**9. Pomegranate juice**

Pomegranate juice consumption slowed atherosclerosis progression through the potent antioxidant properties of pomegranate polyphenols [35].

Pomegranate fruit (*Punica granatum L.*) has been rated to contain the highest anti-oxidant ca‐ pacity in its juice, when compared to other commonly consumed polyphenol rich beverages. The anti-oxidant capacity of pomegranate juice was shown to be three times higher than that of red wine and green tea, based on the evaluation of the free-radical scavenging and iron reducing capacity [30]. It was also shown to have significantly higher levels of anti-oxidants in comparison to commonly consumed fruit juices, such as grape, cranberry, grapefruit or orange juice. The principal anti-oxidant polyphenols in pomegranate juice are ellagitannins and anthocyanins. Ellagitannins account for 92% of the anti-oxidant activity of pomegranate juice and are concentrated in peel, membranes and piths of the fruit. The bioavailability of pomegranate polyphenols is affected by several factors, including: interindividual variabili‐ ty, differential processing of pomegranate juice, as well as the use of analytical techniques sensitive enough to detect low postprandial concentrations of these metabolites [30].

One pomegranate fruit contains about 40% of an adult's recommended daily requirement of vitamin C and is high in polyphenol compounds. The pomegranate plant contains alkaloids, mannite, ellagic acid and gallic acid and the bark and rind contain various tannins. The pol‐ yphenols in pomegranate are believed to provide the anti-oxidant activity and protect LDL against cell-mediated oxidation directly by interaction with the LDL [49]. In fact, the supple‐ mentation of pomegranate juice revealed a significant reduction in the atherosclerotic lesion area compared to the water-treated group reporting significant anti-oxidant capacities of all pomegranate extracts.

The principal mechanisms of action of pomegranate juice may include: increased serum an‐ ti-oxidant capacity, decreased plasma lipids and lipid peroxidation, decreased ox-LDL up‐ take by macrophages, decreased intima-media thickness, decreased atherosclerotic lesion areas, decreased inflammation and decreased systolic blood pressure, thereby reducing/ inhibiting the progression of atherosclerosis and the subsequent potential development of CVDs [30,50].

On the basis of limited safety data, high doses of pomegranate polyphenol extracts may have some deleterious effects: gastric irritation, allergic reactions, including pruritus, urtica‐ ria, angioedema, rhinorrhea, bronchospasm, dyspnea and red itchy eyes. Moreover, dried pomegranate peel may contain aflatoxin, a potent hepatocarcinogen; thus, it should be used cautiously by patients who have hepatic dysfunction or who are taking other hepatotoxic agents. Pomegranate may also increase the risk for rhabdomyolysis during statin therapy, as a result of intestinal CYP3A4 inhibition and increased absorption of active drugs [49].

**Figure 8.** Main polyphenols in wine. \* Polyphenols contained only in white wine. Modified from [36].

A high intake of some unsaturated fatty acid and/or anti-oxidant compounds can both re‐ duce pro-atherogenic risk factors and the susceptibility of the vascular wall to pro-inflam‐

Atherosclerosis and Current Anti-Oxidant Strategies for Atheroprotection

http://dx.doi.org/10.5772/53035

15

Many Authors started to recognize olive oil as one of the key elements in the cardioprotec‐ tion and longevity of inhabitants of Mediterranean regions. The healthful properties of olive oil have been often attributed to its high content of monounsaturated fatty acids, namely oleic acid [7]. However, it should be underlined that olive oil, unlike other vegetable oils, contains high amounts of several micronutrient constituents, including polyphenolic com‐

The major phenolic compounds in olive oil are: simple phenols (*i.e.*, hydroxytyrosol, tyro‐ sol); polyphenols (oleuropein glucoside); secoiridoids, dialdehydic form of oleuropein and ligstroside lacking a carboxymethyl group and the aglycone form of oleuropein glucoside and ligstroside and lignans. Around 80% or more of the olive oil phenolic compounds are lost in the refination process, thus, their content is higher in virgin olive oil (around 230 mg/

Olive oil supplementation (50 mg/day) to the diet enriched LDL with oleic acid and signifi‐ cantly reduced human LDL susceptibility to *in vitro* oxidation, thus making them signifi‐ cantly less atherogenic. In part, this reflects the lesser susceptibility of monounsaturated fatty acids to lipid peroxidation compared with that of polyunsaturated fatty acids, which are particularly prone to peroxidation due to the greater number of double bonds [10,52].

Olive oil consumption could reduce oxidative damage, on one hand, due to its richness in oleic acid and, on the other hand, due to its minor components of the olive oil particularly

**11. Olive oil**

matory and pro-atherogenic triggers.

pounds (100– 1000 mg/kg) [10].

kg) than in other olive oils.
