The effect of aged garlic extract on the atherosclerotic process - a randomized double-blind placebo-controlled trial

Martiné Wlosinska, Ann-Christin Nilsson, Joanna Hlebowicz, Anders Hauggaard, Maria Kjellin, Mohammed Fakhro, Sandra Lindstedt, Martiné Wlosinska, Ann-Christin Nilsson, Joanna Hlebowicz, Anders Hauggaard, Maria Kjellin, Mohammed Fakhro, Sandra Lindstedt

Abstract

Background: One of the most serious secondary manifestations of Cardiovascular Disease (CVD) is coronary atherosclerosis. This study aimed to evaluate whether aged garlic extract (AGE) can influence coronary artery calcification (CAC) and to predict the individual effect of AGE using a standard process for data mining (CRISP-DM).

Method: This was a single-center parallel randomized controlled study in a university hospital in Europe. Patients were randomized, in a double-blind manner, through a computer-generated randomization chart. Patients with a Framingham risk score ≥ 10 after CT scan (n = 104) were randomized to an intake of placebo or AGE (2400 mg daily) for 1 year. Main outcome measures were changes in CAC score and secondary outcome measures changes in blood pressure, fasting blood glucose, blood lipids and inflammatory biomarkers.

Result: 104 patients were randomized and 46 in the active group and 47 in the placebo group were analyzed. There was a significant (p < 0.05) change in CAC progression (OR: 2.95 [1.05-8.27]), blood glucose (OR: 3.1 [1.09-8.85]) and IL-6 (OR 2.56 [1.00-6.53]) in favor of the active group. There was also a significant (p = 0.027) decrease in systolic blood pressure in the AGE group, from a mean of 148 (SD: 19) mmHg at 0 months, to 140 (SD: 15) mmHg after 12 months. The AGE Algorithm, at a selected probability cut-off value of 0.5, the accuracy score for CAC progression was 80%, precision score of 79% and recall score 83%. The score for blood pressure was 74% (accuracy, precision and recall). There were no side-effects in either group.

Conclusions: AGE inhibits CAC progression, lowers IL-6, glucose levels and blood pressure in patients at increased risk of cardiovascular events in a European cohort. An algorithm was made and was used to predict with 80% precision which patient will have a significantly reduced CAC progression using AGE. The algorithm could also predict with a 74% precision which patient will have a significant blood pressure lowering effect pressure using AGE.

Trial registration: Clinical trials NCT03860350, retrospectively registered (1/32019).

Keywords: Aged garlic extract; Blood pressure; CRISP-DM; Calcium score; Data mining; Data science; Double-blinded; Placebo-controlled.

Conflict of interest statement

Dr. Lindstedt has received a research grant to support this research from Wakunaga of America Ltd. None of the other authors has conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
CONSORT statement (consolidated standards of reporting trials) flow chart. Showing demographics and baseline clinical information of the study cohort. Aged garlic extract (AGE), coronary artery calcification (CAC)

References

    1. WHO . Cardiovascular diseases (CVDs) 2017.
    1. Achenbach S, Ropers D, Pohle K, Leber A, Thilo C, Knez A, et al. Influence of lipid-lowering therapy on the progression of coronary artery calcification: a prospective evaluation. Circulation. 2002;106(9):1077–1082.
    1. Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2010;56(25):e50–103.
    1. Waters D, Craven TE, Lesperance J. Prognostic significance of progression of coronary atherosclerosis. Circulation. 1993;87(4):1067–1075.
    1. Luo L, Pang B, Chen J, Li Y, Xie X. Assessing the Impact of Lifestyle Interventions on Diabetes Prevention in China: A Modeling Approach. Int J Environ Res Public Health. 2019;16(10):1677.
    1. Prentice RL, Aragaki AK, Van Horn L, Thomson CA, Beresford SA, Robinson J, et al. Low-fat dietary pattern and cardiovascular disease: results from the Women's Health Initiative randomized controlled trial. Am J Clin Nutr. 2017;106(1):35–43.
    1. Rees K, Hartley L, Flowers N, Clarke A, Hooper L, Thorogood M, et al. 'Mediterranean' dietary pattern for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013;8:CD009825.
    1. Denke MA. Diet and lifestyle modification and its relationship to atherosclerosis. Med Clin North Am. 1994;78(1):197–223.
    1. Ruan Y, Huang Y, Zhang Q, Qin S, Du X, Sun Y. Association between dietary patterns and hypertension among Han and multi-ethnic population in Southwest China. BMC Public Health. 2018;18(1):1106.
    1. Wang CJ, Shen YX, Liu Y. Empirically derived dietary patterns and hypertension likelihood: a meta-analysis. Kidney Blood Press Res. 2016;41(5):570–581.
    1. Wang X, Ding N, Tucker KL, Weisskopf MG, Sparrow D, Hu H, et al. A Western diet pattern is associated with higher concentrations of blood and bone lead among middle-aged and elderly men. J Nutr. 2017;147(7):1374–1383.
    1. Kostapanos MS, Milionis HJ, Elisaf MS. Rosuvastatin-associated adverse effects and drug-drug interactions in the clinical setting of dyslipidemia. Am J Cardiovasc Drugs. 2010;10(1):11–28.
    1. Kostapanos MS, Rizos CV, Elisaf MS. Benefit-risk assessment of rosuvastatin in the treatment of atherosclerosis and related diseases. Drug Saf. 2014;37(7):481–500.
    1. Ahmadi N, Nabavi V, Hajsadeghi F, Zeb I, Flores F, Ebrahimi R, et al. Aged garlic extract with supplement is associated with increase in brown adipose, decrease in white adipose tissue and predict lack of progression in coronary atherosclerosis. Int J Cardiol. 2013;168(3):2310–2314.
    1. Allison GL, Lowe GM, Rahman K. Aged garlic extract inhibits platelet activation by increasing intracellular cAMP and reducing the interaction of GPIIb/IIIa receptor with fibrinogen. Life Sci. 2012;91(25–26):1275–1280.
    1. Budoff M. Aged garlic extract retards progression of coronary artery calcification. J Nutr. 2006;136(3 Suppl):741S–744S.
    1. Zeb I, Ahmadi N, Flores F, Budoff MJ. Randomized trial evaluating the effect of aged garlic extract with supplements versus placebo on adipose tissue surrogates for coronary atherosclerosis progression. Coron Artery Dis. 2018;29(4):325–328.
    1. Zeb I, Ahmadi N, Nasir K, Kadakia J, Larijani VN, Flores F, et al. Aged garlic extract and coenzyme Q10 have favorable effect on inflammatory markers and coronary atherosclerosis progression: a randomized clinical trial. J Cardiovasc Dis Res. 2012;3(3):185–190.
    1. Budoff MJ, Ahmadi N, Gul KM, Liu ST, Flores FR, Tiano J, et al. Aged garlic extract supplemented with B vitamins, folic acid and L-arginine retards the progression of subclinical atherosclerosis: a randomized clinical trial. Prev Med. 2009;49(2–3):101–107.
    1. Budoff MJ, Takasu J, Flores FR, Niihara Y, Lu B, Lau BH, et al. Inhibiting progression of coronary calcification using aged garlic extract in patients receiving statin therapy: a preliminary study. Prev Med. 2004;39(5):985–991.
    1. Brown AW, Kaiser KA, Keitt A, Fontaine K, Gibson M, Gower BA, et al. Science dialogue mapping of knowledge and knowledge gaps related to the effects of dairy intake on human cardiovascular health and disease. Crit Rev Food Sci Nutr. 2020:1–17.
    1. Astrup A. Yogurt and dairy product consumption to prevent cardiometabolic diseases: epidemiologic and experimental studies. Am J Clin Nutr. 2014;99(5 Suppl):1235S–1242S.
    1. Diaz-Lopez A, Bullo M, Martinez-Gonzalez MA, Corella D, Estruch R, Fito M, et al. Dairy product consumption and risk of type 2 diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk. Eur J Nutr. 2016;55(1):349–360.
    1. Leigh JA, Alvarez M, Rodriguez CJ. Ethnic minorities and coronary heart disease: an update and future directions. Curr Atheroscler Rep. 2016;18(2):9.
    1. Schulz KF, Altman DG, Moher D, Group C CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332.
    1. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837–1847.
    1. Harper G, Pickett SD. Methods for mining HTS data. Drug Discov Today. 2006;11(15–16):694–699.
    1. Budoff M, Benson D. The cardiovascular effects of garlic supplementation. Altern Ther Health Med. 2014;20(5):10–12.
    1. Simons S, Wollersheim H, Thien T. A systematic review on the influence of trial quality on the effect of garlic on blood pressure. Neth J Med. 2009;67(6):212–219.
    1. Percival SS. Aged garlic extract modifies human immunity. J Nutr. 2016;146(2):433S–436S.
    1. Ahmadi N, Tsimikas S, Hajsadeghi F, Saeed A, Nabavi V, Bevinal MA, et al. Relation of oxidative biomarkers, vascular dysfunction, and progression of coronary artery calcium. Am J Cardiol. 2010;105(4):459–466.
    1. Reinhart KM, Coleman CI, Teevan C, Vachhani P, White CM. Effects of garlic on blood pressure in patients with and without systolic hypertension: a meta-analysis. Ann Pharmacother. 2008;42(12):1766–1771.
    1. Ried K, Frank OR, Stocks NP, Fakler P, Sullivan T. Effect of garlic on blood pressure: a systematic review and meta-analysis. BMC Cardiovasc Dis. 2008;8:13.
    1. Cruz-Bermudez JL, Parejo C, Martinez-Ruiz F, Sanchez-Gonzalez JC, Ramos Martin-Vegue A, Royuela A, et al. Applying data science methods and tools to unveil healthcare use of lung cancer patients in a teaching hospital in Spain. Clin Trans Oncol. 2019;21:1472–1481.
    1. Rivo E, de la Fuente J, Rivo A, Garcia-Fontan E, Canizares MA, Gil P. Cross-industry standard process for data mining is applicable to the lung cancer surgery domain, improving decision making as well as knowledge and quality management. Clin Trans Oncol. 2012;14(1):73–79.
    1. Kwiterovich PO., Jr Clinical relevance of the biochemical, metabolic, and genetic factors that influence low-density lipoprotein heterogeneity. Am J Cardiol. 2002;90(8A):30i–47i.
    1. Decharatchakul N, Settasatian C, Settasatian N, Komanasin N, Kukongviriyapan U, Intharapetch P, et al. Association of combined genetic variations in SOD3, GPX3, PON1, and GSTT1 with hypertension and severity of coronary artery disease. Heart Vessel. 2020. 10.1007/s00380-020-01564-6. [Epub ahead of print].
    1. Naghavi M, Libby P, Falk E, Casscells SW, Litovsky S, Rumberger J, et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: part II. Circulation. 2003;108(15):1772–1778.
    1. Naghavi M, Libby P, Falk E, Casscells SW, Litovsky S, Rumberger J, et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: part I. Circulation. 2003;108(14):1664–1672.
    1. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358(13):1336–1345.
    1. Callister TQ, Raggi P, Cooil B, Lippolis NJ, Russo DJ. Effect of HMG-CoA reductase inhibitors on coronary artery disease as assessed by electron-beam computed tomography. N Engl J Med. 1998;339(27):1972–1978.
    1. Hartman J, Frishman WH. Inflammation and atherosclerosis: a review of the role of interleukin-6 in the development of atherosclerosis and the potential for targeted drug therapy. Cardiol Rev. 2014;22(3):147–151.
    1. Shekar C, Budoff M. Calcification of the heart: mechanisms and therapeutic avenues. Expert Rev Cardiovasc Ther. 2018;16(7):527–536.
    1. Dillon SA, Lowe GM, Billington D, Rahman K. Dietary supplementation with aged garlic extract reduces plasma and urine concentrations of 8-iso-prostaglandin F (2 alpha) in smoking and nonsmoking men and women. J Nutr. 2002;132(2):168–171.
    1. Rahman K. Garlic and aging: new insights into an old remedy. Ageing Res Rev. 2003;2(1):39–56.
    1. Banerjee SK, Dinda AK, Manchanda SC, Maulik SK. Chronic garlic administration protects rat heart against oxidative stress induced by ischemic reperfusion injury. BMC Pharmacol. 2002;2:16.
    1. Banerjee SK, Maulik M, Mancahanda SC, Dinda AK, Gupta SK, Maulik SK. Dose-dependent induction of endogenous antioxidants in rat heart by chronic administration of garlic. Life Sci. 2002;70(13):1509–1518.
    1. Banerjee SK, Maulik SK. Effect of garlic on cardiovascular disorders: a review. Nutr J. 2002;1:4.
    1. Hamal S, Cherukuri L, Birudaraju D, Matsumoto S, Kinninger A, Chaganti BT, et al. Short-term impact of aged garlic extract on endothelial function in diabetes: a randomized, double-blind, placebo-controlled trial. Exp Ther Med. 2020;19(2):1485–1489.
    1. Kristiansen OP, Mandrup-Poulsen T. Interleukin-6 and diabetes: the good, the bad, or the indifferent? Diabetes. 2005;54(Suppl 2):S114–S124.
    1. Gottlieb I, Miller JM, Arbab-Zadeh A, Dewey M, Clouse ME, Sara L, et al. The absence of coronary calcification does not exclude obstructive coronary artery disease or the need for revascularization in patients referred for conventional coronary angiography. J Am Coll Cardiol. 2010;55(7):627–634.

Source: PubMed

3
Abonneren