According to WHO, cardiovascular diseases (CVDs) globally cause around 17.9M death yearly.1 Risk factors associated with coronary heart disease and stroke vary; some cannot be modified (e.g., genetics), while others can be addressed (e.g., blood pressure, cholesterol, lifestyle). People could be unaware of their CVD risk status, so it is important to approach it both in preventive and supporting ways.
Growing evidence demonstrates how the combination of different metabolic comorbidities can affect the development of CVDs. Thus, not only a single factor, but rather a real syndrome is linked to higher CVD risk. As an example, non-alcoholic fatty liver disease (NAFLD), in recent years, has become the most common chronic liver disease in Western countries, causing a huge clinical and economic burden. It is generally considered as the hepatic manifestation of the metabolic syndrome.2 Likewise, metabolic syndrome (MetS) is defined as a cluster of interconnected factors that directly increase coronary heart disease risk, in addition to other forms of cardiovascular atherosclerotic diseases, and type 2 diabetes. It is mainly characterized by at least three concomitant hallmarks among dyslipidemia, high blood pressure, dysregulated glucose homeostasis, insulin resistance, and abdominal obesity; its average prevalence is over 30%, more frequently among elderly, making MetS another public health challenge.3
Considering the multitude of factors involved in the development of these conditions, it is mandatory to act on life habits. The growing prevalence of conditions such as NAFLD and MetS has encouraged researchers to look for supportive strategies for their prevention and treatment. Simultaneously, there is a growing number of dietary supplements focusing on supporting healthy blood lipids, blood sugar levels,weight management, and circulation. It is fundamental to identify proper solutions with proven clinical efficacy, testifying that a product really addresses causes, targeting specific biological mechanism, instead of acting vaguely on such a complex system as the cardiometabolic one.
So how to choose? While there has been a huge focus on cholesterol in the past, more recently the focus has moved on to additional factors such as inflammation and antioxidant effects, together with blood sugar and hormone levels, and with hepatic function support. Such a shift is in line with the more open-minded vision, trying not only to address a single issue, but rather understanding causes hidden behind certain distresses. For this reason, the nutraceutical market targeting cardiometabolic health is providing a wide range of products among which to select the most suitable for the end-consumer: from phytochemicals of natural origins to innovative probiotics, increasingly exploring axes between microbiota and human metabolism.
One of the most innovative strategies aiming to support heart health is the use of probiotics, which highlights the so-called Gut-Heart axis; indeed, the connection amid gut microbiota imbalance and low-grade systemic inflammation, as well as its role in the enhanced CVDs risk has now become the starting point for preventive approaches. Different gut microbiota profiles are important for the pathogenesis of inflammatory disorders associated with metabolic syndromes. Intestinal microbiota perturbation and gut permeability impairment can trigger a chronic inflammatory state. Since gut microorganisms are involved in bioconversion of food components, leading to the production of bioactive metabolites (e.g., short-chain fatty acids, vitamins, peptides, enzymes…), the intestinal bacteria ecosystem may represent a new predictor of health issues, and their manipulation could turn into a promising, safe and sustainable approach for the prevention and management of metabolic conditions.4 In addition, natural extracts are widely recognized for their ability to positively modulate a wide range of specific physiological processes, positively affecting metabolism and cardiometabolic health. Indeed, specific phytochemicals can regulate crucial processes such as glucose uptake, adipogenesis, as well as provide a strong antioxidant and anti-inflammatory action.
ROELMI HPC’s expertise in both botanicals and biofermentation has resulted in development of SelectSIEVE® Apple, an apple fruit extract standardized in polyphenols, and SynBalance® MetSyn, a specific probiotic complex, two clinically proven solutions to promote cardiometabolic health.
Recent clinical evidence shows that SelectSIEVE® Apple is effective in positively modulating a wide range of cardiometabolic health indicators.5 For example, it strongly controls carbohydrate digestion and glucose uptake, avoiding glycaemia peaks and drops, normalizing blood sugar levels after one month of intake. Further, it is shown to increase endothelial reactivity, increasing performance of the cardiovascular system. Additionally, the latest evidence confirmed its metabolic effect, supporting anthropometric indexes, such as body weight and circumferences, and healthy status parameters. SelectSIEVE® Apple also recently was shown to have clinical efficacy in supporting liver functions, modulating specific transaminases values and reducing uric acid serum levels.
On the other side, SynBalance® MetSyn is a probiotic complex (Lactobacillus plantarum PBS067, Lactobacillus acidophilus PBS066, Lactobacillus reuteri PBS072) selected by in-vitro screening of best performance in terms of specific cardiometabolic mechanisms, including enzymatic cholesterol modulation, lipid and carbohydrate metabolism, inflammatory process, and antioxidant activity. A randomized, double-blind, controlled clinical trial confirmed product efficacy on subjects diagnosed with MetS.6 Evaluations of both physical and hemodynamic indexes, together with Quality of Life evaluation, performed at baseline and after two months, showed a significant global improvement in body circumferences and visceral fat, and in triglycerides, fasting blood glucose, fasting plasma insulin, and HDL and LDL cholesterol levels. Additionally, a considerable enhancement of systemic inflammation markers, known to be strongly related with CVDs risk, was achieved. The findings support the idea that daily intake of a specific probiotic product could positively modulate metabolic syndrome markers, providing the basis for further investigations about a preventive role of probiotics and healthy lifestyle in reducing the risk of developing CVDs.
Nutritional strategies intended for cardiometabolic health support should be addressed from a global viewpoint, considering their wide range of benefits. Technological progress in nutraceuticals research and formulation keep opening up the opportunity to develop clinically effective and versatile biotech and natural solutions, in order to exploit the best in term of wellbeing support, and provide new approaches of combining different actives, aiming at providing a 360° solution.
2.Kasper, P., Martin, A., Lang, S., Kütting, F., Goeser, T., Demir, M., & Steffen, H. M. (2020). NAFLD and cardiovascular diseases: A clinical review. Clinical Research in Cardiology, 1-17
3.Kassi, E., Pervanidou, P., Kaltsas, G., & Chrousos, G. (2011). Metabolic syndrome: definitions and controversies. BMC medicine, 9(1), 48
4.Forkosh, E., & Ilan, Y. (2019). The heart-gut axis: new target for atherosclerosis and congestive heart failure therapy. Open heart, 6(1), e000993
5.Scientific manuscript under publication
6.Cicero, Arrigo FG, et al. "Impact of a short‑term symbiotic supplementation on metabolic syndrome and systemic inflammation in elderly patients: a randomized placebo‑controlled clinical trial." European journal of nutrition (2020)