Hemostasis and thrombosis

Abstract

Hemostasis is a complex phenomenon involving numerous coagulation factors. These factors circulate as inactive zymogen (an inactive enzyme precursor) and act by cleaving downstream proteins so that they become active enzymes. The Mediterranean diet (MeD), extravirgin olive oil (EVOO), and polyphenols have been shown to affect several coagulation factors. The circulating level of Factor VII (FVII) is deeply influenced by the diet. There is a substantial increase in FVII circulating levels in the postprandial phase. The intake of dietary fat is the main determinant of postprandial FVII plasma levels. The ratio of saturated to monounsaturated fatty acids (MUFAs) is crucial to postprandial levels of FVII. Diets rich in MUFAs from olive oil are associated with a significantly lower postprandial peak level of FVII and very likely explain the lower rates of coronary heart disease in countries where the diet is habitually rich in MUFAs, such as the Southern European countries. Also, platelet activity is influenced by diet. n-3 polyunsaturated fatty acids eicosapentaenoic and docosahexaenoic acid actively reduce platelet aggregation. This effect is the result of several mechanisms: (1) competition with arachidonic acid, replacing active thromboxane A2 with thromboxane A3; (2) the inhibition of cyclooxygenase; and (3) a direct antagonistic effect on the thromboxane A2-prostaglandin H2 receptor in human platelets. Polyphenols of EVOO, particularly luteolin, also reduce platelet aggregability, acting as inhibitors of platelet phosphodiesterase 3. The MeD, which is rich in olive oil, MUFAs, and polyphenols have been demonstrated to exert a modulatory effect toward a protective mode on genes related to chronic degenerative diseases, oxidation, inflammation, and thrombosis (modulating the activity of tissue factor, tissue factor pathway inhibitor, and thrombin).