IMR Press / FBE / Volume 12 / Issue 1 / DOI: 10.2741/E859
Atherosclerosis prevention: the role of special diets and functional food
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1 Plekhanov Russian University of Economics, Stremyanny Pereulok 36, 117997 Moscow, Russia
2 Institute of Human Morphology, Tsyurupa str. 3, 117418, Moscow, Russia
3 Institute of General Pathology and Pathophysiology, Baltiyskaya str. 8, 125315 Moscow, Russia
4 Institute of Cellular and System Medicine, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 35053, Taiwan R.O.C.
5 Laboratory of Medical Genetics, National Medical Research Center of Cardiology, 15A 3-rd Cherepkovskaya Street, Moscow 121552, Russia
Send correspondence to: Vasily Karagodin, Plekhanov Russian University of Economics, Stremyanny Pereulok, 36, 117997 Moscow, Russia, Tel: 74956053551, E-mail:
Front. Biosci. (Elite Ed) 2020, 12(1), 95–101;
Published: 1 January 2020

Accumulating evidence highlight the importance of diet in the pathogenesis as well as prevention of atherosclerosis. In this review, we summarize the results of recent studies that demonstrate direct and indirect effects if functional foods and their analogues in prevention of initiation and progression of atherosclerosis. We discuss the epidemiological and clinical observations of such diets and dicuss their effects on the pathological mechanisms that drive atherosclerosis at cellular and molecular level.

Functional foods
Dietary supplements

Diet is an important factor in the development of atherosclerosis which leads to hypercholesterolemia, ischemic heart disease and myocardial infarction. A high-calorie diet, with a great proportion of saturated fat and cholesterol, increases the risk of cardiovascular disease (CVD) (1-2). Diet is also responisble for the differences in the risk level and clinical manifestations of atherosclerosis among individuals in different populations (3-5). Thus, it follows that special diets can also be made that halt or slow down the atherogenesis.

Atherosclerosis results from accumulation of lipids, primarily free cholesterol, cholesterol esters, and low-density lipoprotein (LDL) in the vascular wall (7-9). However, chemical modification of the lipoprotein particles is necessary for acquiring atherogenic properties, since, in most cases, native LDL does not cause intracellular accumulation of lipid (10). Among the atherogenic modification of LDL, desialylation facilitates subsequent oxidation and formation of aggregated lipid in human plasma (12). Apart from alterations in blood lipid profile, inflammation is also considered as a key factor in the development of atherosclerosis (11).

A good strategy for preventing atherosclerosis is to prevent the development of modified LDL with atherogenic potential. For example, high-density lipoprotein (HDL) appear to have a protective role in atherogenesis (13). During the recent years, the development of pharmacological approaches to treat atherosclerosis received much attention. However, the clinical application of the existing drugs is quite limited due to their narrow indications, side effects and relatively high cost. Lifestyle modification, including introduction of special diets, dietary supplements and functional foods (FF), appear to be promising alternatives to pharmacological intervention for prevention or treatment of atherosclerosis (14-15). Most diets and dietary supplements are characterized by affordable price and little or no known side effects, which allows their long-term, or even lifelong use. Here, we describe the diets with anti-atherogenic effects, mainly from plants, that prevent the occurrence and progression of atherosclerotic lesions and summarize the recent achievements in the development of functional foods and diets aimed at prevention and treatment of atherosclerosis (6).


The development of special diets targeting atherogenesis is complicated by the lack of a solid research algorithm. Tests based on cultured cells may be helpful for preliminary screening and rough assessment of the anti-atherogenic potential of different food components. Our group has developed a number of cell-based and in vivo tests for these purposes that characterized the cellular accumulation of cholesterol and efflux, expression of inflammatory cytokines (HLA-DR, ICAM-1, IL-1 and TNF-α), and changes in activity of sialidase in blood (16-17).

1. Aortic intima cell model for assessing cholesterol accumulation, cholesterol efflux and cytokine production

2. Cellular model based on human monocyte-derived macrophages to assess the accumulation and efflux of cholesterol

3. An enzymatic model for determining activity of sialidase and searching for agents that prevent atherogenic modification of LDL

4. In the in vivo model, the atherogenic factors are measured in the plasma of volunteers before and after consumption of distinct food substances.

In one model, the effect of eight different plants on monocyte-derived macrophages on removal of excess cholestrol was tested (17). Among these, onion (Allium cepa) powder likely, through flavonoids, saponins, allicin and ascorbic acid exerted anti-atherosclerotic effect including a decrease in cholesterol content in lipid-loaded cells (17). Using primary culture of intimal aortic cells, we identified a positive correlation between the accumulation of intracellular lipids and the expression of HLA-DR, TNF-α and IL-1 (17). These studies also revealed that Allium cepa, calendula (Calendula officinalis), violet (Viola tricolor) and black elder berries (Sambucus nigra) reduced inflammatory cytokines (17).

The anti-inflammatory efficacy of the combination of these plants was as high as 88% of that of diclofenac, one of the most potent non-steroid anti-inflammatory drugs. The active ingredients of plants that convey anti-inflammatory properties may include carotenoids, flavonoids, saponins, phytosterols, flavon glycoside violacvercetin and anthocyanin glycosides (delphinidin, peonidin, violin). Grape seed, hop, garlic and green tea also have exhibited anti-atherogenic potential(17).

One of the events associated with atherosclerosis is the formation of foam cells and recruitment of macrophages with a pro-inflammatory phenotype in the atheromas. A combination of three biologically active agents (phytosterols, omega-3 polyunsaturated fatty acids, and flavanols) inhibited the recruitment of monocytes, pro-inflammatory polarization of macrophages as well as formation of foam cells (18). Other effects included the increase of ApoA-I-mediated efflux of cholesterol from foam cells, which was independent from the presence of phytosterols in the tested mixture and suppression of the expression of two antiatherogenic genes.

3.1. Traditional foods and atherosclerosis

Among the traditional foods tomatoes, that are rich in lycopene, have a positive influence on body weight, blood pressure, blood glucose level, lipid metabolism, and endothelial function, and show antioxidant and anti-inflammatory properties (19-20). Moreover, the anti-atherosclerotic effect of tomatoes appears to depend on the method of their culinary processing (21). High levels of polyunsaturated fatty acids (PUFA) in fish are thought to have anti-atherosclerotic properties. However, according to a report, intake of fatty fish or fish oil as a dietary supplement had no impact on the formation of atherosclerotic plaques visible on ultrasound examination of carotid arteries (22). Likely independent from PUFA, and by their specific contents of peptides and amino acids, including taurine and glycine, consumption of lean fish reduced the likelihood of developing plaques (22-24). Moreover, it has been shown that the beneficial activity of PUFA may decrease during thermal processing of fish (25- 26). Cranberry, has been shown to exert beneficial effect on inflammation, oxidative stress, blood pressure, endothelial function, regulation of blood glucose level, and a variety of biomarkers (27). These effects are largely conveyed mostly through polyphenols along with other substances including phenolic acids, isoprenoids, and oligosaccharides. Cornel (Cornelian cherry), likely through their polyphenol compounds, also has been reported to have anti-atherosclerotic activity, and to alter lipid-carbohydrate metabolism, platelet activity, total cholesterol, plasma LDL, and markers of inflammation and oxidative stress (28). Molecular and cellular effects of polyphenols, tocopherols and PUFAs persent in olive oil have been recently described (29). The most important molecular effect has been attributed to reduced oxidative stress that leads to endothelial dysfunction. It appears that components in olive oil attenuate oxidative stress and improve the endothelial function through their anti-inflammatory, anti-oxidant, and anti-thrombotic properties (30).

3.2. Functional food and biologically active food supplements

The concept of “functional food” has been evolving since the early 1980s, and the definition of the relevant product categories has undergone repeated changes. One of the latest definitions of functional food (FF) is natural or processed foods that contain known or unknown biologically-active compounds; which provide a clinically proven and documented health benefit for the prevention, management, or treatment of chronic diseases (31). Thus, FF can be either natural or processed, that is, specially designed, such as folate-fortified cereal or vitamin C-enriched milk. Moreover, in some countries, the definition of FF also includes dietary supplements in the form of pills and capsules. Methods for production of designed FF have been described in detail elsewhere (32). Regarding the effects of nutritionally engineered foods on atherosclerosis, only a limited number of studies exist (33-34). Among these, feeding animals FF consisting of chicken egg yolk conjugated with linoleic acid led to reduction of blood cholesterol, and anti-inflammatory and modified the composition of cholesterol-containing plaques (35). Extracts of leaves of Mallotus furetianus fed to rats for nine weeks, modified lipid profile of blood associated with changes in histology and and the thickness of the intima-media (36). A 2-year study using a FF form of garlic (Allicor) and a series of double-blind placebo-controlled clinical trials using this formulation have established the anti-atherosclerotic and preventative effects of Allicor in reducing the risk of developing atheroscloerosis as well as a direct effect at the level of the vascular wall (37). Other dietary supplements with similar composition that have shown to inhibit accumulation of lipid in the vascular wall are Inflaminat and Karinat (38).


This work was supported by the Russian Science Foundation (Grant #19-15-00010). The authors declare no conflict of interest.

Abbreviation Expansion

FF: functional food, CVD: cardiovascular disease, LDL: low-density lipoproteins, HDL: high-density lipoproteins, PUFAs: omega-3 polyunsaturated fatty acids

AlissaE. MAGFerns, Functional foods and nutraceuticals in the primary prevention of cardiovascular diseases. J Nutr Metab20122012569486DOI: 10.1155/2012/569486 PMid:22570771 PMCid:PMC3335253
HeKMerchantARimmE. BRosnerB. AStampferM. JWillettW. CAscherioADietary fat intake and risk of stroke in male US healthcare professionals: 14 year prospective cohort study. BMJ2003327777782DOI: 10.1136/bmj.327.7418.777 PMid:14525873 PMCid:PMC214078
ReddyK. SrinathBMKatan, Diet, nutrition and the prevention of hypertension and cardiovascular diseases. Public Health Nutr20047167186DOI: 10.1079/PHN2003587
OrekhovA. NAEIvanova, Introduction to the special issue "Atherosclerosis and Related Diseases". Vessel Plus20171163165DOI: 10.20517/2574-1209.2017.33
SinyovV. VSazonovaM. ARyzhkovaA. IGalitsynaE. VMelnichenkoA. APostnovA. YOrekhovA. NGrechkoA. VAISobenin, Potential use of buccal epithelium for genetic diagnosis of atherosclerosis using mtDNA mutations. Vessel Plus20171145150DOI: 10.20517/2574-1209.2016.04
AlipovV. ISukhorukovV. NKaragodinV. PGrechkoA. VNAOrekhov, Chemical composition of circulating native and desialylated low density lipoprotein: what is the difference? Vessel Plus20171107115DOI: 10.20517/2574-1209.2017.20
LibbyPInflammation and cardiovascular disease mechanisms. Am J Clin Nutr200683456S460SDOI: 10.1093/ajcn/83.2.456S PMid:16470012
TabasIMacrophage death and defective inflammation resolution in atherosclerosis. Nat Rev Immunol2010103646DOI: 10.1038/nri2675 PMid:19960040 PMCid:PMC2854623
HarangiMSzentpéteriANádróBLőrinczHSeresIPállDParaghGHDL subfraction distribution and HDL function in untreated dyslipidemic patients. Vessel Plus20171166173DOI: 10.20517/2574-1209.2017.27
TertovV. VKaplunV. VSobeninI. ABoytsovaE. YBovinN. VNAOrekhov, Human plasma trans-sialidase causes atherogenic modification of low density lipoprotein. Atherosclerosis2001159103115DOI: 10.1016/S0021-9150(01)00498-1
NikiforovN. GGalstyanK. ONedosugovaL. VElizovaN. VKolmychkovaK. IAEIvanova, Proinflammatory monocyte polarization in type 2 diabetes mellitus and coronary heart disease. Vessel Plus20171192195DOI: 10.20517/2574-1209.2017.21
OrekhovA. NTertovV. VNDMukhin, Desialylated low density lipoprotein--naturally occurring modified lipoprotein with atherogenic potency. Atherosclerosis199186153161DOI: 10.1016/0021-9150(91)90211-K
WeberCZerneckeALibbyPThe multifaceted contributions of leukocyte subsets to atherosclerosis: lessons from mouse models. Nat Rev Immunol20088802815DOI: 10.1038/nri2415 PMid:18825131
KirichenkoT. VMyasoedovaV. ANAOrekhov, Phytotherapy for the Prevention of Atherosclerosis-Associated Early Cerebral Ischemia, 2018, 10.2174/1389200219666180305151601 PMid:29512455
Orekhov A. N A E Ivanova, Editorial: Conventional, Traditional and Alternative Therapies for Cardiovascular Disorders. 2017, Part 3: Alternative Therapy, 2017
GorchakovaT. VSuprunI. VSobeninI. ANAOrekhov, Use of natural products in anticytokine therapy. Bull Exp Biol Med2007143316319DOI: 10.1007/s10517-007-0099-6 PMid:18225751
OrekhovA. NGrechkoA. VRomanenkoE. BADChistiakov, Novel Approaches to Anti-Atherosclerotic Therapy: Cell-Based Models and Herbal Preparations (Review of Our Own Data), (2019) 10.2174/1570163816666190101112241 PMid:30621565
MossJ. W. EDaviesT. SGaraiovaIPlummerS. FMichaelD. RPDRamji, A Unique Combination of Nutritionally Active Ingredients Can Prevent Several Key Processes Associated with Atherosclerosis In vitro. PLoS One201611e0151057e0151057DOI: 10.1371/journal.pone.0151057 PMid:26950833 PMCid:PMC4780775
MordenteAGuantarioBMeucciESilvestriniALombardiEMartoranaG. EGiardinaBBohmALycopene and cardiovascular diseases: an update. Curr Med Chem20111811461163DOI: 10.2174/092986711795029717 PMid:21291369
Yanai H Adachi H Kawaguchi A Hakoshima M Waragai Y Harigae T Masui Y Kakuta K Hamasaki H Katsuyama H Sako A Тhe anti-atherosclerotic effects of tomatoes. Funct Foods Heal Dis 2017 7 411 428
Valderas-MartinezPChiva-BlanchCCasasRArranzSMartínez-HuélamoMUrpi-SardaMTorradoXCorellaDLamuela-RaventósR. MEstruchRTomato Sauce Enriched with Olive Oil Exerts Greater Effects on Cardiovascular Disease Risk Factors than Raw Tomato and Tomato Sauce: A Randomized Trial. Nutrients20168170DOI: 10.3390/nu8030170 PMid:26999197 PMCid:PMC4808898
JohnsenS. HJacobsenB. KBrækkanS. KHansenJ.-BBEMathiesen, Fish consumption, fish oil supplements and risk of atherosclerosis in the Tromsø study. Nutr J20181756DOI: 10.1186/s12937-018-0364-8 PMid:29801499 PMCid:PMC5970507
JensenI.-JWalquistMLiasetBElvevollE. OEilertsenK.-E.Dietary intake of cod and scallop reduces atherosclerotic burden in female apolipoprotein E-deficient mice fed a Western-type high fat diet for 13 weeks. Nutr Metab (Lond)2016138DOI: 10.1186/s12986-016-0068-z PMid:26839578 PMCid:PMC4735963
TorrisCMolinMCMCvancarova, Lean fish consumption is associated with lower risk of metabolic syndrome: a Norwegian cross sectional study. BMC Public Health201616347DOI: 10.1186/s12889-016-3014-0 PMid:27093865 PMCid:PMC4837629
CandelaMAstiasaránINABelloJDeep-Fat Frying Modifies High-Fat Fish Lipid Fraction. J Agric Food Chem19984627932796DOI: 10.1021/jf9709616
MozaffarianDLemaitreR. NKullerL. HBurkeG. LTracyR. PSDSiscovick, Cardiac benefits of fish consumption may depend on the type of fish meal consumed: the Cardiovascular Health Study. Circulation200310713721377DOI: 10.1161/01. CIR.0000055315.79177.16 PMid:12642356
BlumbergJ. BBasuAKruegerC. GLilaM. ANetoC. CNovotnyJ. AReedJ. DRodriguez-MateosADCToner, Impact of Cranberries on Gut Microbiota and Cardiometabolic Health: Proceedings of the Cranberry Health Research Conference 2015. Adv Nutr20167759S770SDOI: 10.3945/an.116.012583 PMid:27422512 PMCid:PMC4942875
LietavaJBeerovaNKlymenkoS. VPanghyovaEVargaIPechanovaOEffects of Cornelian Cherry on Atherosclerosis and Its Risk Factors. Oxid Med Cell Longev201920192515270DOI: 10.1155/2019/2515270 PMid:30911343 PMCid:PMC6397968
SummerhillVKaragodinVGrechkoAMyasoedovaVOrekhovAVasculoprotective Role of Olive Oil Compounds via Modulation of Oxidative Stress in Atherosclerosis. Front Cardiovasc Med20185188DOI: 10.3389/fcvm.2018.00188 PMid:30622950 PMCid:PMC6308304
OrekhovA. NIvanovaE. AMelnichenkoA. AAISobenin, Circulating desialylated low density lipoprotein. Cor Vasa201759e149e156DOI: 10.1016/j.crvasa.2016.10.003
Martirosyan D. M Singh J A new definition of functional food by FFC: what makes a new definition unique? Funct Foods Heal Dis 2015 5 209 223
SmithJCharterEShahidiFDevelopmentFunctional Food ProductBlackwell Publishing Ltd2010DOI: 10.1002/9781444323351
Gyorgy S , From techno-corporate food to alternative agri-food movements". Local Glob 2007 4 112 140
KohlerJTeupserDElsasserAWeingartnerOPlant sterol enriched functional food and atherosclerosis. Br J Pharmacol201717412811289DOI: 10.1111/bph.13764 PMid:28253422 PMCid:PMC5429322
Franczyk-ZarowMKostogrysR. BSzymczykBJawienJGajdaMCichockiTWojnarLChlopickiSMPPisulewski, Functional effects of eggs, naturally enriched with conjugated linoleic acid, on the blood lipid profile, development of atherosclerosis and composition of atherosclerotic plaque in apolipoprotein E and low-density lipoprotein receptor double-knockout mice (apoE/LDLR-/-) Br J Nutr2008994958DOI: 10.1017/S0007114507793893 PMid:17678565
YueliLLiqunWHaitaoWLianboLXinanYComparison of anti-atherosclerotic effects of two different extracts from leaves of Mallotus furetianus. Asian Pac J Trop Med20114878882DOI: 10.1016/S1995-7645(11)60212-5
KaragodinV. PSobeninI. ANAOrekhov, Antiatherosclerotic and Cardioprotective Effects of Time-Released Garlic Powder Pills. Curr Pharm Des201622196213DOI: 10.2174/1381612822666151112153351
NAOrekhov, Anti-atherosclerotic Drugs from Natural Products. Nat Prod Chem Res20131DOI: 10.4172/2329-6836.1000121
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