Use of complementary and alternative medical therapies in patients with cardiovascular disease

doi:10.1016/S0002-8703(03)00084-X

American Heart Journal

Volume 145, Issue 5, May 2003, Pages 806-812

https://doi.org/10.1016/S0002-8703(03)00084-X Get rights and content

Abstract

Background

Complementary and alternative medical (CAM) therapies are becoming increasingly popular, yet little information is available about the prevalence and patterns of CAM therapy use by patients with cardiovascular disease (CVD).

Methods

Interviewers administered telephone questionnaires to 107 patients randomly selected from a stratified cohort of 2487 eligible patients participating in a registry of patients with CVD.

Results

The current use of CAM therapies was reported by 64% of the patients surveyed. Nutritional supplements (40%) and megadose vitamins (35%) were the most frequently used preparations. Most CAM therapy users (65%) cited their underlying cardiac condition as the reason for taking such therapy. The most common sources of information about CAM were a friend or relative (43%) or the respondent’s usual physician. However, although 80% of respondents claimed that they had discussed their use of CAM therapies with their physician, 58% of respondents taking a potentially toxic cardiovascular medication (digoxin, warfarin, sotalol, or amiodarone) were simultaneously taking an oral supplement.

Conclusion

The use of CAM therapies was high in the cohort of patients surveyed. Physicians caring for patients with CVD need to inquire about CAM therapy use. Further scientific study should be performed to evaluate the potential benefits and risks of CAM therapies in this patient population.

Section snippets

Study population

Subjects were recruited from individuals consenting to long-term follow-up in the Improving Cardiovascular Outcomes in Nova Scotia (ICONS) study. This is a longitudinal, disease-management study involving all patients hospitalized with ischemic heart disease, congestive heart failure, and atrial fibrillation in the province of Nova Scotia, Canada (population approximately 940,000). The rationale and methods of the ICONS study have been described elsewhere.16 Participants who gave consent were

Characteristics of survey population

As designed, the mean age of the survey population was similar to that of the parent population (64.3 ± 11.9 years vs 68.8 ± 13.3 years, respectively), and there was no statistically significant difference between the 2 groups in the sex mix (Table II). However, despite age- and sex-matching, the study cohort differed from the larger population from which it was drawn across several variables, including mean household annual income, age of women, and underlying cardiovascular diagnosis.

CAM therapy use

The use

Discussion

Recent reports have documented the increasing popularity of CAM therapy use by patients with chronic disease.20, 21, 22, 23 The findings of our study suggest that patients with cardiovascular disease, like patients with other medical conditions, are very likely to incorporate CAM therapies into their treatment plans. This may be done in an attempt to improve their health and to prevent further illness.20, 21, 22, 23 Our survey found a much higher prevalence of dietary supplement use compared

Acknowledgements

We thank David Eisenberg, MD, for his thoughtful review and constructive advice.

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A total of 749 patients were included in the study, of which 168 (22%) were classified as patients with CVD. High usage of herbal medicine was observed in all of the interviewed patients; 39% of patients were using herbs with primary effects on CVD (ginkgo and garlic being the most common), and 56% of them used herbs for other ailments. Approximately half of the patients considered that it was not necessary to inform or consult a doctor about herbal co-therapy. No adverse effects were recorded.
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Despite the shortage of adequate evidence on the safety of herbal products, their practice as an alternative or complementary medicine is gaining popularity worldwide among health practitioners. Evidence shows increasing attention toward the medical herbs as a forerunner for a pharmacological activity to treat different ill patients. One of the severe associations is the coadministration of herbal medicine along with traditional/conventional drugs. Herb–drug interaction becomes the single most essential clinical consequence of the practice. It can impact health and the effectiveness of treatments. Using the structural evaluation process, the confirmation of herb–drug interaction presents a different degree of clinical importance. Various pharmacokinetic and pharmacodynamic mechanisms were proposed for herb–drug interactions, including the alteration/modification in the gastrointestinal function with the subsequent effects on the absorption, distribution, inhibition, and induction of the metabolic enzymes and transporters, and altercation of renal elimination of the drugs and their respective metabolites. This chapter expounds on the risk associated with herb–drug interactions with some classical examples supported with clinical evidence and mechanisms involved. A cross-talk on the regulatory aspects and methods followed for the prediction of herb–drug interactions is also provided.
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Nutraceuticals are pharmacologically active substances extracted from vegetable or animal food and administered to produce health benefits. We recently reviewed the current evidence for nutraceuticals in patients diagnosed with heart failure as part of the writing of the Australian Guidelines for the prevention, diagnosis, and management of heart failure.
A systematic search for studies that compared nutraceuticals to standard care in adult patients with heart failure was performed. Studies were included if >50 patients were enrolled, with ≥6 months follow-up. If no studies met criteria then studies <50 patients and <6 months follow-up were included. The primary outcomes included mortality/survival, hospitalization, quality of life, and/or exercise tolerance. Iron was not included in this review as its role in heart failure is already well established.
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Only one nutraceutical, omega-3 polyunsaturated fatty acid, received a positive recommendation in the Australian heart failure guidelines. Although occasionally showing some promise, all other nutraceuticals are inadequately studied to allow any conclusion on efficacy. Clinicians should favor other treatments that have been clearly shown to decrease mortality.
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In this regard, herbal medicine approach can be a promising adjunctive therapy due to its multipronged mechanisms of action [11–15]. Historically, many herbal agents have been tested and applied in the prevention and management of CVD and its risk factors [11–14,16–18]. Among these compounds, saffron has attracted significant attention recently, both in the scientific and consumer societies.
Cardiovascular disease is a one of most common causes of mortality around the world. This meta-analysis aims to summarize and conclude the clinical evidence regarding the use of saffron and its constituents, in particular crocin, on cardiovascular risk factors. A systematic review was conducted with PubMed, Scopus, Web of Science, Cochrane library and Google Scholar up to 24 May 2018. Randomized controlled trials (RCTs) that assessed the clinical effects of saffron and/or its constituents on blood lipid profile, glycemic parameters, blood pressure and anthropometric indices in human subjects were included. Eleven publication from ten studies comprising 622 participants included in quantitative analysis. Pooling of results showed significant effect of saffron on diastolic blood pressure (−1.24 mmHg; 95% CI: −1.51 to −0.96; I² = 0%), body weight (−1.29 kg; 95% CI: −2.14 to −0.44; I² = 70%) and waist circumstance (−1.68 cm; 95% CI: −3.31 to −0.04; I² = 51%). When subgroup analysis was performed based on quality of studies, a significant reduction in fasting plasma glucose levels was observed in subgroup with high quality studies (−10.14 mg/dl; 95% CI: −13.80 to −6.48; I² = 0%). Meta-analysis did not reveal any significant change in lipid profile, fasting insulin, systolic blood pressure and body mass index following saffron consumption. Present meta-analysis suggests that saffron might be beneficial in several outcomes related with cardiovascular disease. However, further RCTs with long term intervention with different dose of administration are needed.
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Complementary and alternative medicines are developing at a growing rate but their use in the hospital setting is little known, ignoring risk or benefit in practice. The objectives of the study were to quantify the prevalence of complementary and alternative medicines used by patients admitted to a cardiac surgery department.
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^☆

The ICONS study is supported through a nondirected educational grant from Merck Frosst Canada and through in-kind support from the Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada, and the Nova Scotia Department of Health.

Dr Cox receives salary support from a Canadian Institutes of Health Research/Regional Partnership Program Investigator Award and a Clinical Research Scholarship from the Faculty of Medicine, Dalhousie University.

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Progress in cardiologyUse of complementary and alternative medical therapies in patients with cardiovascular disease☆

Abstract

Background

Methods

Results

Conclusion

Section snippets

Study population

Characteristics of survey population

CAM therapy use

Discussion

Acknowledgements

Lancet

J Thorac Cardiovasc Surg

Am J Gastroenterol

Chest

Am J Med

Unconventional medicine in the United States

N Engl J Med

Trends in alternative medicine use in the United States, 1990–1997results of a follow-up national survey

JAMA

Recent patterns of medication use in the ambulatory adult population of the United States

JAMA

Herbs of choicethe therapuetic use of phytomedicinals

Herbal medicine for the treatment of cardiovascular disease

Arch Intern Med

Elevated serum digoxin levels in a patient taking digoxin and Siberian ginseng

CMAJ

Adverse effects from traditional Chinese medicine

Lancet

Adverse reactions and interactions with herbal medicines part 1adverse reactions

Adverse Drug React Toxicol Rev

The role of plant-derived drugs and herbal medicines in healthcare

Drugs

Progress in cardiology
Use of complementary and alternative medical therapies in patients with cardiovascular disease☆