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Natural Medicine Journal

January 28, 2014

Cardioprotective Effects of Aged Garlic Extract

Aged garlic extract reduces blood pressure among hypertensive patients

Matthew J. Budoff

MD, FACC, FAHA
Cardiovascular disease is the leading cause of morbidity and mortality among the US population. Aged garlic extract helps to modulate multiple cardiovascular risk factors by lowering blood pressure, inhibiting platelet aggregation and adhesion, lowering cholesterol, and preventing LDL oxidation and smoking-induced oxidative damage.

Reference

Ried K, Frank OR, Stocks NP. Aged garlic extract reduces blood pressure in hypertensives: a dose-response trial. Eur J Clin Nutr. 2013 Jan;67(1):64-70.
 

Study Design

Randomized, placebo-controlled, double-blind trial of 12 weeks duration
 

Participants and Study Design

A total of 79 participants were allocated into 4 groups treated with either aged garlic extract (AGE) and S-allylcysteine (groups g1, g2 and g4 containing 240/480/960 mg of AGE and 0.6/1.2/2.4 mg of S-allylcysteine) or placebo based on 80% power analysis to detect 10 mmHg of difference in systolic blood pressure. These participants were on an established plan of prescription antihypertensive medications for the 2 months prior to enrolling in the trial.
 

Outcome Measure

The primary outcome was to detect significant difference in systolic blood pressure in 3 treatment groups (g1, g2 and g4) compared to placebo at 4, 8 and 12 weeks. The secondary outcome was to determine tolerability and acceptability of the supplements.
 

Key Findings

There was a significant reduction in systolic blood pressure among participants in the g2 group compared to the placebo over 12 weeks (-11.8±5.4 mmHg, P=0.006), whereas it reached borderline statistically significant reduction in the group g4 at 8 weeks (-7.4±4.1 mmHg, P=0.07). There was improvement in diastolic blood pressure in the g2 group, though it was statistically insignificant compared to placebo (-5.3±4.2 mmHg). Gastrointestinal intolerance was the main side effect, especially among group g4 participants. The pills were easy to take and acceptable to most participants.
 

Commentary

Multiple randomized clinical trials have shown cardioprotective effects of AGE. The current clinical trial provides further evidence of the role of AGE in lowering blood pressure among hypertensive patients. According to Reid K and colleagues, "The observed reduction in systolic blood pressure is comparable to that achieved with commonly prescribed antihypertensive medicines, and is of clinical significance, whereby a reduction of about 10 mmHg in SBP is associated with a risk reduction in cardiovascular disease by 16–40%."
 
The benefit was greatest with the 480 mg preparation of AGE, whereas the antihypertensive effect was smaller with the 960 mg preparation of AGE, perhaps due to poor compliance and less tolerability associated in the g4 group. In another randomized clinical trial, Reid K et al. showed a significant reduction in systolic blood pressure (-10.2±4.3 mmHg, P=0.03) associated with the use of 960 mg of AGE and 2.4mg of S-allylcysteine in participants with baseline systolic blood pressure greater than ≥140 mmHg. The current study showed a borderline significant reduction of systolic blood pressure in the g4 group (-7.4±4.1 mmHg, P=0.07). Further large-scale studies may be required to validate these findings.
 
Cardiovascular disease is the leading cause of morbidity and mortality among the US population. AGE helps to modulate multiple cardiovascular risk factors by lowering blood pressure, inhibiting platelet aggregation and adhesion, lowering cholesterol, and preventing LDL oxidation and smoking-induced oxidative damage.1–4 Our previous studies have shown that AGE retards the progression of coronary atherosclerosis, improves vascular function, and has favorable a effect on oxidative biomarkers among high-risk firefighter populations.5–8 AGE has been proposed to effect coronary atherosclerosis by preventing smooth muscle cell transformation and proliferation, preventing entry of lipids into the arterial wall and macrophages, and also directly suppressing atherosclerosis.2,9 AGE has also been shown to have a beneficial effect on arterial function by inhibiting endothelial cell damage, transforming smooth muscle cells, and inhibiting the damage of nitric oxide synthesis.10,11
 
Cardiovascular disease is the leading cause of morbidity and mortality among the US population.
 
AGE was shown to have promising effects on systolic blood pressure reduction among group g2 participants in this study. The effect on diastolic blood pressure could not reach statistical significance due to limited power to detect significant changes in diastolic blood pressure. Similarly, the analysis could not be powered by the type of antihypertensive medications. The results from this trial will have far-reaching consequences and provide a scientific evidence for the use of AGE for its antihypertensive effects, especially among patients who are interested in using supplements to control blood pressure. Reid and colleagues showed "AGE to be an effective and tolerable treatment in uncontrolled hypertension," stating it "may be considered as a safe adjunct treatment to conventional antihypertensive therapy." Further large studies can be performed to confirm these findings and to answer questions that could not be answered in this trial, including the effect of AGE on diastolic blood pressure, to determine whether the antihypertensive effect of AGE is different in combination with different antihypertensive classes of medications, and to evaluate the effect of AGE on long-term cardiovascular morbidity and mortality.

Categorized Under

Matthew J. Budoff

MD, FACC, FAHA

Matthew J. Budoff, MD, FACC, FAHA, is a professor of medicine at the David Geffen School of Medicine and is the director of cardiac CT at Harbor-UCLA Medical Center in Torrance, Calif. Budoff is chief investigator in several active medical research trials and is a frequent lecturer on topics of cardiology at symposia, congresses, and annual conferences on nearly every continent. He has authored or coauthored more than 500 research papers, 6 books, and 36 book chapters. Budoff received the Einstein Award for Scientific Achievement from the International Biographical Centre, Cambridge, UK, and was awarded the Top Oral Abstract at the American Heart Association’s 2009 meeting. Most recently, he was named to the U.S. News & World Report list of Top Doctors for 2011.

Irfan Qureshi

ND

Irfan Qureshi, ND, is vice president, technical and regulatory affairs for AIBMR Life Sciences in Puyallup, Wash., a natural products consulting firm specializing in regulatory guidance and research strategies. Qureshi earned a bachelor’s degree in microbiology from the University of Washington and a degree in Naturopathic Medicine from Bastyr University. He is a member of the American Association of Naturopathic Physicians. Qureshi also maintains a private naturopathic medical practice in SeaTac, Wash., specializing in the treatment of chronic diseases and autism. He is a frequent contributor to industry trade journals such as Nutritional Outlook.

References

  1. Steiner M, Khan AH, Holbert D, Lin RI. A double-blind crossover study in moderately hypercholesterolemic men that compared the effect of aged garlic extract and placebo administration on blood lipids. Am J Clin Nutr. 1996;64(6):866-870.
  2. Campbell JH, Efendy JL, Smith NJ, Campbell GR. Molecular basis by which garlic suppresses atherosclerosis. J Nutr. 2001;131(3s):1006S-1009S.
  3. Okuhira M HH, Sandhu R, Steiner M. Modication of cardiovascular risk factors aged garlic extract (AGE). Phytomedicine. 2000;7:49-50.
  4. Rahman K, Billington D. Dietary supplementation with aged garlic extract inhibits ADP-induced platelet aggregation in humans. J Nutr. 2000;130(11):2662-2665.
  5. Budoff MJ, Takasu J, Flores FR, 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.
  6. Budoff MJ, Ahmadi N, Gul KM, 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.
  7. Zeb I, Ahmadi N, Nasir K, 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.
  8. Larijani VN, Ahmadi N, Zeb I, Khan F, Flores F, Budoff M. Beneficial effects of aged garlic extract and coenzyme Q10 on vascular elasticity and endothelial function: the FAITH randomized clinical trial. Nutrition. 2013;29(1):71-75.
  9. Gonen A, Harats D, Rabinkov A, et al. The antiatherogenic effect of allicin: possible mode of action. Pathobiology. 2005;72(6):325-334.
  10. Ho SE, Ide N, Lau BH. S-allyl cysteine reduces oxidant load in cells involved in the atherogenic process. Phytomedicine. 2001;8(1):39-46.
  11. Morihara N, Sumioka I, Moriguchi T, Uda N, Kyo E. Aged garlic extract enhances production of nitric oxide. Life Sci. 2002;71(5):509-517.

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