50 nmol/l.?However, the study has some limitations, such as limiting the analysis to white British participants, so it is not clear whether the findings are generalizable to other ethnic groups.

In spite of vitamin D's crucial role in regulating cardiovascular health and its role as a menace for primary heart diseases, there is a lack of supporting evidence. Prior to advocating vitamin D supplements for improving cardiovascular health, it is imperative to prolong the study of vitamin D's effects on cardiovascular health with more emphasis on the pathology.

Selenium and Heart Health

Another trace element that affects cardiovascular health is selenium. About 30 selenoproteins have been identified so far, and it plays a crucial role in their formation. Keshan disease, a type of heart disease seen in some parts of China with soil low in selenium, has been linked to selenium deficiency for years.?It has yet to be discovered how selenium deficiency causes heart muscle cells to deteriorate and increases damage susceptibility.?Other studies have shown an association between decreased selenium and an increased risk of acute coronary syndrome.

There is insufficient evidence from clinical studies to support the efficacy of selenium supplementation in the treatment or prevention of cardiovascular disease. The benefits of selenium supplementation are uncertain, and their arbitrary use carries the risk of toxicity, so more evidence is needed before prescribing them for cardiovascular health. It is better to rely on naturally available sources since supplements have adverse effects on health. Protein foods from animals are generally good sources of selenium.?Seafood, organ meats, and Brazil nuts?are the foods highest in selenium although Americans obtain most of their selenium from everyday staples, like bread, cereals, poultry, red meat, and eggs.?

Conclusion

According to large observational studies and available data, micronutrients play a significant role in cardiovascular health. The underlying mechanism, however, is not well understood.?Furthermore, high levels of these micronutrients adversely affect heart function. The benefits of supplements need to be established in clinical trials and studies, and the risks must be weighed before taking them. Make sure your daily micronutrient needs are met by eating a nutritious balanced diet with a variety of foods.