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Background |
Cor pulmonale |
Coronary artery disease (cad) |
Endocarditis |
High blood pressure |
High cholesterol |
Hyperhomocysteinemia |
Pericarditis |
Integrative therapies |
Prevention |
Author information |
Bibliography
Heart disorders (heart disease)
Heart disease, or heart disorders, are conditions that affect the heart muscle or the blood vessels of the heart. There are many different types of heart disease, but the most common is coronary artery disease (CAD). This condition causes the arteries to narrow, and it may lead to stroke or heart attack.High cholesterol and high blood pressure are often precursors to heart disease. In addition, recent evidence suggests that high levels of homocysteine in the blood increases a patient's risk of developing coronary artery disease (CAD). These factors may damage or irritate the blood vessels, leading to blockages in arteries.
Heart disease is potentially life threatening. In the United States, heart disease is the leading cause of death in adults. According to the U.S. Centers for Disease Control and Prevention (CDC), nearly 700,000 Americans die of heart disease each year. This is because the heart is responsible for pumping blood throughout the body. Blood contains oxygen, which is necessary for the body to function properly.
Patients with heart disease may have heart attacks (myocardial infarctions), which may be fatal. A heart attack occurs when the supply of blood and oxygen to an area of heart muscle is blocked. If treatment is not started quickly, the affected area of heart muscle begins to die. This injury to the heart muscle can lead to serious complications, including death. It is possible to survive a heart attack, but the part of the heart muscle affected may be damaged, causing shortness of breath and chest pain during exertion or rest. Patients who have experienced a heart attack have an increased risk of having another one.
Patients with heart disease also have an increased risk of developing strokes. This occurs when the blood vessels in the brain become blocked. As a result, the brain does not receive enough oxygen.
Although some patients may be genetically predisposed to heart disease, individuals can take steps to reduce their risks. Eating healthfully, exercising regularly, maintaining a healthy weight, and not smoking lower a patient's risk of developing heart disease.
Background
Heart disease, or heart disorders, are conditions that affect the heart muscle or the blood vessels of the heart. There are many different types of heart disease, but the most common is coronary artery disease (CAD). This condition causes the arteries to narrow, and it may lead to stroke or heart attack.High cholesterol and high blood pressure are often precursors to heart disease. In addition, recent evidence suggests that high levels of homocysteine in the blood increases a patient's risk of developing coronary artery disease (CAD). These factors may damage or irritate the blood vessels, leading to blockages in arteries.
Heart disease is potentially life threatening. In the United States, heart disease is the leading cause of death in adults. According to the U.S. Centers for Disease Control and Prevention (CDC), nearly 700,000 Americans die of heart disease each year. This is because the heart is responsible for pumping blood throughout the body. Blood contains oxygen, which is necessary for the body to function properly.
Patients with heart disease may have heart attacks (myocardial infarctions), which may be fatal. A heart attack occurs when the supply of blood and oxygen to an area of heart muscle is blocked. If treatment is not started quickly, the affected area of heart muscle begins to die. This injury to the heart muscle can lead to serious complications, including death. It is possible to survive a heart attack, but the part of the heart muscle affected may be damaged, causing shortness of breath and chest pain during exertion or rest. Patients who have experienced a heart attack have an increased risk of having another one.
Patients with heart disease also have an increased risk of developing strokes. This occurs when the blood vessels in the brain become blocked. As a result, the brain does not receive enough oxygen.
Although some patients may be genetically predisposed to heart disease, individuals can take steps to reduce their risks. Eating healthfully, exercising regularly, maintaining a healthy weight, and not smoking lower a patient's risk of developing heart disease.
Cor pulmonale
Cor pulmonale, also called pulmonary heart disease, occurs when the right ventricle of the heart becomes enlarged. If left untreated, the condition may lead to heart failure.Long-term lung diseases, such as emphysema, chronic bronchitis, or cystic fibrosis, cause cor pulmonale. It may also be caused by serious lung infections. These lung diseases increase the blood pressure in the lungs, causing a condition called pulmonary hypertension (high blood pressure). As a result of this increased pressure, the right ventricle of the heart has to work harder to pump blood and it eventually becomes enlarged causing cor pulmonale. Cor pulmonale may also come on suddenly if the patient's pulmonary artery is blocked with a blood clot, a condition called a pulmonary embolism.
Symptoms of cor pulmonale are usually similar to the underlying cause, which is typically a lung disease such as emphysema or bronchitis. Symptoms often include frequent coughing, wheezing, weakness, fatigue, difficulty breathing, shortness of breath, and irregular heartbeat. Fluid may build up in the body tissue and cause swelling (edema). Patients may feel weak or experience discomfort in the upper chest.
A magnetic resonance imaging (MRI) scan is the standard diagnostic procedure for cor pulmonale. A machine takes pictures of the patient's heart. The pulmonary arteries will be enlarged in patients with cor pulmonale. An electrocardiograph (EKG) may be also performed. During this noninvasive procedure, electrodes are taped to the patient's chest to measure the electrical activity of the heart. Patients with the condition will have frequent premature contractions in the atria or ventricles of the heart because the heart muscle is overworked. A chest X-ray may show an enlarged right pulmonary artery.
Even with treatment, many patients with cor pulmonale develop heart failure. This is because cor pulmonale occurs in the later stages of serious lung diseases. In general, a low-salt diet and restricted fluids are recommended for patients who have cor pulmonale or have an increased risk of developing the condition. Antibiotics may be prescribed if a lung infection is causing the condition. Blood thinners (anticoagulants) may be prescribed if a pulmonary embolism caused the condition. Supplemental oxygen may also be used to increase the amount of oxygen in the blood.
Coronary artery disease (cad)
Coronary artery disease (CAD), also called coronary heart disease (CHD), occurs when the blood vessels that supply oxygenated blood to the heart muscle gradually become narrowed or blocked by plaque deposits. Plaque is a combination of fatty material, calcium, scar tissue, and proteins.Plaque buildup in the arteries is associated with several risk factors, including high cholesterol, high levels of low-density lipoprotein (LDL or "bad cholesterol") in the blood, low levels of high-density lipoprotein (HDL or "good cholesterol"), high blood pressure, smoking, diabetes mellitus, obesity, age, family history of heart disease, sedentary or inactive lifestyle, stress, and male gender. All of these factors cause the inner lining of the arteries (called the endothelium) to become injured. When the endothelium is injured, the substances that make up plaque cannot flow through the artery. As a result, plaque builds up in the artery.
The plaque deposits decrease the space through which blood can flow. As platelets (disc-shaped particles in the blood that aid clotting) come to the area, blood clots form around the plaque, causing the artery to narrow even more.
Sometimes the blood clot in the artery breaks apart, and blood supply is restored. In other cases, the blood clot may completely block the blood supply to the heart muscle. This lack of blood flow (called ischemia) can "starve" some of the heart muscle of oxygen and lead to chest pain (angina). A heart attack, also known as a myocardial infarction, results when blood flow is completely blocked. Heart attacks usually happen when a blood clot forms over a plaque that has ruptured.
Common symptoms of CAD include chest pain, shortness of breath, irregular or fast heartbeat, weakness or dizziness, nausea, and increased sweating.
The standard diagnostic procedure for CAD is a carotid ultrasonography. This procedure evaluates blood flow using a wand-like device, called a transducer. The transducer sends high-frequency sound waves into the neck to determine if there is any narrowing or clotting in the arteries.
Drugs used that treat CAD include platelet inhibitors such as aspirin or clogidogrel (Plavix®); beta blockers such as metoprolol (Lopressor® or Toprol®); calcium channel blockers such as amlodipine (Norvasc®) or diltiazem (Cardizem®); angiotensin inhibiting drugs or ACE inhibitors such as lisinopril (Prinivil® or Zestril®) or ramipril (Altace®); statins; or HMG-CoA reductase inhibitors such as atorvastatin (Lipitor®) or lovastatin (Mevacor®).
Arteries that are severely blocked may need to be expanded using balloon angioplasty (also called percutaneous transluminal coronary angioplasty or PCTA) and stent placement. This procedure involves using a wire mesh that expands in the blood vessel, allowing more blood to flow normally. A specialized doctor, called a cardiologist, performs these procedures at a hospital. A tube, or catheter, is inserted into a blood vessel. Several types of balloons, stents, and/or catheters are available to treat the plaque inside the vessel. Some of these surgical tools contain anti-clotting medications. The physician chooses the type of procedure based on individual patient needs. Common complications include restinosis (re-narrowing of the artery), bleeding, and infection.
Patients with significant CAD may undergo a procedure called coronary artery bypass graft (CABG) surgery. GABG surgery is when one or more blocked blood vessels is bypassed by a graft (transplant of healthy arteries or veins) to restore normal blood flow to the heart. These grafts usually come from the patient's own arteries and veins located in the chest, leg, or arm. The graft goes around the clogged artery to create new pathways for oxygen-rich blood to flow to the heart. Some problems associated with CABG include heart attack, stroke, blood clots, death, and sternal wound infection. Infection is most often associated with obesity, diabetes, or having had a previous CABG. Some patients may develop swelling in the tissue around the heart (a condition called post-pericardiotomy syndrome) a few days to six months after surgery. Symptoms typically include fever and chest pain. The incision in the chest or the graft site may be itchy, sore, numb, or bruised after surgery. Some patients report memory loss or loss of mental clarity after a CABG.
Endocarditis
Endocarditis occurs when the inner lining of the heart is infected. The infection starts in the bloodstream and spreads to the heart.Bacteria cause most cases of endocarditis, but viruses, fungi, and other microorganisms can also lead to the condition. For instance, dental procedures that have bleeding risks may allow bacteria to enter the bloodstream. Bacteria may also enter the bloodstream during surgical procedures. Other medical conditions, such as skin sores, gum diseases, or intestinal disorders, may also increase a patient's risk of developing a bacterial infection in the blood.
Common symptoms of endocarditis include fever, chills, fatigue, weakness, aching muscles and joints, shortness of breath, night sweats, pale complexion, persistent cough, blood in urine, unexplained weight loss, tenderness in the spleen, new heart murmur (abnormal sound of the heart that can be heard with a stethoscope), and swelling in the legs or abdomen. Some patients may develop tender, red spots under the skin of the fingers (called Osler's nodes). Some may also experience tiny purple or red spots on the skin called petechiae. Similar spots may be present in the whites of the eyes or under the fingernails.
Several tests, including blood tests, echocardiograms, and a chest X-ray, may be necessary to confirm a diagnosis. Blood tests may reveal low levels of iron in the blood, called anemia. This is because chronic infections often interfere with the production of red blood cells and lead to anemia. Because endocarditis may make it harder for the heart to pump blood, an X-ray may reveal blood and fluid backed up in the lungs. An echocardiogram uses sound waves to produce images of the heart. Patients with endocarditis may have abnormally thick and/or leaky heart valves. Others may have abnormal growths in the heart that contain collections of the disease-causing bacteria.
Left untreated, endocarditis can damage the heart valves and permanently damage the lining of the heart. If the heart suffers from permanent damage, it may lead to heart failure, which is fatal, unless the patient undergoes a heart transplant. However, most patients who are diagnosed and treated promptly experience a full recovery.
Patients with endocarditis receive intravenous (IV) antibiotics to treat the infection. The type of antibiotic and duration of treatment depends on the type and severity of the infection, as well as the patient's overall health.
High blood pressure
Blood pressure is the force of blood pushing against the walls of arteries (blood vessels). Each time the heart beats, it pumps blood through blood vessels, supplying the body's muscles, organs, and tissues with the oxygen and nutrients that they need to function. Throughout the day, an individual's blood pressure rises and falls many times in response to various stimuli. For instance, stress typically increases blood pressure, and patients generally have lower blood pressure during sleep. Elevated blood pressure over a sustained period of time is a condition called hypertension (HTN) or high blood pressure.The cause of 90-95% of the cases of high blood pressure is unknown. Patients who are obese, sensitive to salt, consume excessive amounts of alcohol, do not exercise regularly, smoke, eat poor diets, or experience frequent stress have an increased risk of developing high blood pressure. In addition, individuals may be genetically predisposed to developing high blood pressure. Also, blood pressure tends to increase with age.
Hypertension is called the silent killer because an individual can have it for years without knowing it. High blood pressure rarely causes symptoms at first, but it is a risk factor for many other conditions, including kidney disease and CAD, which may lead to heart attack and/or stroke. Although it rarely happens, high blood pressure that has persisted for many months to years occasionally causes symptoms, such as dizziness, ringing in the ears, impaired vision, fatigue, irregular heartbeat, inability of males to achieve or maintain erection (erectile dysfunction), and fainting. Extremely high blood pressure can cause a headache upon awakening or, even more rarely, nosebleed, nausea, or vomiting.
Blood pressure is measured with a stethoscope and an inflatable arm cuff with a pressure-measuring gauge called a sphygmomanometer. A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first number measures the pressure in the arteries when the heart beats (systolic pressure). The second number measures the pressure in the arteries between beats when the chambers of the heart are filling with blood (diastolic pressure). To get an accurate blood pressure reading, a healthcare professional should evaluate the readings based on the average of two or more blood pressure readings.
The latest blood pressure (BP) guidelines, issued in 2003 by the National Heart, Lung, and Blood Institute, divide blood pressure measurements into four general categories. Normal blood pressure is below 120/80 mmHg. Patients have pre-hypertension if their systolic pressure is 120-139 and their diastolic pressure is 80-89. Patients have stage 1 hypertension when their systolic pressure is140-159 and their diastolic pressure is 90-99. Patients have stage 2 hypertension when their systolic pressure is 160 or higher and their diastolic pressure is 100 or higher.
Treating high blood pressure can help prevent serious and life-threatening complications. Experts recommend using the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Experts also recommend: getting plenty of potassium (e.g. bananas and green leafy vegetables such as spinach), which can help prevent and control high blood pressure; eating less saturated fat (animal fat) and total fat; and limiting the amount of sodium (salt) in the diet. Although 2,400 milligrams of sodium a day is the current limit for otherwise healthy adults, limiting sodium intake to 1,500 milligrams a day will have a more dramatic effect on blood pressure. Consumers should look at the food labels to determine sodium content. If cooking at home, individuals should use less salt or a salt substitute that contains potassium iodide, which does not increase blood pressure.
Other lifestyle changes, including bodyweight management, regular exercise, smoking cessation, and stress management, may also help treat high blood pressure.
Medications may also be prescribed to reduce blood pressure. Beta-blockers, such as propranolol (Inderal®), metoprolol (Lopressor® or Toprol®), or atenolol (Tenormin®), may reduce the workload on the heart, causing the heart to beat slower and with less force. Angiotensin converting enzyme inhibitors (ACE inhibitors) may be taken to dilate blood vessels and increase oxygen to the heart. Calcium channel blockers (CCBs), such as amlodipine (Norvasc®), felodipine (Plendil®), nicardipine (Cardene® or Carden SR®), and nifedipine (Procardia® or Adalat®), may also be used. These medications affect the transport of calcium into the cells of the heart and blood vessels, causing blood vessels to relax. Alpha blockers, such as doxazosin (Cardura®), prazosin (Minipress®), and terazosin (Hytrin®), may be taken to help dilate the blood vessels. Alpha-beta blockers, such as carvedilol (Coreg®) and labetolol (Normodyne® or Trandate®), may be taken to reduce nerve impulses to blood vessels and slow the heartbeat. This helps reduce the amount of blood that must be pumped through the vessels. Vasodilators, such as hydralazine (Apresoline®), may also be taken. These medications work directly on the muscles in the walls of the arteries, preventing the muscles from tightening and the arteries from narrowing. Medications should be taken exactly as prescribed. Taking more or less than recommended may have serious effects on the heart.
High cholesterol
High cholesterol, or hypercholesterolemia, is a condition in which there are unhealthy high levels of cholesterol in the blood. It is less commonly called dyslipidemia, hyperlipidemia, and lipid disorder.Cholesterol is a soft, waxy, fat-like substance found within the bloodstream and cells of the body. Cholesterol is naturally produced in the body and consumed in the diet. Cholesterol is needed to make membranes for all cells in the body, including those in the brain, nerves, muscles, skin, liver, intestines, and heart. Cholesterol is also converted into steroid hormones, such as the male and female sex hormones (androgens and estrogens) and the adrenal hormones (cortisol, corticosterone, and aldosterone). In the liver, cholesterol is the precursor to bile acids that aid in the digestion of food, especially fats. Cholesterol is also used to make vitamin D.
Too much cholesterol in the blood increases a patient's risk of developing heart disease, which may lead to a heart attack, heart failure, stroke, and death. Although eating an unhealthy diet may increase cholesterol, some patients are genetically predisposed to developing high cholesterol.
High cholesterol can cause plaque deposits to form in the arteries. Plaque is composed of cholesterol, other fatty substances, fibrous tissue, and calcium. When plaque builds up in the arteries, it causes atherosclerosis (hardening of the arteries) or coronary heart disease (CHD). Atherosclerosis can lead to plaque ruptures and blockages in the arteries. If the blood supply to the heart is blocked, a heart attack may occur. If blood supply to the brain is blocked, a stroke may occur.
High cholesterol does not lead to specific symptoms unless it is a long-term condition. If patients have high cholesterol for many months to years, they may develop thickening of tendons due to accumulation of cholesterol (xanthoma), yellowish patches around the eyelids (xanthelasma), and white discoloration of the outer edges of the cornea due to cholesterol deposits (arcus senilis). A high level of blood cholesterol causes the arteries to narrow (atherosclerosis) and can slow, or even block, blood flow to the heart. This reduced blood supply prevents the heart from receiving enough oxygen. Left untreated, persistent high blood pressure may cause chest pain (angina), heart attack, transient ischemic attacks (TIAs, or temporary lack of blood flow and oxygen to the brain), lack of oxygen to the brain (called cerebrovascular accidents or stroke), and blocked peripheral arteries (called peripheral artery disease or PAD).
Healthcare providers typically take a sample of the patient's blood to measure the patient's total cholesterol levels, lipoprotein levels, and triglyceride levels and diagnose high cholesterol.
Healthy total cholesterol levels are less than 200 milligrams per deciliter of blood. If the total cholesterol is less than 200 milligrams per deciliter of blood, the risk of heart attack risk is relatively low, unless there are other risk factors, such as smoking, a previous heart attack, or high blood pressure. Borderline high cholesterol is diagnosed in patients who have 200-239 milligrams of cholesterol per deciliter of blood. High cholesterol is diagnosed when patients have 240 milligrams of cholesterol per deciliter of blood. These patients are twice as likely to develop coronary artery disease as patients who have cholesterol levels lower than 200 milligrams per deciliter of blood.
Lipoprotein levels are also measured. A high level of low density lipoprotein (LDL), also called "bad" cholesterol, is a major risk factor for atherosclerosis and coronary artery disease. LDL levels are reported in several categories. An LDL level below 100 milligrams per deciliter of blood is best for people at risk for heart disease. If an individual is at very high risk for heart disease, such as having a previous heart attack, an LDL level less than 70 milligrams per deciliter of blood is optimal. LDL levels can also be near optimal (100-129 milligrams per deciliter of blood), borderline high (130-159 milligrams per deciliter of blood), high (160-189 milligrams per deciliter of blood), and very high (190 or more milligrams per deciliter of blood). When LDL levels are high, the condition is sometimes called hyperlipoproteinemia.
HDL ("good") cholesterol protects against heart disease, so for HDL, higher numbers are better. A level less than 40 milligrams per deciliter of blood is low and is considered a major risk factor for developing heart disease. HDL levels of 60 milligrams per deciliter of blood or more help to lower the risk for developing heart disease.
High levels of triglycerides also indicate an increased risk of heart disease risk. Patients that have levels that are borderline high (150-199 milligrams per deciliter of blood) or high (200 milligrams or more per deciliter of blood) may need treatment.
The main goal of cholesterol-lowering treatment is to lower LDL levels enough to reduce the risk of developing heart disease or having a heart attack. There are two main ways to lower cholesterol: therapeutic lifestyle changes (TLC) and drug therapy. TLC includes a cholesterol-lowering diet (called the TLC diet), physical activity, and weight management. TLC is for anyone whose LDL is more than their target number and goal. Drug treatment with cholesterol-lowering drugs can be used together with TLC treatment to help lower LDL. Prevention of elevated cholesterol with TLC and possibly drug therapy is started if the individual is at risk for high cholesterol level or heart disease, or if the patient has suffered from a heart attack or stroke in the past.
Hyperhomocysteinemia
Hyperhomocysteinemia is a medical condition that is characterized by high levels of an amino acid, called homocysteine, in the blood. Patients with hyperhomocysteinemia have an increased risk of developing coronary artery disease (CAD). This is because high levels of homocysteine may irritate blood vessels, leading to blockages in arteries.Deficiencies in folic acid (folate), vitamin B6, or vitamin B12 may lead to hyperhomocysteinemia. Patients with kidney failure who are undergoing dialysis also have an increased risk of developing hyperhomocysteinemia. However, researchers have not discovered exactly why this condition may develop in dialysis patients.
Hyperhomocysteinemia does not cause any symptoms. Therefore, the American Heart Association recommends regular homocysteine testing in patients who have high risks of developing heart disease.
Hyperhomocysteinemia is diagnosed after a blood test, called a homocysteine test. Patients who have 14 or more micromoles of homocysteine per liter of blood are diagnosed with the condition.
Patients with hyperhomocysteinemia receive folate, vitamin B6, or vitamin b12 supplements until homocysteine levels are normal.
Pericarditis
Pericarditis occurs when the sac-like membrane that surrounds the heart (called the pericardium) becomes inflamed.Pericarditis is usually caused by an infection, such as staphylococcus, tuberculosis, or herpes simplex, which spreads to the heart through the blood. It may also occur after a traumatic injury to the heart or after heart surgery. Some patients may develop pericarditis after a severe heart attack. Pericarditis may occur as a result of inflammatory conditions, such as systemic lupus erythematosus or rheumatoid arthritis.
Symptoms of pericarditis may include chest pain, shortness of breath, fever, fatigue, dry cough, and swollen legs and/or abdomen.
Patients with pericarditis may also have pleural effusions, which occur when the membrane that surrounds the heart fills with fluid.
During a physical examination, a healthcare provider listens to the patient's heart. When the sac around the heart is inflamed, it will make a distinct noise when it rubs against the outer layer of the heart. If abnormal sounds are present, a chest X-ray is warranted. Pericarditis is diagnosed after a chest X-ray reveals inflammation around the heart.
Treatment of pericarditis depends on the underlying cause. If an infection is causing the inflammation, patients will receive antibiotics. The specific medication and duration of treatment depends on the type and severity of the infection, as well as the patient's overall health.
In addition to antibiotics, patients with pleural effusions will also need to have the fluid drained at a hospital. During the procedure, called pericardiocentesis, a healthcare provider administers a local anesthetic to numb the patient's chest. Then, a thin needle is inserted into the pericardium and fluid is removed. This treatment may last several days during the course of the patient's hospitalization.
Integrative therapies
Strong scientific evidence:Beta-glucan: Beta-glucan is a fiber that comes from the cell walls of algae, bacteria, fungi, yeasts, and plants. Numerous trials have examined the effects of oral beta-glucan on cholesterol. Small reductions in total and low density lipoprotein (LDL) cholesterol ("bad" cholesterol) have been reported. Little to no significant changes have been noted to occur on triglyceride levels or high density lipoprotein (HDL) cholesterol ("good" cholesterol) levels.
Avoid if allergic or hypersensitive to beta-glucan. When taken by mouth, beta-glucans are generally considered safe. Use cautiously with AIDS or AIDS-related complex (ARC).Avoid using particulate insoluble beta-glucan, as preliminary evidence suggests intravenous beta-glucans in the microparticulate form may cause serious side effects including hepatosplenomegaly (enlargement of both the liver and the spleen).. Avoid if pregnant or breastfeeding.
Beta-sitosterol: Beta-sitosterol is found in plant-based foods, such as fruits, vegetables, soybeans, breads, peanuts, and peanut products. It is also found in bourbon and oils. Many human and animal studies have found that supplementation of beta-sitosterol into the diet decreases total serum cholesterol, as well as low-density lipoprotein (LDL or "bad") cholesterol.
Avoid if allergic or hypersensitive to beta-sitosterol, beta-sitosterol glucoside, or pine. Use cautiously with asthma, breathing disorders, diabetes, primary biliary cirrhosis (chronic liver disease), ileostomy (operation that makes it possible for stool to leave the body), neurodegenerative disorders, diverticular disease (bulging of the colon), short bowel syndrome, celiac disease, or sitosterolemia (lipid metabolic disorder). Use cautiously with a history of gallstones. Avoid if pregnant or breastfeeding.
Calcium: Calcium is the most abundant mineral in the human body. Calcium chloride may be given intravenously (IV or through a vein) by a qualified healthcare professional in cardiac resuscitation, particularly after open-heart surgery, when epinephrine fails to improve weak or ineffective heart contractions. Calcium chloride helps increase heart contractions. Calcium chloride should not be used for cardiac resuscitation with ventricular fibrillation. CPR with calcium chloride should only be done under supervision of a qualified healthcare professional.
Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in urine, hyperparathyroidism (overgrowth of the parathyroid glands), bone tumors, digitalis toxicity, ventricular fibrillation (rapid, irregular twitching of heart muscle), kidney stones, kidney disease, or sarcoidosis (inflammatory disease). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria or irregular heartbeat. Calcium appears to be safe in pregnant or breastfeeding women. Talk to a healthcare provider to determine appropriate dosing during pregnancy and breastfeeding.
Niacin: Niacin, also known as vitamin B3 or nicotinic acid, is a well-accepted treatment for high cholesterol. Multiple studies show that niacin (not niacinamide) has significant benefits on levels of high-density cholesterol (HDL or "good cholesterol"). Niacin has been shown to produce better results than prescription drugs, such as "statins." There are also benefits on levels of low-density cholesterol (LDL or "bad cholesterol"), although these effects are less dramatic. A combination therapy with niacin and a statin may help decrease low-density lipoproteins levels. Individuals should check with their physicians and/or pharmacists before starting niacin.
Avoid if allergic to niacin or niacinamide. Avoid with a history of liver disease, liver dysfunction, irregular heartbeats (arrhythmia), heart disease, blood clotting, bleeding disorders, asthma, anxiety, panic attacks, thyroid disorders, stomach ulcers, gout, or diabetes. Avoid if pregnant or breastfeeding.
Omega-3 fatty acids: Omega-3 fatty acids are found in fish oil and certain plant/nut oils. Fish oil contains both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Multiple human trials report small reductions in blood pressure with intake of omega-3 fatty acid. DHA may have greater benefits than EPA. However, high intake of omega-3 fatty acids per day may be necessary to obtain clinically relevant effects, and at this dose level, there is an increased risk of bleeding. Therefore, a qualified healthcare provider should be consulted prior to starting treatment with supplements.
There is strong scientific evidence from human trials that omega-3 fatty acids from fish or fish oil supplements (EPA + DHA) significantly reduce blood triglyceride levels. Benefits appear to be dose-dependent. Fish oil supplements also appear to cause small improvements (increases) in high-density lipoprotein ("good cholesterol"). However, increases (worsening) in low-density lipoprotein levels (LDL/"bad cholesterol") are also observed. It is unclear if alpha-linolenic acid significantly affects triglyceride levels, and there is conflicting evidence in this area. The American Heart Association has published recommendations for EPA + DHA. Because of the risk of bleeding from omega-3 fatty acids, a qualified healthcare provider should be consulted prior to starting treatment with supplements.
While omega-3 fatty acids from both plants (ALA) and fish (EPA+DHA) have been shown to reduce C-reactive protein (CRP) in some studies, others have failed to show an effect. There is growing evidence that reducing CRP is beneficial towards favorable cardiovascular outcomes, although additional research is pending in this area.
Several well-conducted randomized controlled trials report that in people with a history of heart attack, regular consumption of oily fish or fish oil/omega-3 supplements reduces the risk of non-fatal heart attack, fatal heart attack, sudden death, and all-cause mortality. Most patients in these studies were also using conventional heart drugs, suggesting that the benefits of fish oils may add to the effects of other therapies.
Avoid if allergic or hypersensitive to fish, omega-3 fatty acid products that come from fish, nuts, linolenic acid, or omega-3 fatty acid products that come from nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure, or if taking drugs, herbs, or supplements that treat any such conditions. Use cautiously before surgery. Pregnant and breastfeeding women should not consume doses that exceed the recommended dietary allowance (RDA).
Psyllium: Psyllium, also known as ispaghula, comes from the husks of the seeds of Plantago ovata. Psyllium is well studied as a lipid-lowering agent with generally modest reductions seen in blood levels of total cholesterol and low-density lipoprotein ("bad cholesterol"). Effects have been observed following eight weeks of regular use. Psyllium does not appear to have significant effects on high-density lipoprotein ("good cholesterol") or triglyceride levels. Because only small reductions have been observed, people with high cholesterol should discuss the use of more potent agents with their healthcare providers. Effects have been observed in adults and children, although long-term safety in children is not established.
Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantain (Plantago lanceolata). Prescription drugs should be taken one hour before or two hours after psyllium. Use cautiously if pregnant or breastfeeding because psyllium may lower blood sugar levels.
Red yeast rice: Red yeast rice (RYR) is the product of yeast (Monascus purpureus) grown on rice. Since the 1970s, human studies have reported that red yeast lowers blood levels of total cholesterol, low-density lipoprotein/LDL ("bad cholesterol"), and triglyceride levels. Other products containing red yeast rice extract can still be purchased. However, these products may not be standardized and effects are unpredictable. For lowering cholesterol, there is better evidence for using prescription drugs such as lovastatin.
Avoid if allergic or hypersensitive to red yeast. Avoid with liver disease. Use cautiously with bleeding disorders. Avoid if pregnant or breastfeeding.
Soy: Soy is a subtropical plant, native to southeastern Asia. This member of the pea family (Fabaceae) grows from one to five feet tall and forms clusters of three to five pods, each containing two to four beans per pod. Numerous human studies report that adding soy protein to the diet can moderately decrease blood levels of total cholesterol and low-density lipoprotein ("bad" cholesterol). Small reductions in triglycerides may also occur, while high-density lipoprotein ("good" cholesterol) does not seem to be significantly altered. Some scientists have proposed that specific components of soybean, such as the isoflavones genistein and daidzein, may be responsible for the cholesterol-lowering properties of soy. However, this has not been clearly demonstrated in research, and it remains controversial. It is unknown if products containing isolated soy isoflavones have the same effects as regular dietary intake of soy protein. Dietary soy protein has not been proven to affect long-term cardiovascular outcomes such as heart attack or stroke.
Avoid if allergic to soy. The effects of high doses of soy or soy isoflavones in humans are unclear, and therefore, are not recommended. There has been one case report of vitamin D deficiency rickets in an infant nursed with soybean milk that was not specifically designed for infants. People who experience intestinal irritation from cow's milk may experience intestinal damage or diarrhea from soy. It is unknown if soy or soy isoflavones share the same side effects as estrogens, such as increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone-sensitive conditions, such as endometriosis, may also be worsened. Patients taking blood-thinning drugs should check with their doctors before taking soy supplements. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific evidence of safety in these subgroups.
Good scientific evidence:
Avocado: Avocados are fruits, not vegetables, and are a nutritious source of potassium. Avocados contain no sodium or cholesterol. Avocados added to the diet may lower total cholesterol, LDL ("bad" cholesterol), HDL ("good" cholesterol), and triglycerides. Additional study is needed before a strong recommendation can be made.
Avoid if allergic or hypersensitive to avocado, banana, chestnut, or natural rubber latex. Use cautiously if taking anticoagulants (e.g. warfarin). Avoid if taking monoamine oxidase inhibitors (MAOIs). Pregnant and breastfeeding women should not consume more avocado than is in a normal diet. Some types of avocado may be unsafe when breastfeeding.
Barley: Barley is a cereal used as a staple food in many countries. It is commonly used as an ingredient in baked products and soup in Europe and the United States. Barley malt is used to make beer, and it is also used as a natural sweetener called malt sugar or barley jelly sugar. Several small studies suggest that high-fiber barley, barley bran flour, and barley oil elicit small reductions in serum cholesterol levels by increasing cholesterol excretion. There is good evidence from existing research to support the use of barley along with a cholesterol-lowering diet in mild cases of hypercholesterolemia. Larger and longer studies are warranted to more rigorously confirm lasting benefits.
The U.S. Food and Drug Administration (FDA) has announced that whole grain barley and barley-containing products are allowed to claim that they reduce the risk of coronary heart disease (CHD). To qualify for the health claim, the barley-containing foods must provide at least 0.75 grams of soluble fiber per serving of the food.
Avoid if allergic or hypersensitive to barley flour or beer. Barley appears to be well tolerated in non-allergic, healthy adults in recommended doses for short periods of time, as a cereal or in the form of beer. Use cautiously with diabetes, asthma, or arrhythmia (irregular heartbeat). Contamination of barley with fungus has occurred. Traditionally, women have been advised against eating large amounts of barley sprouts during pregnancy. Infants fed with a formula containing barley water, whole milk, and corn syrup have developed malnutrition and anemia, possibly due to vitamin deficiencies.
Betaine anhydrous: Betaine is found in most microorganisms, plants, and marine animals. It is also found naturally in many foods, most highly concentrated in beets, spinach, grain, and shellfish. Homocystinuria is a severe form of hyperhomocysteinemia caused by genetic defects in homocysteine-metabolizing genes. Patients with severely elevated homocysteine due to a genetic deficiency can use betaine treatment, in combination with other vitamins and diet restrictions, to reduce the risk of vascular events. Betaine anhydrous has been shown to reduce circulating levels of homocysteine in the body. Further studies are needed to determine whether betaine supplementation can lower heart disease risks in the general population.
Overall, betaine supplementation has also shown significant reductions in both fasting and postmethionine load homocysteine. However, additional studies are needed to make a strong recommendation.
Avoid if allergic or hypersensitive to betaine anhydrous or a type of betaine called cocamidopropylbetaine. Use cautiously with kidney disease, obesity, or psychiatric conditions. Avoid if pregnant or breastfeeding.
Carob: Carob (Ceratonia siliqua) is a leguminous evergreen tree of the family Leguminosae (pulse family). Fiber, such as oat fiber, has been shown to reduce serum cholesterol levels. Carob pod fiber or carob bean gum may also have this ability, although additional research is needed to confirm these findings.
Avoid if allergic or hypersensitive to carob (Ceratonia siliqua), its constituents, or any plants in the Fabaceae family, including tamarind. Avoid with metabolic disorders, kidney disorders, acute diarrhea, or with deficient levels of chromium, cobalt, copper, iron, or zinc. Avoid in underweight infants. Use cautiously with anemia, known allergy to peanuts or other nuts, diabetes, or hyperlipidemia (high cholesterol). Use cautiously if taking oral herbs or drugs. Use cautiously in hypouricemic patients. Avoid if pregnant or breastfeeding.
Coleus: The root extract of coleus is known as forskolin. Forskolin may improve cardiovascular function in patients with cardiomyopathy (enlarged heart). However, additional study is needed to confirm these findings.
Avoid if allergic to Coleus forskohlii and related species. Use cautiously with diabetes, thyroid disorders, heart disease, asthma, low blood pressure, or if at risk of developing low blood pressure. Use cautiously with a history of bleeding, homeostatic disorders, or drug-related homeostatic problems. Use cautiously if taking asthma medications (e.g. bronchodilators), anticoagulants, anti-thrombotic agents, or anti-platelet medications. Do not use two weeks before and immediately after surgical or dental procedures that have bleeding risks. Avoid if pregnant or breastfeeding.
Cordyceps: Cordyceps is a fungus found mainly in China, Nepal, and Tibet. Cordyceps supplements may lower total cholesterol and triglyceride levels, although these changes may not be permanent or long lasting. Longer studies with follow up are needed to determine the long-term effects of cordyceps on hyperlipidemia.
Avoid if allergic or hypersensitive to cordyceps, mold, or fungi. Use cautiously with diabetes, bleeding disorders, or prostate conditions. Use cautiously if taking anticoagulants, immunosuppressants, hormonal replacement therapy, or birth control pills. Avoid with myelogenous types of cancers. Avoid if pregnant or breastfeeding.
Gamma oryzanol: Gamma oryzanol is found in rice bran oil, and it has also been extracted from corn and barley oils. Preliminary evidence indicates that gamma oryzanol may help treat hyperlipidemia. Gamma oryzanol seems to reduce total cholesterol, LDL ("bad" cholesterol), HDL ("good cholesterol"), and triglycerides. Additional study is needed to establish gamma oryzanol's effect on hyperlipidemia (high cholesterol).
Avoid if allergic or hypersensitive to gamma oryzanol, its components, or rice bran oil. Use cautiously if taking anticoagulants (blood thinners), central nervous system (CNS) suppressants, growth hormones, immunomodulators, luteinizing hormone, luteinizing hormone-releasing hormone, prolactin, cholesterol-lowering drugs, thyroid drugs, or drugs that alter blood sugar levels. Use cautiously with diabetes, hypothyroidism, hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), or high cholesterol. Avoid if pregnant or breastfeeding.
Garlic: The garlic bulb is made of many cloves that are wrapped in a paper-thin, white skin. It is used both medicinally and as a spice in food. Multiple studies in humans have reported small reductions in total blood cholesterol and low-density lipoproteins ("bad cholesterol") over four to 12 weeks. It is unclear if there are benefits after this amount of time. Effects on high-density lipoproteins ("good cholesterol") are unclear. This remains an area of controversy. Well-designed and longer studies are needed in this area.
Avoid if allergic or hypersensitive to garlic or other members of the Lilaceae (lily) family (e.g. hyacinth, tulip, onion, leek, or chive). Avoid with a history of bleeding problems, asthma, diabetes, low blood pressure, or thyroid disorders. Stop using supplemental garlic two weeks before and immediately after dental/surgical/diagnostic procedures to avoid bleeding problems. Use cautiously if taking anticoagulants. Avoid in supplemental doses if pregnant or breastfeeding.
Globe artichoke: Globe artichoke (Cynara scolymus) is a species of thistle. The edible part of the plant is the base of the artichoke head in bud, harvested well before any fruit develops. Preliminary human study suggests that cynarin and artichoke extracts may reduce serum cholesterol and triglyceride levels. However, additional study is needed to a make a strong recommendation.
Use cautiously if allergic/hypersensitive to members of the Asteraceae or Compositae families (e.g. chrysanthemums, daisies, marigolds, ragweed, or arnica), due to possible cross-reactivity. Use cautiously with gallstones, bile duct obstructions, or kidney disease. Avoid if pregnant or breastfeeding.
L-carnitine: L-carnitine is an amino acid that is made in the muscles and liver. Evidence from clinical trials suggests that L-carnitine and L-propionyl-carnitine (propionyl-L-carnitine) are effective in reducing symptoms of chest pain (angina). Carnitine may not offer further benefit when patients continue conventional therapies. Additional study is needed to confirm these findings.
Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, high blood pressure, alcohol-induced liver cirrhosis, and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.
Niacin: Niacin is a B-complex vitamin found in a many foods, such as liver, poultry, fish, nuts, and dried beans. It is needed for the nervous system and gastrointestinal tract function. Vitamin B3 is made up of niacin (nicotinic acid) and niacinamide. Niacin decreases blood levels of cholesterol and lipoprotein (a), which may reduce the risk of atherosclerosis ("hardening" of the arteries). However, niacin can also increase homocysteine levels, which may have the opposite effect. Overall, the scientific evidence supports the use of niacin in combination with other drugs (but not alone) to decrease cholesterol and slow the process of atherosclerosis. More research is needed in this area before a firm conclusion can be drawn.
Avoid niacin/vitamin B3 if allergic to niacin or niacinamide. Avoid with a history of liver disease, liver dysfunction, irregular heartbeats (arrhythmia), heart disease, blood clotting, bleeding disorders, asthma, anxiety, panic attacks, thyroid disorders, stomach ulcers, gout, or diabetes. Avoid if pregnant or breastfeeding.
Omega-3 fatty acids: Omega-3 fatty acids are found in fish oil and certain plant/nut oils. Fish oil contains both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Several large studies of populations ("epidemiologic" studies) report a significantly lower rate of death from heart disease in men and women who regularly eat fish. Other epidemiologic research reports no such benefits. It is unclear if reported benefits only occur in certain groups of people, such as those at risk of developing heart disease. Overall, the evidence suggests benefits of regular consumption of fish oil. However, well-designed randomized controlled trials that classify people by their risk of developing heart disease are necessary before a firm conclusion can be drawn.
Avoid if allergic or hypersensitive to fish, omega-3 fatty acid products that come from fish, nuts, linolenic acid, or omega-3 fatty acid products that come from nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure, or if taking drugs, herbs, or supplements that treat any such conditions. Use cautiously before surgery. Pregnant and breastfeeding women should not consume doses that exceed the recommended dietary allowance (RDA).
Pantethine: Pantethine is a natural compound. It is the active form of pantothenic acid. Numerous trials have examined the effects of oral pantethine on lipid levels. Reductions in total cholesterol, low-density lipoprotein (LDL), and triglycerides have occurred. However, additional study is needed in this area to confirm these findings.
Avoid if allergic or hypersensitive to pantethine or any component of the formulation. Use cautiously with bleeding disorders. Avoid if pregnant or breastfeeding.
Policosanol: Policosanol is a natural mixture of alcohols derived from plant based waxes that has been shown to lower cholesterol. The effects of policosanol supplementation on exercise-ECG testing responses has been studied in individuals with coronary heart disease (CHD). Beneficial changes were noted in functional capacity, rest and exercise angina, cardiac events, and maximum oxygen uptake. Although this represents early compelling evidence, further research is necessary before a clear conclusion can be reached.
Avoid if allergic or hypersensitive to policosanol. Use cautiously if taking nitrates, aspirin, or drugs that lower cholesterol or blood pressure. Avoid if pregnant or breastfeeding.
Sweet almond: The almond tree is native to Western Asia and North Africa, but it is now grown in most temperate regions. The sweet almond is a popular and nutritious food. There is initial positive evidence from human studies to support the use of almonds in the diet to lower serum lipids. There are supporting data from animal studies. Proposed mechanisms include the presence of monounsaturated fats in raw almonds, or direct effects on low-density lipoprotein (LDL) receptors. Further study is warranted in this area to establish dosing guidelines and degree of benefit.
Avoid if allergic or hypersensitive to almonds or other nuts. Use cautiously with a history of swollen joints, asthma, hair loss, or diabetes. Avoid if pregnant or breastfeeding.
Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Yoga addresses physical, mental, intellectual, emotional, and spiritual dimensions towards an overall harmonious state of being. Several human studies suggest that yoga is helpful in people with heart disease. However, it is unclear if yoga reduces the risk of heart attack or death or if yoga is better than any other form of exercise therapy or lifestyle/dietary change. Therefore, yoga may be a useful addition to standard therapies (such as medications for blood pressure or cholesterol) in people at risk for heart attacks, but further research is necessary before a strong recommendation can be made.
Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, cervical spondylitis, or if at risk for blood clots. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction. However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.
Zinc: Zinc formulations have been used since ancient Egyptian times to enhance wound healing. Zinc may improve serum cholesterol levels in hemodialysis patients. There is some evidence that zinc may improve cholesterol ratio of HDL "good cholesterol" versus LDL "bad cholesterol," which would be considered a positive effect. Well-designed clinical trials are needed before a recommendation can be made.
Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.
Unclear or conflicting scientific evidence:
Acupuncture: Acupuncture is commonly used throughout the world. According to Chinese medicine theory, the human body contains a network of energy pathways through which vital energy, called "chi," circulates. These pathways contain specific "points" that function like gates, allowing chi to flow through the body. Needles are inserted into these points to regulate the flow of chi. Illnesses and symptoms are caused by problems in the circulation of chi through the pathways. Some research has suggested that acupuncture might help reduce distress and symptoms of chest pain (angina), but this has not been consistently shown in other studies.
Acupuncture has been found to be superior to medication (Shenmai injection) for low pulse pressure syndrome. More studies are needed before a firm conclusion can be drawn.
It remains unknown whether acupuncture is an effective treatment for heart disease.
Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders. Avoid if taking drugs that increase the risk of bleeding (e.g. anticoagulants). Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (e.g. asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers because therapy may interfere with the device.
Alfalfa: Alfalfa has a long history of dietary and medicinal use. Alfalfa is usually taken by eating part of the plant. Several studies in animals report reductions in cholesterol plaques of the arteries after use of alfalfa. Well-designed research in humans is needed to determine if alfalfa is an effective treatment for atherosclerosis.
Reductions in blood levels of total cholesterol and low-density lipoprotein ("bad cholesterol") have been reported in animal studies and in a small number of human cases. High-density lipoprotein ("good cholesterol") has not been altered in these cases. Although this evidence is promising, better research is needed before a firm conclusion can be reached.
Avoid if allergic to alfalfa, clover, or grass. Avoid with a history of lupus, thyroid disease, gout, blood clots, seizures, liver disease, or kidney disease. Use cautiously with stroke, hormonal conditions (e.g. breast tenderness, breast cancer, ovarian cancer, or menstrual problems), or diabetes. Avoid if taking drugs that increase the risk of bleeding (e.g. aspirin, aspirin products, or warfarin) or ibuprofen. Do not use two weeks before and immediately after any surgery/dental/diagnostic procedures that may have bleeding risks. Alfalfa may be contaminated with dangerous bacteria (e.g. E. coli, salmonella, or listeria). Avoid if pregnant or breastfeeding.
American hellebore: American hellebore is a plant native to the swampy areas and moist meadows of the eastern and western United States. Isolated jervine alkaloids found in American hellebore have been studied for cardiovascular and kidney dysfunction. Additional study is needed before a firm recommendation can be made.
Avoid if allergic or hypersensitive to American hellebore, plants in the lily family (Liliaceae), or any related species of Veratrum. Use cautiously with cardiovascular disease, cardiac dysfunction, arrhythmias, hemodynamic instability, or compromised kidney function. Use cautiously if taking drugs that are excreted by the kidneys, diuretics, asthma medications, or blood pressure medications. Avoid if pregnant or breastfeeding.
Aortic acid: Aortic extract is typically manufactured from the hearts of animals, usually sheep, cows, or pigs. There are many substances, including aortic acid in this extract. There are several constituents in aortic acid, but mesoglycan has been studied the most. Mesoglycan is a structural aspect of cardiovascular vessels and organs. One preliminary study indicates that mesoglycan supplements may reduce blood vessel thickening. However, additional research is needed in this field.
There are currently no reported allergic reactions available. Due to the heparin sulfate content of mesoglycan, patients who are allergic to heparin or heparinoid derivatives should use aortic acid cautiously. Use cautiously with blood disorders or if taking anticoagulation therapy. Use cautiously with high blood pressure or if taking antihypertension drugs. Avoid if pregnant or breastfeeding.
Arginine: There is initial evidence from several studies that arginine taken by mouth or by injection improves exercise tolerance and blood flow in the arteries of the heart. Benefits have been shown in some patients with coronary artery disease and chest pain (angina). A small randomized, controlled clinical trial studied the effects of a medical food bar enriched with L-arginine and a combination of other nutrients in the management of chronic stable angina. The authors found that this arginine-rich medical food, when used with traditional therapy, improves vascular function, exercise capacity, and aspects of quality of life in these patients. However, further research is needed to confirm these findings and to establish doses that may be safe and effective.
An L-arginine supplement, called "blood cardioplegic solution," is proposed to have protective properties for the heart. A randomized, controlled clinical trial using this solution in patients undergoing heart surgery (coronary artery bypass grafting) reports improved heart protection. Further research is needed before a firm conclusion can be drawn.
Study results of arginine supplementation after heart attack (myocardial infarction) are mixed. Further research is needed before a recommendation can be made. A cardiologist and pharmacist should be consulted prior to initiation of arginine therapy.
Avoid with known allergy or hypersensitivity to arginine. Use cautiously with peripheral vascular disease, high blood pressure, alcohol-induced liver cirrhosis, or diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.
Ashwagandha: Ashwagandha (Withania somnifera) is a small, grayish, erect evergreen shrub that grows to about four to five feet tall, with small greenish flowers and fruits that become orange-red when ripe. Decreases in serum total cholesterol levels, triglycerides, low-density lipoprotein (LDL), and very low-density lipoproteins (VLDL) have been reported with ashwagandha use. Further research is needed before a strong recommendation can be made.
Avoid if allergic or hypersensitive to ashwagandha products or any of their ingredients. Dermatitis (allergic skin rash) was reported in three of 42 patients in one ashwagandha trial. There are few reports of adverse effects associated with ashwagandha, but there are few human trials using ashwagandha and most do not report the doses or standardization/preparation used. Avoid with peptic ulcer disease. Ashwagandha may cause abortions, according to anecdotal reports. Avoid if pregnant or breastfeeding.
Astaxanthin: Astaxanthin can be found in microalgae, yeast, salmon, trout, krill, shrimp, crayfish, crustaceans, and the feathers of some birds. There is insufficient evidence to recommend for or against the use of astaxanthin for LDL oxidation prevention. More research is needed to make a firm conclusion.
Avoid if allergic/hypersensitive to astaxanthin or related carotenoids (e.g. canthaxanthin). Use cautiously if taking 5-alpha-reductase inhibitors, hypertensive agents, asthma medications, menopause agents, birth control pills, Helicobacter pylori agents, or drugs that are broken down by the liver. Use cautiously with hypertension, parathyroid disorders, or osteoporosis. Avoid with hormone-sensitive conditions, immune disorders, or if taking immunosuppressive therapies. Avoid with previous experience of visual changes while taking astaxanthin and with low eosinophil levels. Avoid if pregnant or breastfeeding.
Astragalus: In traditional Chinese medicine (TCM), astragalus is commonly found in mixtures with other herbs. In Chinese medicine, herbal mixtures containing astragalus have been used to treat heart diseases. There are several human case reports of reduced symptoms and improved heart function, although these are not well described. High-quality human research is necessary before a conclusion can be drawn.
Avoid if allergic to astragalus, peas, or any related plants. Avoid with a history of Quillaja bark-induced asthma. Avoid if taking anticoagulants (e.g. aspirin or warfarin) or herbs or supplements with similar effects. Avoid with inflammation (swelling), fever, stroke, organ transplant, or autoimmune diseases. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders. Use cautiously if taking blood sugar drugs, diuretics, or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.
Ayurveda: Ayurveda is a form of natural medicine that originated in ancient India more than 5,000 years ago. Ayurveda is an integrated system of techniques that uses diet, herbs, exercise, meditation, yoga, and massage or bodywork to achieve optimal health on all levels. In India, Ayurveda involves the eight principal branches of medicine: pediatrics, gynecology, obstetrics, ophthalmology, geriatrics, otolaryngology (ear, nose, and throat), general medicine, and surgery. Abana is a combination herbal and mineral formulation traditionally used in Ayurveda for cardiovascular health. Its main ingredients are Terminalia arjuna, Withania somnifera, Terminalia chebula, Phyllanthus emblica, Nardostachys jatamansi, Tinosporia cordifolia, Glycyrrhiza glabra, Zingiber officinale, and Nepeta hindostana. Early studies report that abana may reduce the frequency and severity of chest pain (angina). Other studies suggest that abana may improve cardiac function, but further research is needed before a firm conclusion can be made.
Evidence suggests that carotid intima-media thickness (IMT), a measure of atherosclerosis, may be reduced with a comprehensive program including diet, exercise, stress reduction, and a combination herbal formula (Maharishi Vedic Medicine), particularly in patients with a marked congenital heart disease (CHD) risk.
Evidence indicates that Ayurveda's comprehensive purification and detoxification regime, known as panchakarma, in heart disease patients may lead to increased VIP (a vasodilator), acute reduction in total cholesterol, reduction in lipid peroxide (a measure of free radical damage), and a significant reduction in anxiety.
A study of Arjuna (Terminalia arjuna), a type of bark powder that is traditionally used as an anti-ischemic and cardio protective agent in hypertension and ischemic heart diseases, found evidence that it may reduce cholesterol and lipid peroxide levels as well as have significant antioxidant action that is comparable to vitamin E in coronary heart disease patients. Further research is needed before a firm conclusion can be drawn.
There is preliminary evidence that the herb guggulu (Commiphora), administered as a purified gum, may reduce serum cholesterol and serum triglyceride levels, increase HDL, and decrease LDL levels. More studies are needed to validate this use.
Ayurvedic herbs can interact with other herbs, foods, and drugs. A qualified healthcare professional should be consulted before taking. Ayurvedic herbs should be used cautiously because they are potent and some constituents can be potentially toxic if taken in large amounts or for a long time. Some herbs imported from India have been reported to contain high levels of toxic metals. Use guggul cautiously with peptic ulcer disease and avoid taking with sour food, alcohol, and heavy exercise. Mahayograj guggul should not be taken for long periods of time. Pippali (Piper longum) should be taken with milk and avoided with asthma. Avoid sweet flag and amlaki (Emblica officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages, and medical conditions that require surgery.
Berberine: Berberine is a bitter-tasting, yellow, plant alkaloid with a long history of medicinal use in Chinese and Ayurvedic medicine. Berberine may reduce triglycerides, serum cholesterol, and LDL cholesterol. Higher quality trials are needed before berberine's cholesterol-lowering effect can be established.
Avoid if allergic or hypersensitive to berberine, to plants that contain berberine (e.g. goldenseal, coptis, goldenthread, Oregon grape, barberry, or tree turmeric), or to members of the Berberidaceae family. Use cautiously with heart disease, gastrointestinal disorders, blood disorders, leucopenia (abnormally low level of white blood cells), kidney disease, liver disease, lung disorders, cancer, hypertyraminemia (high levels of tyramine), diabetes, or low blood pressure. Use cautiously in children due to lack of safety information. Use cautiously with high exposure to sunlight or artificial light. Use cautiously for longer than eight weeks. Use cautiously if taking anticoagulants, antihypertensives, sedatives, anti-inflammatories, or medications that are broken down by the liver. Avoid if pregnant or breastfeeding. Avoid in newborns.
Beta-glucan: Beta-glucan is a fiber that comes from the cell walls of algae, bacteria, fungi, yeast, and plants. Evidence suggests that reductions in endothelial function induced by a high-fat meal may be prevented when a high-fat meal is taken along with a beta-glucan-containing cereal or vitamin E. Diabetes, hyperlipidemia (high cholesterol), and hypertension (high blood pressure) data are also promising. Further study is needed in this area.
Avoid if allergic or hypersensitive to beta-glucan. When taken by mouth, beta-glucans are generally considered safe. Use cautiously with AIDS or AIDS-related complex (ARC). Avoid using particulate beta-glucan. Avoid if pregnant or breastfeeding.
Bilberry: Bilberry is an herb made from the berries of a small deciduous shrub. Bilberry has been used traditionally to treat heart disease and atherosclerosis. There is some laboratory research in this area, but there is no clear information in humans.
Avoid if allergic to plants in the Ericaceae family or to anthocyanosides (a component of bilberry). Avoid with a history of low blood pressure, heart disease, bleeding, diabetes, blood clots, or stroke. Avoid if pregnant or breastfeeding. Stop use two weeks before and immediately after surgeries/dental or diagnostic procedures with bleeding risks.
Black tea: Black tea is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. There is conflicting evidence from a small number of studies examining the relationship of tea intake with the risk of heart attack. Tea may reduce the risk of platelet aggregation or endothelial dysfunction, proposed to be beneficial against blockage of arteries in the heart. The long-term effects of tea consumption on heart disease risk factors, such as cholesterol levels, blood pressure, and atherosclerosis, are unknown. One study reports that regular ingestion of black tea does not alter plasma homocysteine concentrations.
Avoid if allergic or hypersensitive to caffeine or tannin. Skin rash and hives have been reported with caffeine ingestion. Use cautiously with diabetes. Use cautiously if pregnant. Heavy caffeine intake during pregnancy may increase the risk of SIDS (sudden infant death syndrome). Very high doses of caffeine have been linked with birth defects. Caffeine is transferred into breast milk. Caffeine ingestion by infants can lead to sleep disturbances/insomnia. Infants nursing from mothers consuming greater than 500 milligrams of caffeine daily have been reported to experience tremors and heart rhythm abnormalities. If breastfeeding mothers consume black tea, it may lead to anemia, decreased iron metabolism, and irritability in their infants
Borage seed oil: Borage (Borago officinalis) is an herb native to Syria that has spread throughout the Middle East and Mediterranean. Borage flowers and leaves may be eaten, and borage seeds are often pressed to produce oil that is very high in gamma-linolenic acid (GLA). Hyperlipidemia means that there are excess levels of fats in the blood. These fats can be triglycerides or cholesterol. Hyperlipidemia is often associated with an increased risk of heart disease and strokes. Gamma linolenic acid may decrease plasma triglyceride levels and increase HDL-cholesterol concentration. However, more research is needed to define borage's effects on lipid levels in the blood.
Avoid if allergic or hypersensitive to borage, its constituents, or members of the Boraginaceae family. Use cautiously with bleeding disorders or epilepsy. Use cautiously if taking anticoagulants (e.g. warfarin or aspirin) or anticonvulsants. Avoid if immunocompromised. Avoid in pregnant patients as borage oil may be contraindicated in pregnancy given the teratogenic and labor-inducing effects of prostaglandin E agonists, such as borage oil's GLA. Avoid if breastfeeding.
Chamomile: Chamomile is an herb that has an apple-like smell and taste. Chamomile is a common tea. Chamomile is not well-known for its cardiac effects, and there is little research in this area. Large, well-designed randomized controlled trials are needed to determine if chamomile can help treat or prevent heart disease.
Avoid if allergic to chamomile or any related plants, such as aster, chrysanthemum, mugwort, ragweed, or ragwort. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
Chondroitin sulfate: Chondroitin sulfate is manufactured from natural sources (e.g. shark, beef cartilage, or bovine trachea) or by artificial means. Several studies have assessed the use of oral chondroitin for the prevention of subsequent coronary events in patients with a history of heart disease or heart attack (myocardial infarction). A recommendation cannot be made in this area until further well-designed clinical trials are available.
Use cautiously if allergic or hypersensitive to chondroitin sulfate products. Use cautiously with bleeding disorders or if taking blood-thinners, such as warfarin. Avoid if pregnant or breastfeeding.
Coenzyme Q10: Coenzyme Q10 (CoQ10) is produced by the human body. It is needed for the basic functioning of cells. Preliminary small human studies suggest that CoQ10 may reduce chest pain (angina) and improve exercise tolerance in people with clogged heart arteries. Better studies are needed before a firm recommendation can be made.
There is conflicting evidence from research on the use of CoQ10 in patients with dilated or hypertrophic cardiomyopathy. Better research is needed in this area before a recommendation can be made.
There is preliminary human study of CoQ10 given to patients within three days after a heart attack. Better research is needed before a firm conclusion can be drawn.
Several studies suggest that the function of the heart may be improved after major heart surgeries, such as coronary artery bypass graft (CABG) or valve replacement, when CoQ10 is given to patients before or during surgery. Better studies are necessary before a recommendation can be made.
There are no reported allergies associated with Coenzyme Q10 supplements. However, rash and itching have been reported rarely. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke. Use cautiously if taking anticoagulants (blood thinners) or anti-platelet drugs, blood pressure drugs, blood sugar drugs, cholesterol drugs, or thyroid drugs. Avoid if pregnant or breastfeeding.
Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains fruits, shellfish, avocado, beef, and animal organs. The effects of copper intake or blood copper levels on cholesterol, atherosclerosis (cholesterol plaques in arteries), or coronary artery disease remain unclear. Studies in humans are mixed, and further research is needed in this area.
Avoid if allergic or hypersensitive to copper. Avoid use of copper supplements during the early phase of recovery from diarrhea. Avoid with a high amount of copper in the blood (hypercupremia), genetic disorders affecting copper metabolism (e.g. Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis), or HIV/AIDS. Use cautiously with water containing copper concentrations greater than 6 milligrams per liter. Use cautiously with anemia (low red blood cell count), arthralgias (painful joints), or myalgias (muscle pain). Use cautiously if taking oral contraceptives. Use cautiously if at risk for selenium deficiency. Pregnant and breastfeeding women should not consume doses that exceed the recommended dietary allowance (RDA).
Creatine: Creatine is an amino acid that is produced in the muscles. There is early evidence that heart muscle may recover better and more rapidly after open-heart surgery if intravenous creatine is administered during the operation. Further study is needed before a recommendation can be made.
There is limited research on the use of creatine to reduce high cholesterol, and the results from different studies disagree with each other (with some trials noting reductions in total cholesterol and triglyceride levels). It remains unclear what effect creatine has on lipids. Additional studies are needed before a clear conclusion can be drawn.
There is early evidence that intravenous creatine following a heart attack may be beneficial to heart muscle function, and may prevent ventricular arrhythmias (irregular heartbeat). Further study is needed before a recommendation can be made in this area.
It has been reported that use of creatine phosphate may have a favorable effect on mental deterioration in "cardio-cerebral syndrome" following heart attacks in the elderly.
Avoid if allergic to creatine or if taking diuretics. Use cautiously with asthma, diabetes, gout, kidney, liver problems, muscle problems, stroke, or with a history of these conditions. Avoid dehydration while taking creatine. Avoid if pregnant or breastfeeding.
Danshen: Danshen (Salvia miltiorrhiza) is widely used in traditional Chinese medicine (TCM), often in combination with other herbs. A small number of poor-quality studies report that danshen may provide benefits for treating disorders of the heart and blood vessels, including heart attacks, cardiac chest pain (angina), or myocarditis. Danshen may have effects on blood clotting, and therefore, may be unsafe when combined with other drugs used in patients with heart disease. Patients should check with their physicians and pharmacists before combining danshen with prescription drugs.
Avoid if allergic or hypersensitive to danshen. Use cautiously if taking sedatives, hypolipidemics, cardiac glycosides, CYP-metabolized agents, nitrate ester, steroidal agents, or some anti-inflammatories (e.g. ibuprofen). Use cautiously with altered immune states, arrhythmia, compromised liver function, or a history of glaucoma, stroke, or ulcers. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously if driving or operating heavy machinery. Avoid if taking blood thinners (anticoagulants), digoxin, or hypotensives, including ACE inhibitors (e.g. captopri), or Sophora subprostrata root or herba serissae. Avoid with bleeding disorders or low blood pressure. Avoid use after cerebral ischemia. Avoid if pregnant or breastfeeding.
DHEA: DHEA (dehydroepiandrosterone) is naturally produced by the adrenal glands. Initial studies report possible benefits of DHEA supplementation in patients with cholesterol plaques ("hardening") in their arteries. There is conflicting scientific evidence regarding the use of DHEA supplements in patients with heart failure or diminished ejection fraction. Other therapies are more proven in this area, and patients with heart failure or other types of heart disease should discuss treatment options with their cardiologists.
Avoid if allergic to DHEA. Avoid with a history of seizures. Use cautiously with adrenal or thyroid disorders. Use cautiously if taking anticoagulants or drugs, herbs, or supplements that treat diabetes, heart disease, seizures, or stroke. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.
Dong quai: Dong Quai (Angelica sinensis), also known as Chinese angelica, has been used for thousands of years in traditional Chinese, Korean, and Japanese medicine. There is insufficient evidence to support the use of Dong quai for the treatment of heart disease.
Although Dong Quai is accepted as being safe as a food additive in the United States and Europe, its safety in medicinal doses is not known. There are no reliable long-term studies of side effects available. Avoid if allergic/hypersensitive to Angelic radix or members of the Aplaceael or Umbelliferae families. Avoid prolonged exposure to sunlight or ultraviolet light. Use cautiously with bleeding disorders or if taking drugs that increase the risk of bleeding. Use cautiously with diabetes, glucose intolerance, or hormone sensitive conditions (e.g. breast cancer, uterine cancer or ovarian cancer). Do not use two weeks before or immediately after dental or surgical procedures with bleeding risks. Avoid if pregnant or breastfeeding.
Elder: European elder grows up to 30 feet tall. It is native to Europe, but it has been naturalized to the Americas. There is no reliable human evidence currently available evaluating elder alone as a treatment for high cholesterol. Early study reports that elderberry juice may decrease serum cholesterol concentrations and increase low-density lipoprotein (LDL) stability. Additional research is needed in this area before a firm conclusion can be reached. Elder should not be used in the place of other more proven therapies, and patients are advised to discuss with their primary healthcare providers before using elderberry for treatment of high cholesterol.
WARNING: Cyanide toxicity is possible. Berries (elderberries) must be cooked to prevent nausea or cyanide toxicity. Avoid if allergic to elder or to plants related to honeysuckle. Some reports exist of allergies from contact with fresh elder stems. Use cautiously with diabetes, high blood pressure, urinary problems, or if taking drugs used for any of these conditions. Use cautiously if taking anti-inflammatories, diuretics, or laxatives. Avoid if pregnant or breastfeeding.
Fenugreek: Fenugreek has been used in Indian and Chinese medicine to help with labor and digestion. There is insufficient evidence to support the use of fenugreek as a hyperlipidemic agent.
Avoid if allergic to fenugreek or chickpeas. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously with asthma, diabetes, or with a history of ulcers or stroke. Avoid if pregnant. Children should not take doses larger than those commonly found in foods.
Flaxseed and flaxseed oil: Flaxseed and flaxseed oil/linseed oil are rich sources of the essential fatty acid alpha-linolenic acid (omega-6). Alpha-linolenic acid is a building block in the body for omega-3 fatty acids. Flaxseed oil should be refrigerated at all times. People who have had a heart attack are reported to benefit from diets rich in alpha-linolenic acid, which is found in flaxseed. Good studies that examine the effect of flaxseed on heart disease in humans are not available. It is unclear whether flaxseed supplementation alters the course of heart disease.
In laboratory and animal studies, flaxseed and flaxseed oil are reported to lower blood cholesterol levels. Effects on blood triglyceride levels in animals are unclear, with increased levels in some research, and decreased levels in other research. Human studies in this area report mixed results, with decreased blood levels of total cholesterol and low-density lipoprotein ("bad cholesterol") in some studies, but no effect in other studies. Most human research has not been well-designed, and further research is needed before a recommendation can be made.
Flaxseed has been well-tolerated in studies for up to four months. Avoid if allergic to flaxseed, flaxseed oil, or other plants of the Linaceae family. Avoid with prostate cancer, breast cancer, uterine cancer, or endometriosis. Avoid ingestion of immature flaxseed pods. Avoid large amounts of flaxseed by mouth and mix plenty of water or liquid. Avoid flaxseed (not flaxseed oil) with a history of esophageal stricture, ileus (loss of bowel motility), gastrointestinal stricture or bowel obstruction. Avoid with a history of acute or chronic diarrhea, irritable bowel syndrome, diverticulitis (bowel inflammation), or inflammatory bowel disease. Avoid topical flaxseed in open wounds or abraded skin surfaces. Use cautiously with a history of a bleeding disorders, high triglyceride levels, diabetes, mania, seizures, or asthma. Use cautiously if taking drugs that increase the risk of bleeding or nonsteroidal anti-inflammatory drugs (NSAIDs). Avoid if pregnant or breastfeeding.
Folate: Folate and folic acid are forms of a water-soluble B vitamin. Folate occurs naturally in food, and folic acid is the synthetic form of this vitamin. Elevated homocysteine levels may be a marker of heart disease. Preliminary data suggest that folic acid lowers homocysteine levels and might reduce the risk of vascular disease (cardiac, peripheral, or cerebral). However, folic acid does not seem to help with secondary prevention of death or cardiovascular events, such as stroke or heart attack, in people with existing coronary artery disease (CAD) or prior stroke. Large randomized controlled trials are needed before a firm conclusion can be drawn.
Avoid if allergic or hypersensitive to folate or any of the product ingredients. It is recommended that pregnant women consume 400 micrograms daily in order to reduce the risk of the fetus developing a defect. Folate is likely safe if breastfeeding.
Gamma oryzanol: Gamma oryzanol occurs in rice bran oil and has been extracted from corn and barley oils as well. Gamma oryzanol has been used to reduce restenosis (return of blood vessel blockages after treatment) after coronary dilation, in combination with ticlopidine and probucol. Although restenosis was not impacted by any of the treatments, study with gamma oryzanol alone is needed to establish its effect on restenosis.
Avoid if allergic/hypersensitive to gamma oryzanol, its components, or rice bran oil. Use cautiously if taking anticoagulants (blood thinners), central nervous system (CNS) suppressants, growth hormone, drugs or herbs that alter blood sugar levels, immunomodulators, luteinizing hormone, luteinizing hormone-releasing hormone, prolactin, cholesterol-lowering drugs, thyroid drugs, or herbs or supplements with similar effects. Use cautiously with diabetes, hypothyroidism, hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), or high cholesterol. Avoid if pregnant or breastfeeding.
Garlic: The garlic bulb is made of many cloves that are wrapped in a paper-thin, white skin. It is used both medicinally and as a spice in food. Preliminary research in humans suggests that deposits of cholesterol in blood vessels may not grow as quickly in people who take garlic. It is unclear if this is due to the ability of garlic to lower cholesterol levels or to other effects of garlic.
Familial hypercholesterolemia is a genetic disorder in which very high cholesterol levels run in families. Research in children with an inherited form of high cholesterol suggests that garlic does not have a large effect in lowering cholesterol levels in these patients.
It is unclear if garlic prevents future heart attacks in people who have already had heart attacks. The effects of garlic on cholesterol levels may be beneficial in such patients.
Avoid if allergic or hypersensitive to garlic or other members of the Lilaceae (lily) family (e.g. hyacinth, tulip, onion, leek, or chive). Avoid with a history of bleeding problems, asthma, diabetes, low blood pressure or thyroid disorders. Stop using supplemental garlic two weeks before and immediately after dental/surgical/diagnostic procedures with bleeding risks. Avoid in supplemental doses if pregnant or breastfeeding.
Ginseng: The roots of this slow-growing plant have been valued in Chinese medicine. Several studies from China report that ginseng in combination with various other herbs may reduce symptoms of coronary artery disease. Without further evidence of the effects of ginseng specifically, a firm conclusion cannot be reached.
Low-quality studies have studied various doses of Panax ginseng to reduce cholesterol levels. Further research is warranted in this area.
Avoid ginseng if known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in the ginseng formulation.
Goldenseal: Goldenseal is one of the five top-selling herbal products in the United States. Berberine, a compound isolated from goldenseal, may lower cholesterol and triglycerides with a mechanism of action different from that of statin drugs.
Avoid if allergic or hypersensitive to goldenseal or any of its constituents, such as berberine or hydrastine. Use cautiously with bleeding disorders, diabetes, or low blood sugar. Avoid if pregnant or breastfeeding.
Grapefruit: Grapefruit pectin supplementation may inhibit hypercholesterolemia (high cholesterol). There is promising but inconclusive human evidence to support the use of grapefruit pectin in the prevention of heart disease. Additional study is needed in this area.
Avoid if allergic to grapefruit. Grapefruit may interact with prescription drugs, herbs, or supplements. Use cautiously if taking anticoagulants, anti-platelet drugs, antiarrhythmics, anticonvulsants, antidepressants, antihistamines, antihypertensives, benzodiazepines, channel blockers, caffeine, corticosteroids, erectile dysfunction medications, estrogens, immune modulators, HMG-CoA reductase inhibitors, macrolide antibiotics, protease inhibitors, or drugs that are broken down by the liver. Use cautiously if drinking red wine or tonic water. Use cautiously when smoking or with liver cirrhosis or if at risk for kidney stones. Use cautiously in patients that have undergone gastric bypass surgery. Use cautiously if pregnant or breastfeeding.
Green tea: Green tea is made from the dried leaves of Camellia sinensis, an evergreen shrub. There is early suggestive evidence that regular intake of green tea may reduce the risk of heart attack or atherosclerosis (clogged arteries). Further well-designed clinical trials are needed before a recommendation can be made in this area.
Laboratory studies, animal studies, and limited human research suggest possible effects of green tea on cholesterol and triglyceride levels. Better human evidence is necessary in this area.
Avoid if allergic or hypersensitive to caffeine or tannin. Use cautiously with diabetes or liver disease.
Guggul: Guggul (gum guggul) is a resin produced by the mukul mirth tree. Prior to 2003, the majority of scientific evidence suggested that guggulipid elicits significant reductions in serum total cholesterol, low-density lipoprotein (LDL), and triglycerides, as well as elevations in high-density lipoprotein (HDL). However, recent evidence provides preliminary evidence against the efficacy of guggul for hypercholesterolemia. Due to the precedent of prior research and historical use, further study is necessary before a definitive conclusion can be reached.
Avoid if allergic to guggul. Avoid with a history of thyroid disorders, anorexia, bulimia, or bleeding disorders. Signs of allergy to guggul may include itching and shortness of breath. Avoid if pregnant or breastfeeding.
Gymnema: Gymnema is found in India and some parts of Africa. It is commonly used in Ayurvedic medicine. Preliminary research in people with type 2 diabetes reports decreased cholesterol and triglyceride levels. Better evidence is needed before a clear conclusion can be drawn.
Avoid if allergic or hypersensitive to plants in the Asclepiadaceae (
Prevention
High blood pressure (hypertension) control: One of the most important things that can be done to prevent coronary artery disease (CAD) and heart attack is to reduce high blood pressure. Blood pressure should be a systolic reading of 120 and a diastolic reading of 80 (120/80 millimeters of mercury). Exercising, managing stress, maintaining a healthy weight, and limiting sodium and alcohol intake are all ways to keep blood pressure in check. Medications to treat hypertension, such as diuretics, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers, may also be used.Cholesterol and saturated fat intake reduction: Eating less cholesterol and fat, especially saturated fat, may reduce the amount of plaque in the arteries. Most people should aim for a low density lipoprotein (LDL) level below 130 milligrams per deciliter of blood. If there are other risk factors for heart disease, the target LDL may be below 100 milligrams per deciliter of blood. If the individual is at a very high risk for heart disease, such as having a previous heart attack, an LDL level below 70 milligrams per deciliter of blood may be optimal. Statin drugs (HMG-CoA reductase inhibitors) can be prescribed to help maintain healthy cholesterol levels.
Platelet inhibitors: In otherwise healthy men who are older than 50 years, 325 milligrams of aspirin every other day helps prevent heart attack (at a rate of two men per 1,000), but not stroke. In otherwise healthy women older than 45 years, a 100 milligram dose of aspirin every other day prevents ischemic stroke (at a rate of three women per 1,000) but not heart attack (myocardial infarction). Platelet inhibitors, or antiaggregants (prevent platelet clumping), such as aspirin may increase the risk of gastrointestinal bleeding. Other platelet inhibitors include dipyridamole (Persantine®), ticlopidine (Ticlid®), and clopidogrel (Plavix®). A 15% relative risk reduction in vascular events (stroke, death, and heart attack) has been documented for aspirin compared with placebo.
Smoking cessation: Smoking is a major risk factor for coronary artery disease. Nicotine constricts blood vessels and forces the heart to pump harder. A buildup of carbon monoxide (CO) reduces oxygen in the blood and damages the lining of the blood vessels. Therefore, individuals can decrease their risk of heart disease by not smoking.
Flu shots: Flu shots for patients with chronic cardiovascular disease are now used routinely. This is because patients with cardiovascular disease have an increased risk of dying from the flu.
Weight control: Being overweight contributes to other risk factors for stroke, such as high blood pressure, cardiovascular disease, and diabetes. Weight loss of as little as 10 pounds may lower blood pressure and improve cholesterol levels.
Exercise: Exercise can lower blood pressure, increase the level of HDL cholesterol (good cholesterol), and improve the overall health of blood vessels and heart. It also helps control weight, control diabetes and reduce stress. Thirty minutes daily of exercise is normally recommended.
Stress management: Stress can cause an increase in blood pressure along with increasing the blood's tendency to clot. Chronic stress can lead to an increase in the release of the stress hormone cortisol from the adrenal glands. Researchers believe that this increase in cortisol leads to increased blood pressure. Managing stress can be vital to keeping a heart healthy.
Diet: Eat healthy foods. A healthy diet should include five or more daily servings of fruits and vegetables, foods rich in soluble fiber (such as oatmeal and beans), foods rich in calcium (dairy products, spinach), soy products (such as tempeh, miso, tofu, and soy milk), and foods rich in omega-3 fatty acids, including cold-water fish, such as salmon, mackerel, and tuna. Pregnant women and women who plan to become pregnant in the next several years should limit their weekly intake of cold-water fish because of the potential for mercury contamination. The U.S. Food and Drug Administration (FDA) has announced that whole grain barley and barley-containing products are allowed to claim that they reduce the risk of coronary artery disease.
Alcohol consumption: In some studies, moderate use of alcohol (particularly red wine) has been linked with increasing levels of HDL cholesterol. No more than two glasses of red wine (four ounces each) should be consumed daily for heart protection. Excessive drinking can have a negative impact on cholesterol levels, actually raising triglyceride levels and increasing blood pressure.
Cholesterol screenings: Everyone age 20 and older should have their cholesterol measured at least once every five years.
Author information
Natural Standard is an international research collaboration that aggregates and synthesizes data on complementary and alternative therapies. Using a comprehensive methodology and reproducible grading scales, information is created that is evidence-based, consensus-based, and peer-reviewed, tapping into the collective expertise of a multidisciplinary Editorial Board. The mission of this collaboration is to provide objective, reliable information that aids clinicians, patients, and healthcare institutions to make more informed and safer therapeutic decisions. Natural Standard is widely recognized as one of the worlds premier sources of information in this area.Bibliography
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Centers for Disease Control and Prevention (CDC). www.cdc.gov. Accessed July 30, 2007.
Harris WS, Assaad B, Poston WC. Tissue omega-6/omega-3 fatty acid ratio and risk for coronary artery disease. Am J Cardiol. 2006 Aug 21;98(4A):19i-26i. Epub 2006 May 30. View Abstract
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Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com. Copyright © 2007. Accessed July 30, 2007.
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Related Terms
Angioplasty, blood pressure, blood vessels, CAD, cardiovascular disease, cardiovascular health, cholesterol, cor pulmonale, coronary artery disease, EKG, electrocardiograph, endocarditis, heart, heart attack, heart disease, heart failure, high blood pressure, high cholesterol, hyperlipidemia, hypertension, myocardial infarction, pericarditis, stroke.
Natural Standard Bottom Line Monograph, Copyright © 2009 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intendedfor informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
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