Medical, Socialogical and environmental issues in cardiovascular disease epidemiology, prevention and rehabilitation.
SK Verma, A Bordia, P Jain, KC Srivastava*
Indigenous Drug Research Centre, Department of Medicine, R.N.T. Medical College, Udaipur. India
Department of Environmental Medicine*, Odense University, Odense, Denmark.
Background: Ginger contains components with strong antiplatelet, prostanoid synthesis inhibitory activity and antioxidant potential, prompted us to study its antioxidant effect in healthy subjects and in patients with coronary artery disease.
Study Design: Randomised, double blinded, placebo controlled study.
Material and Methods: Twenty healthy individuals (Group-A) and twenty patients with coronary artery disease (Group-B) were selected. Both the groups were randomly assigned either dry ginger (5gm) or matched placebo (Lactose powder) for four weeks. Blood lipids and lipoprotein oxidation susceptibility were estimated initially and at the end of the study and the results were analysed using paired t-test.
Results: Ginger administration significantly (P<0.001) decreased lipoprotein oxidation susceptibility in healthy subjects as well as in patients with coronary artery disease without any effect on blood lipids. No adverse effects were observed.
Conclusion: Ginger appears to have strong free radical scavenging property. This antioxidant potential along with other beneficial effects of ginger merits strong consideration of its use in patients with ischemic heart disease.
Ginger (Zingiber officinale) is a popular food spice, and occupies an important place in Ayurvedic and Graeco-Arabic systems of medicine to treat various ailments, from time immemorial 1. It has attracted much scientific attention during past few years. Several pharmacological activities including antiemetic, antithrombotic, antimicrobial, anticancer, antioxidant and anti-inflammatory properties have been documented for preparations of ginger in vitro and / or animal studies 2. In many human studies it has been evaluated regarding, its effects on blood lipids3,4 fibrinolysis 5, and platelet aggregation 6 both in healthy individuals 4,5 and patients of coronary artery disease (CAD) 3. Its antioxidant property has been observed in animal studies. However, its effect on lipoprotein oxidation susceptibility (LOS) has not been studied in man. The present study therefore was envisaged to observe the effect of dry ginger on LOS in healthy individuals and patients with CAD.
After approval from the institutional ethical committee the study was conducted on 20 healthy individuals (Group A) and 20 patients with CAD (Group B). CAD patients were of old healed myocardial infarction (> 6 months) and were stable in their symptoms. They were receiving isosorbide dinitrate (20 mg twice daily) and aspirin 150 mg daily. In both the groups half (n=10) were randomly assigned ginger powder (5gm) in gelatin capsules or placebo in matched gelatin capsules for a period of 4 weeks. The blood samples were collected initially and after 4 weeks of ginger administration. Samples were subjected for estimation of blood lipids enzymatically using standard kits and lipid peroxidation employing lipoprotein oxidation susceptibility (LOS) test7.
Statistical analysis: The data's were expressed as mean ± standard error (SE). The results were analyzed with student 't' test for paired data (paired 't' test). A p value less than 0.05 was considered significant.
Preparation of ginger capsules: Dry ginger rhizomes were powdered in an electric grinder. The dry powder was filled in gelatin capsules. Each capsule contained 625 mg of dry ginger powder. Four capsules were administered twice daily with meals. Placebo capsules contained same amount of lactose powder.
The administration of ginger produced a significant (P<0.001) decrease in lipoprotein oxidation susceptibility both in healthy individuals and patients with CAD. Lipoprotein oxidation susceptibility decreased by 18 percent and 23 percent in healthy individuals and patient of CAD respectively at the end 4 weeks. The control subjects (placebo group) in both the groups however did not show any significant alteration in LOS (Table-1). Moreover, the blood lipid levels were not altered to any significant extent by ginger administration (Table-2).
Table 1: -Effect of Ginger on Lipoprotein Oxidation Susceptibility (in mol MDA/mg of non-HDL-C)
  Initial After 4 weeks
Healthy Subjects    
Treated (N=10) 58.40±4.62 47.90±3.87*
Control (N=10) 55.80±3.95 57.20±3.71**
CAD Patients    
Treated (N=10) 72.10±3.72 55.40±3.16*
Control (N=10) 69.90±4.62 67.60±4.31**
Values are mean ± SE. * p<0.001, as compared with initial. ** P=NS (not significant) as compared with initial.
In the present study there has been a definite decrease in lipoprotein oxidation susceptibility after 5 gm of ginger administration daily in both healthy subjects and patients with CAD (Table-1) without any significant alteration in lipid levels (Table-2). In our most of previous studies on ginger3-5, we used 5gm dosage, as lesser amounts gives inconsistent results. Therefore, the same dose (5 gm) has been used in the present study also. No side effects were observed even in this dose when administered for 4 weeks.
The free radical damaging reaction has been proposed to be a significant contributor to the process of atherosclerosis, inflammation, cancer and aging. Increasing evidences indicate an inverse correlation between consumption of certain food (containing antioxidants) and incidence of ischemic heart disease (IHD) and Cancer 8. Sizeable randomized trials of antioxidant vitamins have shown equivocal results in patients with IHD 9. More importantly, a potential harmful effect of synthetic antioxidant vitamins in patients with known or suspected CAD has also been observed 10. In this context, the antioxidant property of ginger merits special consideration, which is a widely used food spice and can be consumed by all. It has added advantage of being a natural antioxidant, which might prove more useful by providing flavenoids and other antioxidant compounds not present in standard oral synthetic antioxidant vitamin supplements 9.
Table 2: - Effect of ginger on blood lipids
  Total Cholesterol Triglycerides HDL-Cholesterol
  Initial 4 Weeks Initial 4 Weeks Initial 4 Weeks
Healthy Subjects  
Treated (N=10) 201.70 ± 7.54 205.06 ± 8.34* 125.0 ± 6.50 120.50 ± 6.10* 51.64 ± 2.40 59.09 ± 3.35*
Control (N=10) 208.60 ± 7.87 201.7 ± 8.25* 121.10 ± 7.10 124.60 ± 6.50* 52.12 ± 1.73 51.31 ± 1.33*
Cad Patients  
Treated (N=10) 247.48 ± 9.47 245.81 ± 8.42* 160.5 ± 12.20 156.20 ± 11.60* 44.90 ± 3.26 42.50 ± 3.20*
Control (N=10) 237.75 ± 11.29 232.15 ± 10.80* 158.20 ± 11.80 162.45 ± 12.80* 41.62 ± 1.81 42.99 ± 1.97*
Values (mg %) are means ± SE. * P = NS (not significant) as compared with initial.
Chemically, ginger contains several classes of compounds including starch (40-60%), proteins (10%), fats (10%), fibers (5%), inorganic material (6%), moisture (10%) and essential oil (1-4%) 1. The essential oil (oleoresin) of ginger contains various terpins and sesquiterpenes (Zingiberene). In all, more than 200 different volatile substances have been characterized in the essential oil fraction. The characteristic pungent odour is due to its oleoresin content, which is an oily liquid containing oxymethyl phenols like shagoal, zingerone and gingerol, which are probably responsible for its antioxidant property11. Various animal studies have documented antioxidant property of ginger11-12. An ethanolic ginger extract standardized to contain 40mg/gm gingerols, shagoals and zingerone and 90mg/gm total polyphenols, have been reported to inhibit low density lipoprotein oxidation and to reduce the development of atherosclerosis in atherosclerotic mice when compared to control 11.The antioxidant property of ginger has also been demonstrated in vitro 13.
Ginger has been a popular food spice possessing many medicinal properties 1-2. Recently it has drawn a lot of scientific attention. It has been reported to have components (gingerol, shagoal), which are potent inhibitor of platelet aggregation, and inhibits platelet aggregation in vitro6 and in healthy individuals as well as patients with CAD ex vivo3-4. It has also shown amelioration in pain and inflammation in patients with rheumatism, musculoskeletal disorders and migraine 14.However, it does not alter blood lipids, blood sugar and fibrinogen in patients with CAD 3.
We have earlier reported that ginger neutralizes altered fibrinolytic state, induced by fatty meals in healthy individuals 5. The antioxidant property further adds to its therapeutic potential. Recently, a preliminary study using a 'living cell' flow-cytometric approach to membrane protection has demonstrated that ginger contains antioxidant component(s) that act with in the cell membrane and slow lipid peroxidation in situ 15. In view of the above observations, ginger deserves serious thought regarding its therapeutic application in patients with IHD because of its potential beneficial properties of inhibiting platelet aggregation, enhancing fibrinolysis and preventing lipoprotein oxidation susceptibility in man with and without IHD.
The authors thank the Danish International Development Agency (DANIDA) for the financial support (grant No. 104 Dan. 8/808).
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