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Meta-analysis concludes protective effect for L-carnitine against premature mortality in heart attack patients

Meta-analysis concludes protective effect for L-carnitine against premature mortality in heart attack

Thursday, April 19, 2013. A meta-analysis reported on April 12, 2013 in Mayo Clinic Proceedings found an association in myocardial infarction patients between supplementation with L-carnitine and a lower risk of ventricular arrhythmias, angina and death from all-causes in comparison with placebo over a period of up to two months. Carnitine is a trimethylamine that occurs in meat and other foods, which is synthesized in the body from the amino acid lysine. L-carnitine has been suggested as beneficial for heart disease patients for the past several decades, and is widely available as an over-the-counter supplement.

"Although therapies for acute coronary syndrome (ACS), including percutaneous coronary intervention, dual antiplatelet therapy, beta-blockers, statins, angiotensin-converting enzyme inhibitors (ACEIs), omega-3 fatty acids, and cardiac rehabilitation, have markedly improved clinical outcomes, adverse cardiovascular events still occur too frequently after ACS," noted lead author James DiNicolantonio, PharmD of Wegmans Pharmacy in Ithaca, New York. "One promising therapy for improving cardiac health involves using L-carnitine to improve free fatty acid levels and glucose oxidation."

For their analysis, Dr DiNicolantonio and his associates selected 13 placebo-controlled trials involving a total of 3,629 men and women who had experienced an acute myocardial infarction. Eleven of the trials reported data on mortality, which included 250 deaths from all causes.

The researchers uncovered a 27% reduction in all-cause mortality in association with L-carnitine supplementation in comparison with a placebo over a median follow-up period of up to two months. Additionally, participants who received L-carnitine experienced a 65% average reduction in the risk of ventricular arrhythmia and a 40% reduction in the development of angina. While there were also fewer reinfarctions and cases of heart failure among those who received L-carnitine, the numbers failed to reach statistical significance.

"The potential mechanisms responsible for the observed beneficial impact of L-carnitine in acute myocardial infarction are likely multifactorial and may, in part, be conferred through the ability of L-carnitine to improve mitochondrial energy metabolism in the heart by facilitating the transport of long-chain fatty acids from the cytosol to the mitochondrial matrix, where beta-oxidation occurs, removing toxic fatty acid intermediates, reducing ischemia induced by long-chain fatty acid concentrations, and replenishing depleted carnitine concentrations seen in ischemic, infarcted, and failing myocardium," Dr DiNicolantonio explained.

The current findings are at odds with those of another recently publicized study appearing in Nature Medicine which found that metabolism by gut bacteria of dietary L-carnitine in mice resulted in the production of a compound known as trimethylamine N-oxide (TMAO), which increased atherosclerosis. "The Nature Medicine paper is of interest, but the main study reported there was in animals, and unlike our study, lacks hard outcomes," noted the current study's senior investigator Carl J. Lavie, MD, FACC, FACP, FCCP, who is the Medical Director of the Cardiac Rehabilitation and Prevention Center at the John Ochsner Heart and Vascular Institute at the University of Queensland School of Medicine in New Orleans. "There are various forms of 'carnitine' and our relatively large meta-analysis specifically tested L-carnitine on hard outcomes in humans who had already experienced acute myocardial infarction."

The authors conclude that "Further study with large randomized controlled trials of this inexpensive and safe therapy in the modern era is warranted." However, Dr DiNicolantonio added that "L-carnitine therapy can already be considered in selected patients with high-risk or persistent angina after acute myocardial infarction who cannot tolerate treatment with ACE inhibitors or beta blockers, considering its low cost and excellent safety profile."

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Research suggests coffee could be reason for Ikarian longevity

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An article published on March 18, 2013 in the journal Vascular Medicine suggests that the consumption of boiled coffee could be the reason for the exceptional longevity of residents of the Greek island Ikaria, which has a high percentage of long-lived individuals. While 0.1 percent of Europeans survive longer than 90 years, ten times as many inhabitants of Ikaria live to the age of 90 or older.

The study included 142 residents of Ikaria aged 66 to 91. The participants underwent ultrasound assessment of flow-mediated dilation to assess endothelial function, a measure of cardiovascular health. Responses to dietary questionnaires were used to quantify coffee intake as low, moderate or high.

While flow mediated dilation increased with coffee intake, drinking boiled Greek coffee was associated with better endothelial function in comparison with drinking other types of coffee, even among subjects with hypertension. "Boiled Greek type of coffee, which is rich in polyphenols and antioxidants and contains only a moderate amount of caffeine, seems to gather benefits compared to other coffee beverages," lead researcher Gerasimos Siasos of the University of Athens Medical School explained.

"To our knowledge, there are no clinical studies evaluating the effects of chronic coffee consumption on endothelial function, especially in subjects with established cardiovascu­lar risk factors such as elderly individuals," the authors write.

"The present study provides evidence that chronic consump­tion of the boiled Greek type of coffee is associated with improved endothelial function in elderly individuals with an increased burden of cardiovascular risk factors," they conclude. "Given the wide­spread use of coffee beverages across the world and the fact that even small health effects of coffee could have a large impact on public health, further studies are needed to docu­ment the exact beneficial mechanisms of coffee in vascular integrity."

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