Cardiovascular disease is associated with a range of factors including raised cholesterol and triglyceride levels, high blood pressure, sticky platelets, obesity, smoking, diabetes and chronic systemic inflammation.
Spices are powerful preventative agents against cardiovascular disease, as they modify most risk factors as well as other illnesses and pathological processes associated with this condition.

Caper, cinnamon, coriander, fenugreek, garlic, ginger, mustard, oregano, rosemary,  thyme and others exhibit powerful, protective effects against the development of heart attacks and strokes.

Cardioprotective Properties of Some Key Spices

Blood pressure control                                 Garlic

LDL cholesterol lowering                             Caper, coriander, cinnamon,                                                                                         fenugreek, garlic, ginger

LDL antioxidant                                              Ginger, oregano, rosemary, star anise , thyme  
                                                                          
Reduce platelet aggregation                       Clove , ginger, onion , oregano, rosemary, thyme                                                                                     
Lower homocysteine levels                         Mustard and other brassicas

Anti-inflammatory                                           Bay leaf ,  garlic, ginger, oregano,     
                                                                           rosemary, thyme, turmeric
         

Cardiovascular disease and atherosclerosis 
Although the term cardiovascular disease includes any disease that affects the heart and blood vessels, it is commonly used to refer to those diseases caused by atherosclerosis.

Atherosclerosis is a pathological process characterized by the deposition of cholesterol- and calcium-containing atheromatous plaques in the lining of the coronary, cerebral and other arteries. In their earlier stages of development atheromatous deposits do not cause narrowing of the arteries but inhibit their ability to dilate; in this way they restrict the flow of blood during times of increased oxygen demand by heart muscle and other tissues.

The most important cardiovascular diseases are heart attack and stroke, which are responsible for more deaths in the West than any other illness.  They kill approximately one million Americans and over four million Europeans each year and account for over 50 percent of deaths in these regions. In the USA alone, over 50 million people suffer from cardiovascular-related problems.     

As the principle scourge of the West – and increasingly of developing countries that adopt Western lifestyle habits – vast sums of money are devoted to combating cardiovascular disease. Success is made more elusive as a result of the multitude of risk and causative factors contributing to its underlying pathology including, amongst others, high cholesterol, high blood pressure, smoking and obesity.

Efforts to counteract cardiovascular disease are currently aimed at several levels: from public health programmes that aim to improve dietary habits, reduce obesity and curtail smoking, to the provision of drugs that ameliorate the major risk factors and underlying conditions such hypertension, atherosclerosis and “sticky” platelets.

Some of the most successful medicines used in this context are aspirin and drugs like clopidogrel that reduce platelet aggregation (stickiness) and prevent abnormal blood clotting, statins that lower high blood lipid levels, and antihypertensive drugs. While these medicines can be extremely effective, each only counteracts this multifaceted disease in one or two ways, and by the time they are prescribed irreversible damage may already have occurred.

Given its devastating consequences for so many of us, we all need to pre-empt and fight cardiovascular disease as early on in its development as possible. In addition to other lifestyle modifications, spices provide an ideal means to do this; they enable us to slow or halt the progression of the disease before we reach the stage at which prescription drugs become necessary.

Not only do the phytochemicals in many spices act by lowering cholesterol and preventing abnormal blood clotting, they also counteract a range of processes involved in the development of cardiovascular disease and simultaneously protect against other illnesses too.

Risk Factors for Cardiovascular Disease
Cardiovascular disease is associated with a wide range of lifestyle and other risk factors. The most important of these are elevated cholesterol and triglyceride levels, high blood pressure, sticky platelets, smoking, obesity, raised homocysteine levels, genetic predisposition, and related illnesses such as diabetes. To complicate matters, many of these factors are interlinked and exacerbate one other. Smoking, for instance, also raises blood pressure; obesity increases the chances of developing diabetes and high blood lipid levels, both of which are also associated with a genetic predisposition to these conditions. Aging on its own and, more so, when associated with weight gain and reduced exercise, is also a major risk factor.

Cholesterol and Other Lipids
High blood lipid levels are among the most important of the risk factors associated with cardiovascular disease. Normally cholesterol plays a central role in the production of several crucial hormones and is an important component of cell walls. Similarly triglycerides are not dangerous as long as their blood levels remain normal, and it is only in excess that these lipids become threats to our health. Raised levels of cholesterol and triglycerides, as well as imbalances in their lipoprotein carrier proteins, have all been directly implicated as major risk factors underlying cardiovascular disease. These lipid imbalances can, in turn, be caused by a number of factors, including genetic predisposition, high dietary fat intake and liver disease.

Of the blood lipids, cholesterol – a major constituent of atheromatous plaques – is the one most closely linked to cardiovascular disease. Blood levels of cholesterol may become abnormally high for a number of reasons. Usually the imbalance can be attributed to either a genetic predisposition or a diet high in saturated fats commonly found in animal products.

Once ingested, dietary cholesterol is broken down in the intestines and then re-synthesized in the liver before being released into the blood stream. Although the cholesterol in our blood is not exactly the same as that found in the food that we eat, an excessive dietary intake may increase the risk of high blood cholesterol levels. Irrespective of whether diet or genes are ultimately responsible, high levels of cholesterol and other lipids dramatically increase the risk of cardiovascular disease.

Blood lipid imbalances contribute directly to the development of atherosclerosis which, in turn, can lead to a heart attack or stroke.
 
Atheromatous Plaque Formation
The deposition of cholesterol and triglycerides in the arteries is the fundamental process underlying the development of atherosclerosis. As these lipids are insoluble in water, they need to be transported in the blood by water-soluble lipoprotein carrier molecules. The most important of these “molecular suitcases” are low density lipoprotein (LDL) and high density lipoprotein (HDL) which shuttle cholesterol and triglyceride back and forth between the liver and other tissues. HDL and LDL are both cholesterol transporters, but they have different functions. LDL carries cholesterol to the tissues, and arteries whereas HDL carries it back from these areas to be processed by the liver and excreted in the bile.

Once delivered to the artery by its LDL carrier, cholesterol is oxidised. This oxidative process precipitates an inappropriate immune response, and the ensuing inflammation causes damage to the blood vessels resulting in the deposition of calcium, cholesterol and other substances in the endothelial lining of the arteries. Eventually, sufficient quantities of these substances accumulate to form an atheromatous plaque. The process is accelerated if there is insufficient HDL to remove the cholesterol from the tissues and take it back to the liver. This is the reason that high LDL, cholesterol and triglyceride levels and low HDL levels are associated with increased risk of heart disease, and why we need to keep LDL levels low and HDL levels high.

Chronic Systemic Inflammation 
Atheromatous plaque formation is associated with an inflammatory process involving the oxidation of LDL cholesterol. The mechanism underlying this process is currently under intensive investigation and is thought to be associated with a low grade pathological state called chronic systemic inflammation. Spices like garlic, ginger, oregano, rosemary, thyme and others contain anti-inflammatory phytochemicals that inhibit this abnormal inflammatory condition. Antioxidants present in most spices also play a major role in preventing the oxidation of LDL cholesterol.

Atherosclerosis
The principal cause of heart attack and thrombotic stroke is atherosclerosis-related pathology. If an atheromatous plaque ruptures into a coronary or cerebral artery, it may block the blood flow to parts of the heart or brain, respectively. The oxygen starvation associated with the reduced blood flow is responsible for the often lethal damage that occurs during these events.

Although the precise mechanisms associated with the development of atherosclerosis have not been fully elucidated, some of these processes, and their associated risk factors, are well understood. Its formation typically begins during the teenage years, but the process may be accelerated by poor lifestyle habits. In Western countries today it is not unusual to for atherosclerosis to start in young children, resulting in these unfortunate individuals developing the symptoms of cardiovascular disease in early adulthood.

Consisting mainly of calcified, cholesterol compounds, atheromatous plaques cause a gradual narrowing and hardening of the arteries. This restricts blood flow to tissues, and places extra strain on the heart which has to work harder to pump blood through stiff, narrow blood vessels. Once the plaques occlude more than 50 percent of the lumen of the arteries, cardiovascular disease begins to manifest itself in the form of angina, heart attack and stroke.

“Sticky” Platelets 
The risk of a heart attack or stroke resulting from atherosclerosis is increased in the presence of sticky platelets. Platelets are small cells found in the blood that are involved in the inflammatory response. They are also crucial components of blood clots that help to control bleeding by sticking to one another and, in so doing, help to contain bleeding from damaged blood vessels. Platelets can, however, become a health liability if they are too “sticky” and adhere to one another even when there is no bleeding. If this abnormal aggregation involves a significant number of platelets, a clot may develop. Clot formation may also be precipitated by the rupture of an atheromatous plaque into the lumen of a blood vessel. The more “sticky” the platelets are, the more likely they are to aggregate on the ruptured plaque.

Heart Attack and Thrombotic Stroke
Over time, cholesterol and calcium continue to be deposited in the artery walls, causing the blood vessels to narrow thereby reducing the flow of blood to the tissues. As they grow in size, the atheromatous plaques become unstable and may rupture into the lumen of an artery, causing permanent blockage to the blood supply. Plaque rupture stimulates platelet aggregation and clot formation at the site of the plaque, and this causes further narrowing of the vessel and aggravation of the already impeded blood flow.  This process occurring in a coronary artery is the fundamental cause of a heart attack. The same event taking place in a cerebral artery may cause a thrombotic stroke, either by blocking an artery at the point of rupture, or by causing a blockage elsewhere in the brain after a piece of the clot becomes dislodged and travels to a smaller, more distant, blood vessel. 

The “Polypill” Concept    
Given the multitude of risk factors and pathological mechanisms involved in the development of heart disease and stroke, it makes sense to adopt a multifaceted approach to prevention. In this respect those with cardiovascular disease are currently prescribed drugs to treat the risk factors appropriate to their condition. However, some experts have gone one step further and proposed that all those over a certain age, regardless of their health status, should take a daily “polypill”. This would contain statin drugs to lower blood lipid levels, aspirin to reduce platelet aggregation, and other drugs that lower blood pressure and homocysteine levels.

The proponents of the polypill concept claim that overall it could reduce cardiovascular mortality by more than 80 percent. However, this shotgun approach has yet to be embraced by the medical profession as a whole. The main reason is that almost all of the drugs it would contain have potential side effects. Statins, for instance, can have pro-inflammatory effects, exacerbating what is already an inflammatory process. Aspirin can cause intestinal bleeding, and drugs to lower blood pressure can result in arrhythmias (irregular heart beats) and other adverse effects. 

Spices vs. Polypill 
Fortunately, we do not need to wait for a risky polypill to become available. Spices contain phytochemicals which have similar beneficial effects to all the components of the proposed polypill. Cinnamon and fenugreek reduce blood lipids and lower LDL levels. Ginger reduces platelet aggregation, garlic lowers blood pressure, and brassica plants such as mustard lower homocysteine levels.

Spices also have additional benefits, offering their own effective shotgun approach to the prevention of cardiovascular disease. The wide range of phytochemicals contained in spices is capable of modifying all the processes implicated in the development of the disease. Spices also combat diseases such as diabetes, obesity and other conditions associated with cardiovascular disease. By giving ourselves a daily dose of these powerful, protective spices, we are counteracting a multitude of pathological processes that collectively pose a greater risk to our health than any other medical condition. 

Examples of Drugs and Spices with Similar Functions

Effect                                              Prescription Drugs                        Spice equivalents

Lower blood lipids                       Statins                                              Cinnamon, coriander,  fenugreek,                                                                                                                             garlic, ginger, oregano,  rosemary,                                                                                                                           star anise ,  thyme                                                                                                                                                    

Lower blood pressure                ACE inhibitors                                 Garlic         
                                                        Calcium channel blockers
                                                        Beta blockers
                                                        Diuretics    
     
Reduce platelet stickiness       Aspirin                                                Cloves , garlic, ginger, onion ,
                                                       Clopidogrel                                        oregano, rosemary, thyme