September 29, 2020 is World Heart Day. The World Heart Federation (WHF) is asking the world to use Heart to beat cardiovascular diseases (CVDs) for your loved ones, society and you. We are living in unprecedented times. The COVID-19 pandemic has shone a spotlight on the healthcare profession, national healthcare systems and our individual responsibilities – for our own health and for the vulnerable in society. The WHF goes on- we do not know what course the pandemic will take in the future but we do know that taking care of our hearts right now is more important than ever.

The World Health Organization (WHO) in the same vein refers to the need to scale up prevention of heart attack and stroke. Cardiovascular diseases (CVDs) take the lives of 17.9 million people every year, 31% of all global deaths. Triggering these diseases – which manifest primarily as heart attacks and strokes – are tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol. These in turn show up in people as raised blood pressure, elevated blood glucose and overweight and obesity. These are all risks detrimental to good heart health.Through the Global Hearts Initiative, WHO is supporting governments around the world to scale-up efforts on CVD prevention and control of cardiovascular diseases.

Cardiovascular diseases (CVDs) are the number 1 cause of death globally. CVDs are a group of disorders of the heart and blood vessels and include coronary heart disease, cerebrovascular disease, rheumatic heart disease and other conditions. Four out of five CVD deaths are due to heart attacks and strokes, and one third of these deaths occur prematurely in people under 70 years of age.Individuals at risk of CVD may demonstrate raised blood pressure, glucose, and lipids as well as overweight and obesity. These can all be easily measured in primary care facilities. Identifying those at highest risk of CVDs and ensuring they receive appropriate treatment can prevent premature deaths. While the number of CVD deaths has not changed significantly in high-income countries since 1990, the number of deaths has increased by about 66% in low- and middle-income countries (LMICs) over the same interval. While attempting to address the burden of CVD, LMICs face the challenges of limited health care budgets and infrastructure as well as constrained professional health workforce capacity.

A nutraceutical approach has been proposed to counteract the increasing burden of CVD. A nutraceutical is a medicinally or nutritionally functional food. A functional food is one that provides health benefits in addition to basic nutrition. The consumption of polyphenol-rich foods has been related to a lower risk of cardiovascular events (cardiovascular mortality, myocardial infarction, and stroke) both in the general population and in patients with cardiovascular risk factors in several interventional and epidemiological trials. Polyphenols are believed to be largely responsible for this protective role. Characterized as compounds with phenolic structural features, they are a class of natural bioactive substances with numerous anti-atherogenic properties including anti-inflammatory, anti-aggregating, and vasodilatory effects, the ability to lower blood pressure (BP), to prevent oxidation of low-density lipoprotein (LDL), and to improve glucose and lipid profiles.

Fruits, vegetables, tea, chocolate, and wine contain a high amount of polyphenols. Among them, cocoa beans are one of the richest known sources of flavonoids, and their protective properties have been recognized and used by several cultures among centuries. Several epidemiological. Interventional studies strongly suggest that cocoa consumption, as well as vegetables and fruit intake, has numerous beneficial effects on cardiovascular health, including lowering of BP, improving vascular function, reducing of platelet aggregation and adhesion, having anti-inflammatory properties, and improving glucose and lipid metabolism. These positive effects have been found in healthy subjects as well as in patients with risk factors (arterial hypertension, diabetes, and smoking) or established CVD (coronary heart disease or heart failure)). Various potential mechanisms, including the increased bioavailability of nitric oxide (NO) and the anti-inflammatory and antioxidant effect, have been linked to the protective properties of cocoa.

Arterial hypertension is a major modifiable risk factor for cardiovascular and cerebrovascular disease. Every 10  mmHg reduction in SBP significantly reduces the risk of major cardiovascular events, coronary heart disease (CHD), stroke, and heart failure, which leads to a significant 13% reduction in all-cause mortality. A small amount of dark chocolate daily (6 g) with minimum 70% cocoa solids in the evening significantly reduced mean systolic blood pressure by 2.91.6 mm Hg and diastolic blood pressure by 1.91.0 mm Hg with no changes in body weight, plasma lipid levels, and glucose. Based on the epidemiological evidence and the results from interventional studies, the European Food Safety Authority (EFSA) published a health claim about the effect of polyphenols derived from cocoa on cardiovascular risk factors, assessing that polyphenol-rich cocoa “help maintaining the elasticity of blood vessels, which contributes to normal blood flow.” To obtain this effect the EFSA recommend the consumption of 200 mg of cocoa flavanols per day, provided

by 2.5 g of high-flavanol (polyphenol-rich) cocoa powder or 10 g of high-flavanol dark chocolate (with minimum 70% cocoa solids, in the context of a balanced diet

I will at this point refer to earlier observation in this piece-While the number of CVD deaths has not changed significantly in high-income countries since 1990, the number of deaths has increased by about 66% in low- and middle-income countries (LMICs) over the same interval.As we prepare to mark the World Heart Day 2020 let us resolve to daily/regularly consume polyphenol-rich cocoa and Use Heart to beat cardiovascular diseases (CVDs.





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