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COAGULATION CORNER: FEBRUARY 2011

HEART HEALTHY VALENTINE: COAGULATION, CHOCOLATE AND WINE! 

Coronary artery disease (CAD) is among the leading causes of death and reduced quality of life in developed countries. Approximately 67 million U.S. adults have high blood pressure (hypertension), with an additional 85 million Americans classified as having pre-hypertension. Hypertension, atherosclerosis and other inflammatory conditions are major contributors to the development of cardiovascular disease (CVD).

Wine and coagulation: 

In 1786, an English doctor noted that wine relieved pains of patients suffering from angina pectoris. In 1970, a cardiologist at the Kaiser Permanente hospital center in Oakland (California) initiated a study on over 100 000 people.The first results where published in 1974, and indicated the fact that the risk of death from coronary diseases (notably myocardium infarct) is lower for moderate consumers (1 to 3 glasses of wine a day): 6,2 to a 1 000 against 8,2 to a 1 000 for people who do not drink wine and 11 to one thousand for people drinking more than six glasses of wine a day.
Okay 6 glasses of wine in the name of science might be a little much and lead to a host of other problems! However, Doctor Rimm of the School of Public Health of Harvard - Cambridge - Massachusetts calculated that the risk of heart disease is reduced from 25 to 45% for people drinking 1 or 2 glasses of wine a day.

So how does this work? Moderate alcohol intake decreases clot formation by multiple additive mechanisms. It reduces platelet aggregation, decreases fibrinogen levels, plasma viscosity, von Willebrand factor, and factor VII. Regular moderate alcohol consumption has no significant effect on fibrinolysis, as opposed to higher levels of consumption. Alcohol consumption up to 14.9 g/d is not associated with increased PAI-1, whereas greater amounts of alcohol intake do result in increased PAI-1. Polyphenolics (ie, catechin, epicatechin, quercetin, resveratrol) found in red wine upregulate both tissue-type plasminogen activator (t-PA) and urokinase-type PA (u-PA) gene transcription. Wine phenolics increase fibrinolytic activity independent of alcohol. Red wine supplementation, in both the Mediterranean-type diet (MD) and high-fat diet (HFD), resulted in decreased plasma fibrinogen and factor VIIc, and increased tPA antigen and PAI-1 antigen. A MD and moderate consumption of red wine has complementary, mostly beneficial effects on hemostatic cardiovascular risk factors.

Prevention and treatment of CAD start with diet and a little wine might not be a bad thing either.

Chocolate:

Cocoa has been around for thousands of years, dating back to the Incas and Aztecs around 1600 BC. The Aztec emperor Montezuma supposedly drank cocoa to fight fatigue. Cocoa was thought to have health benefits, ranging from an aid in digestion, relief of angina to improving kidney and bowel function.

Epidemiological research has shown that a diet robust in fruits and vegetables can prevent or delay the onset of CVD. Many researchers wondered what components of fruits and vegetables are responsible for the possible health effects. Flavanols are abundant in certain fruits and vegetables, leading researchers to focus attention on plants with a higher concentration of flavanols which include cocoa. Cocoa, which is the primary ingredient in finished chocolate, is rich in antioxidant polyphenols, a group of protective chemicals found in many plant foods such as red wine and tea, which have been the objects of scientific investigation for their beneficial influence on cardiovascular health.

Polyphenols are reportedly cardioprotective in two ways. First, they help to reduce the oxidation of low-density lipoproteins (LDL), or so-called ‘bad cholesterol.” Oxidation of LDL is considered a major factor in the promotion of coronary disease, most notably heart attack and stroke. Additionally, polyphenols inhibit blood platelets from clumping together. This clumping process, called aggregation, leads to atherosclerosis, hardening of the arteries. By inhibiting aggregation, polyphenols reduce the risk of atherosclerosis. Since atherosclerosis is a major killer of American adults, the protection provided by the polyphenols in cocoa is of real value.

Cocoa not only inhibits platelet aggregation, but it thins the blood, thus slowing coagulation. In a study of healthy subjects given a strong cocoa beverage, platelet aggregation was reduced and fewer microparticles had formed than normal. Additionally, blood from the subjects took longer to form a clot than blood from control subjects. This study showed that cocoa performs the same beneficial anti-clotting activity as aspirin.

The beneficial effects of dark chocolate (50%-71% cocoa content) were not seen with milk or white chocolate, once again suggesting the dark polyphenols are critically important to this action. The anticoagulant effects of chocolate received additional support by the findings of the GeneSTAR trial which studied genetic differences in the cardioprotective effects of aspirin, however the study also stumbled onto a protective effect of chocolate.About 140 people refused to eliminate chocolate from their diets while participating in the study and so the investigators followed this group separately. They discovered chocolate eaters had slowed blood clotting compared to others. Although the protective effect of chocolate was approximately 1/10th of aspirin, the main action appears to be the same.

Reported cardiometabolic benefits of dark chocolate:

Improves blood pressure
Improves insulin sensitivity
Increases HDL (“good”) cholesterol
Reduces oxidation of LDL (“bad”) cholesterol
Increases total antioxidant capacity
Reduces coagulation of the blood

Conclusion:

In conclusion a nice glass of red wine, and one square (about 6 grams) of dark chocolate can be part of a heart healthy celebration- enjoy!

Donna Castellone

About the Author

Donna Castellone,
MS, MT(ASCP)SH
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