Complementary Alternative Cardiovascular Medicine

82 Alternative Cardiovascular Medicine
There was a 20% reduction in all-cause mortality (p = 0.01), and a 45%
reduction in sudden death (p < 0.001) compared to the control group;
vitamin E provided no additional benefit.
Beneficial effects of ALA on CVD endpoints have also been shown
in a widely cited randomized controlled clinical trial. The Lyon Heart
Trial was a secondary prevention trial designed to test whether a Mediterranean-type
diet, including increased amounts of ALA, would reduce
reoccurrence rates of cardiac events, compared with a prudent Western
diet (40). Subjects in the experimental group were instructed to adopt a
Mediterranean-type diet that contained more bread, more root and green
vegetables, more fish, fruit at least once daily, less red meat (replaced
with poultry), and margarine high in ALA supplied by the study to replace
butter and cream. This diet provided 30% of calories from fat, 8% from
saturated fat, 13% from monounsaturated fat, 4.6% from polyunsaturated
fat (0.84% ALA), and 203 mg/d of cholesterol. Despite a similar
coronary risk factor profile (plasma lipids and lipoproteins, systolic and
diastolic blood pressure, body mass index [BMI], and smoking status),
subjects following the Mediterranean-type diet had a 50–70% lower risk
of recurrent heart disease. There were marked reductions in cardiac
death and nonfatal MI, major secondary endpoints, and minor events.
Although the difference in ALA intakes between groups was 0.5 vs
1.5 g/d, it is impossible to ascribe the benefit unambiguously to ALA,
because there were many other dietary variables: saturated fat and
cholesterol decreased and monounsaturated fat increased, as did the
fruit and vegetable consumption. Nonetheless, this study has provided
exciting, suggestive evidence that ALA has a cardioprotective effect.
Further studies are needed to definitively establish the role of ALA.
CONJUGATED LINOLEIC ACID
Conjugated linoleic acid (CLA) comprises nine different positional
and geometric isomers of linoleic acid in which the double bonds are
conjugated instead of being in the typical methylene-interrupted configuration
(41). Only two of the isomers, cis-9, trans-11 and trans-10,
cis-12, are biologically active (1). They are formed from the microbial
isomerization of dietary linoleic acid. CLA levels are higher in animal
products than in plant products. Foods from ruminants, such as milk and
meat, are the major dietary sources of CLA.
CLA beneficially affects plasma lipids and lipoproteins, as well as
atherosclerosis in rabbits (42) and hamsters (43). In both studies, the
CLA treatment groups had markedly lower (approx 20%) total and LDL
cholesterol levels and triglyceride levels. HDL cholesterol levels were