Discussions of heart disease often revolve around
macrocirculation—the large coronary arteries that feed the
heart. However, in many patients who complain of cardiovascular
symptoms such as chest pain and who later suffer from heart
attacks (myocardial infarctions), angiograms show there is no
evidence of blockages in their larger arteries. In other words,
many patients who were clearly having heart trouble had healthy
coronary arteries. Their larger vessels showed no signs of
stenosis, a term for the narrowing or blockage of arteries.
until about a decade ago, this was somewhat of a medical
mystery. But as diagnostic tools improved, scientists began to
realize that the problem with these patients occurred not in the
larger coronary arteries, but rather in the smaller coronary
arteries that comprise the microcirculatory system. They named
this type of condition microvascular coronary disease, small
vessel heart disease, or microvascular disease. Microvascular
problems occur more often in women than men, but are also an
important concern to males.
According to one group of researchers, “It is now accepted
that the precipitation of acute coronary syndromes and, mostly,
of acute myocardial infarction often occurs in patients who do
not show critical stenoses [blockages]. This and other findings
challenge the relevance of stenosis severity as a major
pathogenetic determinant in ischemic heart disease.”1
Microcirculation supplies oxygen and nutrients to heart
tissue and all of the 75 trillion cells that comprise the human
body. In fact, each cell in the body has its own personal blood
supply no further than 1/500th of an inch from the 18,000 miles
of capillaries that comprise the microcirculatory system of the
human body. Microcirculation also is important to the regulation
of coronary blood flow. New techniques for exploring the
coronary microcirculation have revealed that microvascular
damage lowers coronary vasodilator reserve, the ability of the
vessels to dilate, which is linked to an increased risk of
clinical deterioration and death from heart disease.2
The characteristics of microvascular coronary disease are the
same that occur in larger arteries. Atherosclerosis, the build
up of plaque that blocks arteries, and endothelial dysfunction,
when the vessels do not expand or dilate properly, both occur in
smaller blood vessels just as they do in the larger arteries.
Microvascular disease symptoms are not as obvious as the chest
pain usually associated with a heart attack. Furthermore,
symptoms caused by microcirculatory problems are often assumed
to be caused by macrovascular issues. One more obvious sign that
is associated with microvascular problems is venous
insufficiency (varicose veins).
Microcirculation abnormalities often occur in subjects with
high blood pressure. In fact, it is now thought that the
microvascular changes that occur in hypertensive people may play
a role in the end-organ damage often seen in this disease,
including heart disease. In hypertension, the microvascular
walls thicken and the lumen, the space within an artery,
narrows, ultimately resulting in the blockage of vessels. This
reduces the number of capillaries and small blood vessels known
as arterioles. These destructive changes are known to occur in
the microvascular system that feeds the heart muscle, the
conjunctiva and retina, and the kidneys.2
TABLE 1. Possible Indications
of Microvascular Dysfunction
- Retinal Abnormalities
- Cold hands and feet
- Kidney Disease
- Varicose Veins
- Swelling of the ankles and
- Thinning of the skin
and/or premature skin aging
According to one scientist, “In hypertension a vicious circle
occurs, with an increase in blood pressure producing a rise in
resistance in the microcirculation, leading to further elevation
of blood pressure.”2
Dysfunction in the microcirculatory system (microangiopathy)
is also a significant problem in diabetics, depriving their
tissues of nutrients and oxygen and decreasing the ability to
Clearly, microcirculation is an essential, but often poorly
recognized, factor in heart health. Therefore, enhancing the
microvascular system is as important as maintaining healthy
cholesterol levels or tending to other aspects of cardiovascular
health. Three nutrients—coenzyme Q10, the anthocyanosides found
in bilberries and black currants, and nattokinase—are helpful
for improving microcirculation in the body.
Ubiquinol, the reduced form of ubiquinone (coenzyme Q10 or
CoQ10) is a potent antioxidant present in nearly all human
tissues, and supplemental CoQ10 has been strongly linked to
improving cardiovascular health. Numerous studies point to its
beneficial effect in cardiovascular diseases.3-8
CoQ10 has been shown to enhance the efficacy of a drug in
improving the forearm microcirculation of type 2 diabetics.9
Coenzyme Q10 is thought to decrease peripheral resistance,
the lowering of blood flow in the small blood vessels called
arterioles. When blood flow decreases, this backs up blood in
the arteries that feed blood into the arteriole. Much like a
3-lane highway funneling into a single lane, there is inherent
back up arising from the decreased flow capacity. The back up of
blood causes the arterial pressure to increase.
Some 70-90 percent of the overall peripheral resistance of
the circulatory system arises at the level of the
microcirculation.2 Indeed at rest only 5 percent of the blood is
in the microcirculatory system, yet upwards of 27 percent of the
resistance that the heart must pump against arises in these
microvessels. CoQ10’s ability to decrease peripheral resistance
in hypertensive subjects, as indicated in double-blind, clinical
trials, suggests it has an important influence on the
Bilberries and Black Currants
The anthocyanosides found in bilberries and black currants
can play an important role in improving the health of the body’s
microcirculation. A rodent study showed that black currants can
improve the function of smooth muscle in the aorta. In the
animals given black currant concentrate, there occurred a
relaxation of the aorta, indicating black currant improved blood
Improving the body’s microcirculation can be especially
helpful for people with venous insufficiency and varicose veins.
Animal studies of bilberry show that it helps decrease vascular
permeability and improve vascular tone and blood flow.12
In humans, clinical trials have reached similar conclusions.
One such study involved 15 patients with polyneuritis due to
peripheral vascular insufficiency. Researchers gave the subjects
480 mg per day of bilberry extract and noted significant
improvement in microcirculation in the subjects.13 The same dose
of bilberry extract in 47 patients who suffered from venous
diseases resulted in an elimination of the microstagnation that
occurs in the vessels in these patients and increased blood flow
in the foot.12 A review of uncontrolled trials on bilberry that
involved 568 patients with venous insufficiency of the lower
limbs added further support for bilberry’s vein-enhancing
actions. The review found that bilberry extract rapidly
decreased symptoms and improved both venous microcirculation and
Other studies have confirmed that anthocyanosides can reduce
Natto, a fermented soy cheese, contains an enzyme called
nattokinase, which has been studied for its clot-dissolving
abilities. In one study, 12 volunteers (six men and six women)
were fed 200 grams (seven ounces) of natto. A blood sample was
taken and the formation of a thrombus (clot) was then
artificially stimulated. In those subjects fed natto, the time
needed to completely dissolve the clot was cut in half compared
to those in the control group.16-17
Clinicians have found that nattokinase affects the entire
systemic circulation and will help clear blockages from tiny
blood vessels as well as the larger vessels.18
Microvascular concerns may be an under-recognized reason why
many individuals who experience cardiovascular symptoms have no
blockages in their coronary arteries. Tending to the health of
the smaller blood vessels is therefore a prudent way to ensure
optimal heart health. Consuming a highly bioavailable form of
coenzyme Q10 known as CoQ10-H2™ combined with nattokinase,
bilberries and black currants can ensure the strength and
integrity of all aspects of the vascular system.
Get Neuron Growth Factors
source of nutrients and supplements.
did we qualify them ?
1. L’Abbate A, Sambuceti G. How to study
coronary microvascular dysfunction and its clinical relevance.
Ital Heart J. 2002 Apr;3(4):230-6.
2. Lévy BI. [The importance of
microcirculation and tissue perfusion in hypertension] [Article
in French]. Curr Med Res Opin. 2005;21 Suppl 5:S1-6.
3. Belardinelli R, Mucaj A, Lacalaprice F,
Solenghi M, Seddaiu G, Principi F, Tiano L, Littarru GP.
Coenzyme Q10 and exercise training in chronic heart failure.
European Heart Journal. 2006 Nov; 27(22): 2675-81.
4. Belardinelli R, Mucaj A, Lacalaprice F,
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improves contractility of dysfunctional myocardium in chronic
heart failure. Biofactors. 2005: 137-45.
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double-blind, randomized controlled study. European Heart
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Long-term efficacy and safety of CoQ10 therapy for idiopathic
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9. Playford DA, Watts GF, Croft KD, Burke V.
Combined effect of coenzyme Q10 and fenofibrate on forearm
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11. Nakamura Y, Matsumoto H, Todoki K.
Endothelium-dependent vasorelaxation induced by black currant
concentrate in rat thoractic aorta. Jpn J Pharmacol. 2002
12. Colantuoni A, Bertuglia S, Magistretti MJ,
Donato L. Effects of Vaccinium myrtillus anthocyanosides on
arterial vasomotion. Arzneim Forsch. 1991;41:905-9.
13. Lietti A, Cristoni A, Picci M. Studies on
Vaccinium myrtillus anthocyanosides. I. Vasoprotective and
anti-inflammatory activity. Arzneim Forsch. 1976;26:829-832.
14. Pennarola R, et al. The therapeutic action
of the anthocyanosides in microcirculatory changes due to
adhesive-induced polyneuritis. Gazz Med Ital. 1980;139:485-91.
15. Mian E, Curri SB, Lietti A, Bombardelli E.
Anthocyanosides and the walls of the microvessels: further
aspects of the mechanism of action of their protective effect in
syndromes due to abnormal capillary fragility. Minerva Med. 1977
16. Suzuki Y, Kondo K, Matsumoto Y, Zhao BO,
Otsuguro K, Maeda T, Tsukamoto Y, Urano T, Umemura K. Dietary
supplementation of fermented soybean, natto, suppresses intimal
thickening and modulates the lysis of mural thrombi after
endothelial injury in rat femoral artery. Life Sci. 2003 Jul
17. Sumi H, Hamada H, Nakanishi K, Hiratani H.
Enhancement of the fibrinolytic activity in plasma by oral
administration of nattokinase. Acta Haematol. 1990;84(3):139-43.
18. Mitchell Fleisher, MD., DHt., DABFM.
Cardiovascular Health a Clinician’s Perspective.