European Journal of Cardiovascular Medicine

Cardiovascular disease (CVD) is  the leading cause of morbidity and mortality globally, contributing to approximately 17.9 million deaths annually which is about an estimated 32% of total deaths globally¹. The pathogenesis of CVD is multifactorial, involving dyslipidaemia, oxidative stress, chronic low-grade inflammation and endothelial dysfunction^2,3. Although pharmacological interventions such as statins, fibrates and antiplatelet agents offer proven benefits, there is growing interest in non-pharmacologic adjunctive strategies for reducing CVD risk. Among these, nutraceuticals have a considerable potential to favourably modulate key cardiovascular biomarkers with minimal adverse effects⁴.

Fish oil, particularly rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) has demonstrated efficacy in reducing serum triglycerides, improving endothelial function and exerting anti-inflammatory effects^5–7. The mechanisms by which it reduces the risk of cardiovascular disease include suppression of hepatic lipogenesis, promotion of fatty acid β-oxidation and inhibition of pro-inflammatory cytokines.

Garlic (Allium sativum), especially in the form of garlic pearls, has gained recognition for its organosulfur compounds such as allicin and ajoene. These active ingredients in the garlic pearls have been shown to lower LDL cholesterol, inhibit platelet aggregation and improve blood viscosity^8–10. This in turn will decrease the risk of cardiovascular disease.

While both fish oil and garlic have been individually studied, limited evidence exists on their synergistic effects, when used in combination. Given their complementary mechanisms, fish oil primarily targets triglycerides and inflammation, and garlic influences cholesterol metabolism and coagulation pathways. This study seeks to investigate their combined impact on lipid parameters and inflammatory biomarkers.

Study Design: It is postinterventional study.

Study duration: Study was done over a period of 12 weeks period after obtaining ethical clearance from institutional ethical committee

Study population: 60 Patients aged 35–60 years, attending the cardiology outpatient clinic in a tertiary care centre were recruited randomly. Exclusion criteria included current use of lipid-lowering medication, history of cardiovascular events, or allergy to fish or garlic. All the patient identification details, Patient’s Medical History was collected using a standardised case record sheet after obtaining informed consent.

Intervention: Participants were supplemented with Fish oil capsules: 1000 mg/day (containing 300 mg EPA and DHA) and Garlic pearls: 500 mg/day

Data Collection: Fasting blood samples were collected before and after the 12-week supplementation period. Lipid profile parameters (Total cholesterol, LDLc, VLDL, HDLc, TGL) and inflammatory markers (Hs-CRP, homocysteine, fibrinogen) were assessed using standard enzymatic methods and immunoassays in a fully automated Biochemistry analyser. Data was collected and analysed using paired t-tests. A p-value <0.05 was considered statistically significant.

Data was collected and tabulated. It was statistically analysed using paired t-tests.

Table 1 shows the Lipid Profile changes in the subjects before and after the supplementation of fish oil and garlic pearls. There were statistically significant improvement in Total Cholesterol, LDLc, VLDL, and triglycerides (TGL), along with a rise in HDLc after 12 weeks of supplementation of fish oil and garlic pearls.

TABLE 1: CHANGES IN LIPID PROFILE PARAMETERS BEFORE & AFTER SUPPLEMENTATION

Table 2 shows the Inflammatory Marker changes in the subjects before and after the supplementation of fish oil and garlic pearls. It was observed that there were statistically significant reductions in Hs-CRP, Homocysteine and Fibrinogen after 12 weeks of supplementation of fish oil and garlic pearls.

TABLE 2: CHANGES IN INFLAMMATORY MARKERS BEFORE AND AFTER SUPPLEMENTATION

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide with an alarming rise in myocardial infarctions among younger population. The results of this study demonstrate statistically significant reductions in total cholesterol, LDLc, VLDL, and TGL levels, along with an increase in HDLc following 12 weeks of supplementation with fish oil and garlic pearls. Harris et al, reported that omega-3 fatty acids in fish oil is associated with reduction in coronary heart disease risk by lowering blood pressure, reduced platelet aggregation and decreasing triglycerides, which is accomplished by suppressing hepatic triglycerides synthesis and enhancing the triglycerides clearance¹¹. Morcos et al and Ziaei et al, have shown similar benefits of garlic pearls in lipid modulation as obtained in this study^12,13.

Omega-3 fatty acids, particularly EPA and DHA, are known to reduce hepatic triglyceride synthesis and enhance lipid oxidation^5,14. There is a statistically significant decrease in triglycerides and VLDL levels in our study which may indicate similar mechanism takes place after fish oil supplementation. Yeh YY et al and Silagy et al have shown that the Garlic's active compounds, such as allicin, have been found to inhibit cholesterol biosynthesis and improve lipoprotein metabolism^8,15. Ashraf R et al has shown that the active ingredients in garlic decrease platelet aggregation¹⁶. Our study which shows statistically significant decreased fibrinogen, total cholesterol and LDL level may reflect similar action of allicin in our subjects.

Our study shows the anti-inflammatory effects of Fish oil and Garlic pearls, which were evident in the marked reductions in Hs-CRP, Homocysteine and Fibrinogen levels. Elevated Hs-CRP and homocysteine are independent predictors of cardiovascular events^17,18. These markers in serum decreases after supplementation of fish oil and Garlic pearls. This may indicate that these nutraceutical supplementations may lower systemic inflammatory state and improve vascular function^19–21.

Randomized trials such as the GISSI-Prevenzione study showed significant reduction in myocardial infarction and stroke on supplementation with n-3 PUFA (Polyunsaturated Fatty acid)⁶. Meta-analysis by Ried K et al, showed that the garlic extract reduces blood pressure⁹. Sobenin et al showed decreased cardiovascular risk on taking allicin tablets²². All these evidences support the use of Fish oil and Garlic pearls individually, in reducing CVD risk factors. Our study reinforces that the combined use of Fish oil and Garlic pearls will help in improving the lipid markers and also markers of inflammation and thrombogenesis.

LIMITATIONS: 

This study does not have a placebo control group. Also, relatively short duration may not reflect long-term outcomes. Furthermore, dietary and physical activity changes were not strictly controlled.

The combination of fish oil and garlic pearls significantly improved lipid profiles and reduced inflammatory biomarkers in individuals at risk for cardiovascular disease. These findings support their role as beneficial adjunctive agents in CVD prevention strategies alongside other standard preventive measures.

ACKNOWLEDGEMENTS: Authors thank all the study participants.

CONFLICT OF INTEREST: Nil

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