A Review of the Effect of Diet on Cardiovascular Calcification (Nicoll R, et al.)

Cardiovascular (CV) calcification is a systemic disease known as sub-clinical atherosclerosis and is recognized as a predictor of CV events and mortality. As of yet there is no treatment for CV calcification and conventional CV risk factors are not consistently correlated, leaving clinicians uncertain as to optimum management for these patients. To that end, researchers conducted a recent review, published in International Journal of Molecular Science, on the effect of diet on cardiovascular calcification, and it highlights that the micronutrients magnesium and vitamin K may be worthy of further investigation as a treatment option for CV calcification.

At present there is no specific treatment for arterial calcification; medications such as statins, vasodilators, and other therapy for atherosclerosis and calcific aortic stenosis (CAS) have negligible effect, although they are beneficial in lowering low density lipoprotein (LDL), preventing against development of flow-limiting lesions and reducing inflammation, an important cause of atherosclerosis. This review of dietary factors (macro- and micronutrients) was carried out to determine whether there were any significant associations with CV calcification. Although animal studies have shown that many of the micronutrients may be effective in lowering or preventing CV calcification, there have been remarkably few clinical trials.

The findings include:

  • Although there were few human studies of macronutrients, nevertheless trans fats and simple sugars should be avoided, while long chain ω-3 fats from oily fish may be protective.
  • Among the micronutrients, an intake of 800 μg/day of calcium was beneficial in those without renal disease or hyperparathyroidism, while inorganic phosphorus from food preservatives and colas may induce calcification.
  • A high intake of magnesium (≥380 mg/day) and phylloquinone (vitamin K1; 500 μg/day) proved protective, as did a serum 25(OH)D concentration of ≥75 nmol/L.
  • Although oxidative damage appears to be a cause of CV calcification, the antioxidant vitamins proved to be largely ineffective, while supplementation of α-tocopherol may induce calcification. Nevertheless other antioxidant compounds (epigallocatechin gallate from green tea and resveratrol from red wine) were protective.
  • Finally, a homocysteine concentration >12 μmol/L was predictive of CV calcification, although a plasma folate concentration of >39.4 nmol/L could both lower homocysteine and protect against calcification.

In terms of a dietary program, these recommendations indicate avoiding sugar and the trans fats and preservatives found in processed foods and drinks, and adopting a diet high in oily fish and vegetables. The micronutrients magnesium and vitamin K may be worthy of further investigation as a treatment option for CV calcification.

According to Dr. Katarzyna Maresz, president of the International Science and Health Foundation, “In the case of vitamin K, the researchers note that studies of vitamin K1 intake generally show no association with the coronary artery calcification (CAC) score, CAC progression, or abdominal aorta calcification (AAC) presence, although vitamin K2 may have more effect in arteries.”

She highlighted a specific finding from the researchers: “Serum MK-4 deficiency predicted aortic calcification, while MK-7 deficiency predicted iliac calcification in chronic kidney disease patients. In the only human trial investigating CV calcification, 500 μg/day phylloquinone supplemented for three years in older adults decreased plasma ucMGP (undercarboxylated Matrix Gla Protein), resulting in significantly less CAC progression. Similarly, animal and in-vitro studies also show that phylloquinone and MK-4 reduce CV and renal calcification, with MK4 proving the more effective.”

“While this review builds on the already strong support for the micronutrients magnesium and vitamin K, particularly Vitamin K2, it does not include the recent paper published in Thrombosis and Haemostasis that showed a nutritional dose (180 mcg/day) for three years not only inhibited age-related stiffening of the arteries, but actually improved arterial flexibility, particularly for those women included in the study having high arterial stiffness,” concluded Dr. Maresz, pointing out that vitamin K may work indirectly to prevent calcification through activation of its dependent proteins, with most studies showing an association.

Reference: Nicoll R, Howard JM, Henein MY. A Review of the Effect of Diet on Cardiovascular Calcification. Int. J. Mol. Sci. 2015, 16, 8861-8883.


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