Antioxidant and Antiatherogenic Effects of Pomegranate

Stacy L. Haber, Pharm.D; Jamie K. Joy, Pharm.D; Roxanne Largent, Pharm.D

Disclosures

Am J Health Syst Pharm. 2011;68(14):1302-1305. 

In This Article

Antiatherogenic Effects

In 2001, Aviram and Dornfeld[3] evaluated the effects of pomegranate juice on ACE activity and blood pressure in 10 hypertensive patients. Serum ACE activity and systolic blood pressure (SBP) were assessed before and after the patients ingested 50 mL of pomegranate juice (equal to 1.5 mmol total polyphenols) daily for two weeks. A 36% reduction in ACE activity and a 5% reduction in SBP (155 mm Hg before versus 147 mm Hg after, p < 0.05) were noted. The authors concluded that the significant reductions in ACE activity and SBP suggest that pomegranate juice may offer protection against some cardiovascular diseases; however, the results are limited because the study was not controlled, involved a small number of patients, and was only two weeks in duration.

In 2004, Aviram et al.[8] evaluated the effects of pomegranate juice on carotid intima-media thickness (CIMT), blood pressure, and LDL oxidation in atherosclerotic patients. A total of 19 nonsmoking patients age 65–75 years who had asymptomatic severe carotid artery stenosis (70–90% stenosed) were randomized to receive either 50 mL of pomegranate juice (equal to 1.5 mmol total polyphenols) or placebo daily. All patients were followed for at least 1 year, and 5 of 10 patients in the pomegranate group were followed for 3 years. At 1 year, a mean decrease in CIMT of 35% occurred in the pomegranate group and an increase of 9% (p < 0.01) occurred in the placebo group. Further, SBP was significantly reduced by 12% in the pomegranate group (174 mm Hg pretreatment versus 153 mm Hg posttreatment, p < 0.01); no significant changes occurred in the placebo group (160 mm Hg pretreatment versus 163 mm Hg posttreatment). The concentration of antibodies against oxidized LDL was significantly reduced by 19% in the pomegranate group at three months (p < 0.01), and total serum antioxidants were increased by 130% in the pomegranate group at 1 year; no data were reported for the placebo group. No additional benefit was found in CIMT or SBP after 3 years; however, lipid peroxidation was further reduced. Although this study was limited by its small sample size and use of a surrogate marker, the authors concluded that pomegranate juice decreases progression of carotid lesions and SBP, possibly due to changes in oxidative stress.

A study published in 2004 by Esmaillzadeh et al.[9] investigated the effects of concentrated pomegranate juice on cholesterol levels in hyperlipidemic patients with type 2 diabetes mellitus. Twenty-two patients in Iran consumed 40 g of concentrated pomegranate juice (Nariran, Inc., Tehran, Iran) daily for two months. After treatment, patients' mean total cholesterol concentration decreased from 202 to 191 mg/dL (p < 0.001), mean LDL cholesterol concentration decreased from 123 to 112 mg/dL (p < 0.006), mean HDL cholesterol concentration remained unchanged (38 mg/dL), and mean triglyceride concentration decreased from 202 to 198 mg/dL (not statistically significant). The authors concluded that concentrated pomegranate juice may modify heart disease risk factors and be beneficial to include in balanced diets; however, the applicability of these results is limited, because the study did not have a control group, involved a small number of patients, and had a short duration.

In 2005, Sumner et al.[10] published a randomized, placebo-controlled, double-blind trial of the effects of pomegranate juice on myocardial perfusion in patients with coronary heart disease(CHD). Forty- five patients in the United States were randomized to receive either 240 mL of pomegranate juice (POM Wonderful) or a modified sports beverage of similar caloric content, flavor, and color daily for three months. The groups underwent exercise or pharmacologic (adenosine or dipyridamole) stress testing at baseline and three months. Stress-induced myocardial ischemia was quantified as the summed difference score (SDS) and calculated by subtracting the summed rest score from the summed stress score. At three months, the mean ± S.D. SDS decreased in the pomegranate group by 0.8 ± 2.7 (p < 0.05) and increased in the control group by 1.2 ± 3.1 (p < 0.05); the difference between the groups was significant. Although the applicability of the study's results is limited by the small sample size and short duration, the authors concluded that daily consumption of pomegranate juice may improve stress-induced myocardial ischemia in patients with CHD.

In 2006, Abidov et al.[11] published a randomized, placebo-controlled, double-blind trial of the effects of Radical Fruits (Garden of Life, West Palm Beach, FL) on lipid concentrations. Forty-four nonobese, nonsmoking, nondiabetic men with hypercholesterolemia were randomized to receive either 900 mg of Radical Fruits (a combination fruit supplement containing pomegranate juice) or placebo three times daily before meals for one month. Patients' baseline mean total cholesterol, LDL cholesterol, and HDL cholesterol concentrations were measured. At the end of the trial, the treatment group had a reduction in mean total cholesterol concentration (from 280 to 250 mg/dL, p < 0.001), a reduction in LDL cholesterol concentration (from 195 to 169 mg/dL, p < 0.001), and an increase in HDL cholesterol concentration (from 49 to 52 mg/dL, p < 0.001). The placebo group experienced nonsignificant reductions in mean total cholesterol concentration (from 280 to 275 mg/dL), mean LDL cholesterol concentration (from 195 to 190 mg/dL), and HDL cholesterol concentration (from 49 to 48 mg/dL). The authors concluded that Radical Fruits may be effective for hypercholesterolemia and should be investigated in patients with cardiovascular disease. It is important to note that in addition to involving a small number of patients and having a short duration, this trial involved a product that contains a proprietary blend of many fruit supplements, so the effects cannot be attributed solely to pomegranate.

In 2009, Davidson et al.[12] published the results of a randomized, placebo-controlled, double-blind trial of pomegranate juice on CIMT progression. A total of 289 patients in the United States at moderate risk for CHD were randomized to receive either 240 mL of pomegranate juice (POM Wonderful) or a placebo beverage of similar caloric content and color daily for 18 months. The composite measurement of CIMT progression was smaller at 12 months in the pomegranate juice group compared with the placebo group (0.79 mm versus 0.81 mm, p = 0.022); however, the difference was not significant at 18 months (0.79 mm versus 0.80 mm, p = 0.168). In an exploratory analysis of the patients with the most adverse cardiovascular risk profiles, those in the pomegranate juice group had significantly less anterior wall or composite CIMT progression or both than did those in the placebo group. Although the study was limited by the use of a surrogate marker, the authors concluded that pomegranate juice consumption did not significantly reduce CIMT progression in patients at moderate risk for CHD but that it may slow progression in the subgroup of those patients at greatest risk.

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