Cardiovascular disease (CVD) is one of the leading causes of premature death in Europe. Cardiovascular disease is related to an individual’s existing health conditions and habits, such as smoking, hypercholesterolemia, obesity, high blood pressure, unhealthy eating habits, and diabetes.
Learn: Association of microbiota polyphenols with cardiovascular health in the context of a Mediterranean diet. Image credit: Antonina Vlasova/Shutterstock.com
The American Heart Association (AHA) proposed the Ideal Cardiovascular Health (ICVH) score in 2010 to improve overall health and reduce deaths from CVD. The ICVH score is based on seven parameters including ideal health-related behavioral patterns, including body mass index (BMI), healthy diet, adequate physical activity and non-smoking, as well as favorable health factors such as normoglycemia, cholesterol and blood pressure levels.
Cardiovascular health is closely related to diet. Nutrients and phytochemicals obtained from the diet play an important role in the prevention or development of CVD.
Several studies have shown that the Mediterranean Diet (MedDiet), based on a high intake of nuts, legumes, fruits, vegetables, extra virgin olive oil and moderate amounts of wine, reduces the risk of cardiovascular disease.
MedDiet is rich in healthy fats and antioxidant bioactive molecules like polyphenols. While polyphenols are known to improve cardiovascular health, their availability in the small intestine is low. 90-95% of polyphenols reach the large intestine where they encounter enzymatic reactions catalyzed by the gut microbiome.
After uptake, microbial phenolic metabolites (MPMs) may be associated with various biological functions. However, limited studies have assessed the benefits of MPM on cardiovascular health.
recent Food Research International Studies have identified and quantified MPM in a subset of the PREDIMED trial. Here, the authors identify the association between MPM and MedDiet adherence and impact on cardiovascular health in a Mediterranean older population.
PREDIMED is a five-year multicenter clinical trial designed to examine the impact of the traditional MedDiet on primary prevention of CVD. In Spain, 7,447 participants were recruited between October 2003 and December 2010, and the key eligibility criterion was that participants had no history of CVD at baseline. This study included 200 randomly selected participants from the recruitment center of the PREDIMED-Hospital Clinic in Barcelona, Spain.
The current study applied a linear ion trap quadrupole-Orbitrap-mass spectrometer (LTQ-OrbitrapMS) for analysis. The technique provides accurate structural information that facilitates the detection and quantification of novel metabolites.
The current cross-sectional substudy of the PREDIMED trial showed that higher urinary MPM scores were associated with higher MedDiet adherence and improved ICVH scores. Furthermore, a strong inverse correlation was observed between urinary concentrations of urolithin B glucuronide (UBG) and low-density lipoprotein (LDL)-cholesterol. These findings strongly suggest that the MedDiet is associated with phenolic metabolites, which may improve cardiovascular health.
Previous research has shown that the MedDiet can alter the gut microbial ecosystem and the production of microbial metabolites.Interestingly, greater adherence to the MedDiet was associated with increased BacteroidesSuch as the genus Prevotellain the gut, is associated with polyphenol metabolism.
None of the study participants achieved the highest recorded ICVH score, meaning that the entire cohort did not meet all seven health indicators. This observation is consistent with a previous study in the PREDIMED trial, which reported that only 0.3% of the cohort achieved scores 6 and 7. This finding is not unnatural, since the PREDIMED trial included older Mediterranean populations, who are generally at higher risk for cardiovascular disease.
The current study also observed associations between multiple MPMs and ICVH scores. According to personal health parameters, blood glucose and diet were positively correlated with MPM scores.
This association was also associated with MPM scores and MedDiet adherence; however, a single MPM did not improve overall ICVH. Thus, several phenolic metabolites appear to be beneficial for cardiovascular health together, rather than individually.
Strengths and Limitations
An important strength of the current study is that it included the analysis of biological samples, which provided reliable data on an individual’s metabolism. In addition, LTQ-Orbitrap enables accurate elucidation and quantification of metabolites.
Despite its strengths, the current study has some limitations, such as the inclusion of only Mediterranean older adults at high risk for cardiovascular disease, reducing the generalizability of the findings. In addition, the authors were unable to determine the microbiota composition of the participants due to unavailability of stool samples.
The current study is the first to use the LTQ-OrbitrapMS technique to assess the association between urinary MPM, diet, and cardiovascular health.
A strong association was observed between urinary MPM, MedDiet adherence, and healthier cardiovascular status. In addition, phenolic metabolites associated with the MedDiet appear to confer beneficial properties for cardiovascular health.
In the future, more studies are needed to better understand the impact of phenolic compounds in biological samples on the overall ICVH score.
- Domínguez-López, I., Arancibia-Riveros, C., Marhuenda-Munoz, M. et al. (2023) Association of microbiota polyphenols with cardiovascular health in the context of a Mediterranean diet. Food Research International.doi:10.1016/j.foodres.2023.112499