Ghana: Reducing the Burden of Cardiovascular Diseases … Flavanol-Rich Cocoa, a Promising Nutraceutical

These are the key facts gleaned from the World Health Organization (WHO) website. Cardiovascular diseases (CVDs) are the leading cause of death globally.An estimated 17.9 million people died from CVDs in 2019, representing 32% of all global deaths. Of these deaths, 85% were due to heart attack and stroke.Over three quarters of CVD deaths take place in low- and middle-income countries.Out of the 17 million premature deaths (under the age of 70) due to noncommunicable diseases in 2019, 38% were caused by CVDs.Most cardiovascular diseases can be prevented by addressing behavioural risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol.It is important to detect cardiovascular disease as early as possible so that management with counselling and medicines can begin.

Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. They include, coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheumatic heart disease, congenital heart disease, and deep vein thrombosis and pulmonary embolism.

Heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason for this is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. Strokes can be caused by bleeding from a blood vessel in the brain or from blood clots.

The most important behavioural risk factors of heart disease and stroke are unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. The effects of behavioural risk factors may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity.

Cessation of tobacco use, reduction of salt in the diet, eating more fruit and vegetables, regular physical activity and avoiding harmful use of alcohol have been shown to reduce the risk of cardiovascular disease. Health policies that create conducive environments for making healthy choices affordable and available are essential for motivating people to adopt and sustain healthy behaviours.

An ounce of prevention is worth a pound of cure. Spending geared towards health and prevention should not be seen as simply one cost at a specific point in time, but as an investment towards increased welfare, productivity and economic growth. In study conducted by the American Heart Association in 2011 showed prevention strategies could be cost effective in the long run. A community-based programs promoting physical exercise, a balanced diet, and cessation of smoking and tobacco use carry a return-on-investment of $5.60 for every dollar spent over five years. Prevention saves on costs and also save lives.

The burden of CVD mortality and morbidity has an enormous impact, not only on healthcare systems and patients’ quality of life, but also on their productivity and on that of their informal caregivers. Most studies on the burden of CVD only analyze direct costs (related to devices, technologies, services and other resources used for treatment and prevention of CVD). Indirect costs, those arising from productivity gains or losses relating to illness or death, are much less studied, although productivity loss represents a major negative impact on individual CVD patients, their families, caregivers and society as a whole.

Risk factors for CVD can be categorized as modifiable and non-modifiable. Modifiable risk factors include obesity, hypertension, hyperlipidaemia, diabetes mellitus, metabolic syndrome and lifestyle risk factors such as unhealthy diet, smoking and physical inactivity. Dietary factors are also important contributors to cardiovascular risk, either directly, or through their effects on other risk factors including hypertension, dyslipidaemia and diabetes mellitus. Reduction of risk factors in the population, especially blood pressure reduction and lipid-lowering can have important impacts upon mortality from CVD.

Protective effects against CVD have been demonstrated for several foods and dietary supplements thus presenting new possibilities for population-level reduction of CVD risk. In the PREDIMED observational study, participants in the highest quintile of polyphenol consumption had a relative risk of CVD of 54% compared to those in the lowest quintile (Sosnowska et al. The role of nutraceuticals in the prevention of cardiovascular disease. Cardiovasc Diagn Ther. 2017 Apr; 7(Suppl 1): S21-S31.doi: 10.21037/cdt.2017.03.20

A nutraceutical is defined as a “food, or parts of a food, that provide medical or health benefits, including the prevention and treatment of disease”. The definition encompasses medicinal products made from natural ingredients. Polyphenols are phytochemicals with widespread distribution in foods of plant origin. They are found in fruits, vegetables, cereal and legumes. Additionally, they are found in beverages produced from plant products such as tea, coffee, wine and cocoa.A variety of polyphenols have been identified in cocoa and its derivative. These include catechins, flavanol glycosides, anthocyanins and procyanidins. Cocoa-containing foods provide a higher content of flavonoids per serving than other beverages such as red wine and tea. Dyslipidaemia is an umbrella term for a variety of lipid abnormalities, which increase the risk of CVD. Reduction of total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C) is effective in the primary and secondary prevention of CVD events.

A recent meta-analysis of 19 randomized controlled trials of varying designs with a total of 1,131 participants indicated that cocoa flavanols were associated with reductions in total triglycerides (−0.10 mmol/L) and increases in HDL-C (0.06 mmol/L) intake. Recently published results from the Flaviola Health Study revealed that twice-daily ingestion of 450 mg of cocoa flavanols for 1 month decreased total cholesterol (TC) by 0.20 mmol/L and low-density lipoprotein cholesterol (LDL-C) by 0.17 mmol/L whereas high density lipoprotein cholesterol (HDL-C) increased by 0.10 mmol/L in a low risk, primary prevention population. Consumption of flavanol-rich cocoa provides a significant lowering of 10-year risk for CVD.

Hypertension is an important modifiable risk factor for CVD. It has been shown that lowering blood pressure reduces CV risk by 20-25% for myocardial infarction, 35-40% for stroke and about 50% for heart failure. A meta-analysis of 42 randomized controlled trials indicated that flavanol-rich cocoa was associated with reduced diastolic blood pressure and mean arterial pressure. Flavanol-rich cocoa exerts a beneficial impact on blood pressure in patients with type 2 diabetes and hypertension and in elderly subjects.