Pycnogenol and Coronary Artery Disease
Abstract & Commentary
By Russell H. Greenfield, MD
Synopsis: Results from this small, 8-week crossover study suggest that the antioxidant Pycnogenol, which also possesses anti-inflammatory actions, could help improve endothelial function in people with stable coronary artery disease.
Source: Enseleit F, et al. Effects of Pycnogenol on endothelial function in patients with stable coronary artery disease: a double-blind, randomized, placebo-controlled, cross-over study. Eur Heart J 2012; doi:10.1093/eurheart/ehr482.
The researchers behind this prospective, single-center, double-blind, randomized, placebo-controlled, crossover trial sought to examine the effects of Pycnogenol on endothelial function and, by extension, coronary artery disease (CAD). Pycnogenol is a proprietary bark extract of the French maritime pine tree (Pinus pinaster ssp. atlantica) that reportedly possesses antioxidant and anti-inflammatory actions, as well as antiplatelet effects.
Adult subjects with documented stable CAD whose cardiovascular medications had remained unchanged for at least 1 month were recruited at a university hospital clinic in Zurich, Switzerland. Exclusion criteria included uncontrolled hypertension despite maximal medical therapy, smoking, chronic use of long-acting nitrates, and insulin-dependent diabetes. Subjects were randomized into two groups receiving either Pycnogenol 200 mg/day or matching placebo for 8 weeks, and then were crossed over to the other agent following a washout period of 2 weeks. Participants were evaluated at the clinic at baseline and after 8, 10, and 18 weeks, during which endothelial function (via flow-mediated dilation, or FMD) was assessed and blood for testing was drawn. Subjects were fitted with monitors to evaluate 24-hour ambulatory blood pressure (ABP), with readings taken every 15 minutes during the day and every 30 minutes at night.
The primary endpoint was the change in FMD after 8 weeks' treatment with Pycnogenol compared with placebo. Pre-specified secondary endpoints included change in high-sensitivity C-reactive protein, change in total antioxidative capacity, change in ABP, and change in shear stress-dependent platelet function.
Out of the 28 patients who were enrolled, 23 completed the study (19 men; mean age of 63.1 + 7.1 years; BMI of 27.3 + 3.3 kg/m2). Eleven of the subjects had three-vessel disease, while one had two-vessel disease. Mean left ventricular ejection fraction was 62 + 10%.
Pycnogenol treatment resulted in an increase in FMD from 5.3 + 2.6 to 7.0 + 3.1% (P < 0.0001), while it remained unchanged in the placebo group (5.4 + 2.4 to 4.7 + 2.0%, P < 0.051). The estimated treatment effect of Pycnogenol on FMD was an increase of 2.75 compared with placebo (mean difference 2.75 with an associated 95% confidence interval [CI] 1.75, 3.74, P < 0.0001), which was statistically significant. ABP, both systolic and diastolic, remained unchanged before and after treatment with Pycnogenol. Markers of oxidative stress, including 15-F2t-Isoprostane, decreased significantly after 8 weeks on Pycnogenol compared with baseline and placebo (P = 0.012), yet there was no change in total antioxidant capacity. The estimated effect of Pycnogenol on C-reactive protein was an increase of 2.18 mg/L compared with placebo (mean difference 2.18 mg/L with associated 95% CI -3.35, 7.71; P = 0.42), but this was deemed a statistically non-significant treatment effect. Additional measures of impact on inflammation showed no change. Shear stress-dependent platelet function did not change after treatment with Pycnogenol.
The study authors concluded that Pycnogenol taken for 8 weeks at a daily dose of 200 mg could improve endothelial function in people with stable CAD.
Commentary
Pycnogenol is a supplement well known for its potential health benefits in the setting of chronic venous insufficiency, but less often considered as an aid in the setting of CAD. It is widely reported to possess antioxidant activity, and has been used to help relieve allergy symptoms, as well as to lessen the harmful effects of tobacco smoke on the vascular system. Pycnogenol is known to contain a mixture of flavonoids monomers, phenolic acids, and various procyanidins; has been shown to possess anti- inflammatory effects; and appears to also inhibit oxidation of LDL-C, so its consideration in the area of CAD makes sense.
The current study suggests promise, likely due primarily to Pycnogenol's antioxidant capacity. The investigations performed were both sound and detailed, but the trial was small and of relatively short duration (8 weeks for each intervention arm), so little can be said about long-term effects beyond assumption, and the actual clinical impact on patients has yet to be fleshed out.
It is reasonable to consider the use of Pycnogenol in relatively healthy patients with CAD as long as it is understood that the research in this area is in its infancy. In addition, keep in mind that prior studies have indicated that the supplement can lower blood pressure and inhibit platelet activity, even though such actions were not detected in the current trial.
Results from this small, 8-week crossover study suggest that the antioxidant Pycnogenol, which also possesses anti-inflammatory actions, could help improve endothelial function in people with stable coronary artery disease.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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