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ACC – Amanda Jekowsky: (202) 375-6645,
ajekowsk@acc.org
February
1, 2010
As Use of Herbal Remedies Soars, Patients Taking These and
Cardiovascular Medications May be at Heightened Risk of Dangerous,
Potentially Life-Threatening Interactions
Authors call for greater awareness and scientific
scrutiny, especially among elderly patients
More and more Americans are turning to herbal remedies to
help manage chronic conditions or promote general health and
wellness. But many of today’s popular herbal supplements,
including St. John’s wort, gingko biloba, garlic and
even grapefruit juice can pose serious risks to people who
are taking medications for heart disease, according to a review
article published in the February, 9, 2010, issue of the Journal
of the American College of Cardiology. The use of these
products is especially concerning among elderly patients who
typically have co-morbidities, take multiple medications and
are already at greater risk of bleeding, according to authors.
“Many people have a false sense of security about these
herbal products because they are seen as ‘natural,’”
Arshad Jahangir, M.D., Professor of Medicine and Consultant
Cardiologist, Mayo Clinic Arizona, adding that more than 15
million Americans reportedly use herbal remedies or high-dose
vitamins. “But ‘natural’ doesn’t always
mean they are safe. Every compound we consume has some effect
on the body, which is, in essence, why people are taking these
products to begin with.”
In addition to their direct effects on body function, these
herbs can interact with medications used to treat heart disease,
either reducing their effectiveness or increasing their potency,
which may lead to bleeding or a greater risk for serious cardiac
arrhythmias.
“We can see the effect of some of these herb-drug interactions—some
of which can be life-threatening—on tests for blood
clotting, liver enzymes and, with some medications, on electrocardiogram,”
Dr. Jahangir said.
According to the report, a major concern is that patients
do not readily disclose their use of herbal remedies, and
healthcare providers may not routinely ask about such use.
In addition, because these herbs are regarded as food products,
they are not subject to the same scrutiny and regulation as
traditional medications.
“If patients aren’t satisfied with their care
today, many will turn to herbs because they believe these
compounds can help them manage chronic conditions or improve
health and prevent future disease,” said Dr. Jahangir.
“In fact, patients are willing to spend nearly the same
or more on out-of-pocket expenses for herbal remedies than
traditional medical care.”
Two nationwide surveys conducted in 1990 and 1997 found that
the number of visits to complementary and alternative providers
increased from 427 million to 629 million, whereas the number
of visits to primary care physicians remained basically unchanged.
Some examples of herbs and their adverse effect on heart
disease management include:
- St. John’s wort, which is typically used to treat
depression, anxiety and sleep disorders among other problems,
reduces the effectiveness of medications contributing to
recurrences of arrhythmia, high blood pressure or increase
in blood cholesterol levels and risk for future heart problems.
- Ginkgo biloba, which is supposedly used to improve circulation
or sharpen the mind, increases bleeding risk in those taking
warfarin or aspirin.
- Garlic, which supposedly helps boost the immune system
and is commonly used for its cholesterol and blood pressure
lowering properties, can also increase the risk of bleeding
among those taking warfarin.
In addition to highlighting commonly used herbs and potential
interactions with cardiovascular medications, the present
review also outlines steps for improving their safe use and
reducing harm among patients with heart disease.
“These herbs have been used for centuries—well
before today’s cardiovascular medications—and
while they may have beneficial effects these need to be studied
scientifically to better define their usefulness and, more
importantly, identify their potential for harm when taken
with medications that have proven benefit for patients with
cardiovascular diseases,” said Dr. Jahangir. “Patients,
physicians, pharmacists and other healthcare providers need
to know about the potential harm these herbs can have.”
In addition to greater public education about the risks of
using herbal products, patients and clinicians need to actively
discuss the use of over-the-counter medications, supplements
and herbal products in addition to prescription medications.
Dr. Jahanigir also urges the scientific community to commit
to conducting studies to test manufacturers’ claims
and study the impact of these compounds on heart disease management.
He reports no conflict of interest.
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About the ACC:
The American College of Cardiology is leading the way to optimal
cardiovascular care and disease prevention. The College is
a 37,000-member nonprofit medical society and bestows the
credential Fellow of the American College of Cardiology upon
physicians who meet its stringent qualifications. The College
is a leader in the formulation of health policy, standards
and guidelines, and is a staunch supporter of cardiovascular
research. The ACC provides professional education and operates
national registries for the measurement and improvement of
quality care. More information about the association is available
online at www.acc.org . |
