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- Integrative therapies for a heart attack include supplements that may lower cholesterol, decrease blood pressure, protect the heart, and decrease stress.
- Strong Scientific Evidence:
[Beta glucan]: Beta-glucan is a soluble fiber derived from the cell walls of algae, bacteria, fungi, yeast, and plants. It is commonly used for its cholesterol-lowering effects. Numerous trials have examined the effects of oral beta-glucan on cholesterol. Small reductions in total and LDL cholesterol ("bad" cholesterol) have been reported. Little to no significant changes have been noted to occur on triglyceride levels or HDL ("good" cholesterol) levels. The sum of existing evidence is suggestive and not definitive. Caution is advised when taking beta glucan supplements, as numerous adverse effects including drug interactions are possible. Beta glucan supplements are not generally used during pregnancy or breastfeeding unless otherwise advised by a doctor.
[Beta-sitosterol]: Beta-sitosterol is one of the most common dietary plant sterols (chemical found in certain plants) found and synthesized exclusively by plants such as in fruits, vegetables, soybeans, breads, peanuts and peanut products. Many studies in humans and animals have demonstrated that eating more foods that contain beta-sitosterol decreases total serum cholesterol, as well as low-density lipoprotein (LDL) cholesterol. Caution is advised when taking beta-sitosterol supplements, as numerous adverse effects including drug interactions are possible. Beta-sitosterol supplements are not generally used during pregnancy or breastfeeding unless otherwise advised by a doctor.
[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"), with better results than prescription drugs such as "statins" like atorvastatin (Lipitor ®). There are also benefits on levels of low-density cholesterol (LDL or "bad cholesterol"), although these effects are less dramatic. Adding niacin therapy as a second drug when using a statin may increase the effects on low-density lipoproteins. The use of niacin for the treatment of high blood cholesterol associated with type 2 diabetes has been controversial because of the possibility of worsening blood sugar control. Individuals should check with a physician and pharmacist before starting niacin.
[Omega-3 fatty acids]: Omega-3 fatty acids are essential fatty acids found in some plants and fish. There should be a balance of omega-6 and omega-3 fatty acids for health. There is strong scientific evidence from human trials that omega-3 fatty acids from fish or fish oil supplements significantly reduce blood triglyceride levels. Fish oil supplements also appear to cause small improvements in high-density lipoprotein ("good cholesterol"); however, increases (worsening) in low-density lipoprotein levels (LDL/"bad cholesterol") are also observed. 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 (death due to any cause). 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. Preliminary studies also report reductions in angina associated with fish oil intake. Better research is necessary before a firm conclusion can be drawn. Caution is advised when taking omega-3 supplements, as numerous adverse effects including an increase in bleeding and drug interactions are possible. Omega-3 supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
[Policosanol]: Policosanol is a cholesterol-lowering natural mixture of higher aliphatic primary alcohols, isolated and purified from sugar cane wax. Policosanol has been used to treat high cholesterol levels, and numerous studies have analyzed the effects of policosanol on cholesterol levels, including a number of well-designed trials. At this time, the evidence supporting the efficacy of this agent is compelling, although greater acceptance in the U.S. market may await completion of a large, well-conducted randomized trial in the United States. Caution is advised when taking policosanol, as adverse effects including drug interactions are possible. Policosanol supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
[Psyllium]: Psyllium (Plantago ovata), also referred to as ispaghula, is derived from the husks of the seeds of psyllium. Psyllium contains a high level of soluble dietary fiber, and is the chief ingredient in many commonly used bulk laxatives, including products such as Metamucil ® and Serutan ®. Psyllium is well studied as a cholesterol 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 health care provider. Effects have been observed in adults and children, although long-term safety in children is not established. Psyllium can decrease the absorption of many prescription and non-prescription medications and dietary supplements.
[Red yeast rice]: Red yeast rice is the product of yeast (Monascus
purpureus) grown on rice, and the resulting product is served as a dietary staple in some Asian countries. It contains several compounds collectively known as Monacolins, substances known to inhibit cholesterol synthesis. One of these, "Monacolin K", is a potent inhibitor of HMG-CoA reductase and is also known as lovastatin (Mevacor ®). Preliminary evidence reports that taking red yeast rice
by mouth may result in heart benefits and improve blood flow. 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. Caution is advised when taking red yeast rice supplements, as adverse effects including drug interactions are possible. Red yeast rice supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor. Red yeast rice should not be used in people with liver problems or in heavy alcohol users.
[Soy]: Soy (Glycine max) is a member of the pea family and has been a dietary staple in Asian countries for at least 5,000 years. 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. Dietary soy protein has not been proven to affect long-term cardiovascular outcomes such as heart attack or stroke. Soy products such as tofu are high in protein and are an acceptable source of dietary protein. Caution is advised when taking soy supplements, as adverse effects including drug interactions are possible. Soy supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
- Good Scientific Evidence:
[Betaine]: Betaine is found in most microorganisms, plants, and marine animals. Its main physiologic functions are to protect cells under stress and to serve as a source of methyl groups needed for many biochemical pathways. Betaine is also found naturally in many foods and is most highly concentrated in beets, spinach, grain, and shellfish. Overall, betaine supplementation may produce significant reductions in homocysteine, a known risk factor of CAD. However, additional studies are needed. Betaine supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
[Cordyceps]: Cordyceps sinensis 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. Caution is advised when taking cordyceps supplements, as adverse effects including drug interactions are possible. Cordyceps supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
[Garlic]: Garlic (Allium sativum) is traditionally used for heart health. Multiple studies in humans have reported small reductions in total blood cholesterol and low-density lipoproteins ("bad cholesterol") over short periods of time (4 to 12 weeks). It is not clear if there are benefits after this amount of time. Effects on high-density lipoproteins ("good cholesterol") are not clear. This remains an area of controversy. Well-designed and longer studies are needed in this area. Caution is advised when taking garlic supplements, as adverse effects including an increase in bleeding and drug interactions are possible. Garlic supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
[L-carnitine]: L-carnitine, or acetyl-L-carnitine, is an amino acid found in the body. Evidence from clinical trials suggests that L-carnitine is effective in reducing symptoms of angina. Carnitine may not offer further benefit when patients continue conventional therapies. Additional study is needed to confirm these findings. L-carnitine is generally safe when used in recommended dosages.
[Yoga]: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Several human studies suggest that yoga is helpful in people with heart disease. However, it is not clear 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.
- Unclear or Conflicting Scientific Evidence:
[Acupuncture]: The practice of acupuncture, or the insertion of needles, originated in China 5,000 years ago. Some research has suggested that acupuncture might help reduce distress and symptoms of angina, but this has not been consistently shown in other studies.
[L-arginine]: L-arginine, or arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required. There is initial evidence from several studies that arginine taken by mouth or by injection improves exercise tolerance and blood flow in arteries of the heart. Benefits have been reported in some patients with coronary artery disease and angina. Studies also suggest that arginine supplementation after myocardial infarction (heart attack) may decrease the heart damage. However, further research is needed to confirm these findings. L-arginine is generally safe in recommended dosages.
[Astragalus]: Astragalus products are derived from the roots of Astragalus membranaceus or related species, which are native to China. 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. Caution is advised when taking astragalus supplements, as adverse effects including drug interactions are possible. Astragalus supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
[Bilberry]: Bilberry (Vaccinium myrtillus) is also known as the European blueberry, is widely used as an antioxidant for general health. 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. Caution is advised when taking bilberry supplements, as adverse effects including an increase in bleeding and drug interactions are possible. Bilberry supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
[Coenzyme Q10 (CoQ10)]: CoQ10 is produced by the human body and is necessary for the basic functioning of cells. Preliminary small human studies suggest that CoQ10 may reduce angina and improve exercise tolerance in people with clogged heart arteries. Several studies also 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 needed. CoQ10 is generally safe in recommended dosages.
[Ginseng]: Asian ginseng, or Panax ginseng, has been used for more than 2,000 years in Chinese medicine for various health conditions. Several studies from China report that ginseng in combination with various other herbs may reduce symptoms of coronary artery disease. Ginseng may also lower blood pressure. Caution is advised when taking ginseng supplements, as adverse effects including drug interactions are possible. Ginseng supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
[Green tea]: Green tea is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. Green tea has a long history of use, dating back to China approximately 5,000 years ago. Green tea, black tea, and oolong tea are all derived from the same plant, but the leaves are processed differently. There is evidence that regular intake of green tea may lower cholesterol levels and reduce the risk of heart attack or atherosclerosis (clogged arteries). Caution is advised when taking green tea supplements, as adverse effects including drug interactions are possible. Green tea supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
[Hawthorn]: Hawthorn (Crataegus sp.), a flowering shrub of the rose family, has an extensive history of use in cardiovascular disease dating back to the first century. Increased blood flow to the heart and heart performance have been observed in animals due when given hawthorn supplements, and one randomized clinical trial indicates that hawthorn may be effective in decreasing frequency or severity of anginal symptoms. Hawthorn has not been tested in the setting of concomitant drugs such as beta-blockers or ACE-inhibitors, which are often considered to be standard-of-care. At this time, there is insufficient evidence to recommend for or against hawthorn for coronary artery disease or angina. Caution is advised when taking hawthorn supplements, as adverse effects including drug interactions are possible. Hawthorn supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
[Kudzu]: Kudzu (Pueria lobota) is well known to people in the Southeastern United States as an invasive weed, but it has been used in Chinese medicine for centuries. Kudzu has a long history of use in the treatment of cardiovascular disorders, including angina, acute myocardial infarction, and heart failure. A small number of poorly designed trials found kudzu to reduce the frequency of angina events in human subjects. Overall, the studies have been methodologically weak. Caution is advised when taking kudzu supplements, as adverse effects including drug interactions are possible. Kuzdu supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
[Kundalini yoga]: Kundalini yoga is one of many traditions of yoga that shares common roots in ancient Indian philosophy. It is comprehensive in that it combines physical poses with breath control exercises, chanting (mantras), meditations, prayer, visualizations, and guided relaxation. One case series report, but no formal clinical trials, suggests that breathing techniques used in Kundalini Yoga may help people with angina pectoris reduce symptoms and need for medication. A specific breathing technique of Kundalini yoga reputed to help prevent heart attacks was examined in one study to determine its effects on heart function. The technique is a one breath per minute respiratory exercise with slow inspiration for 20 seconds, breath retention for 20 seconds, and slow expiration for 20 seconds, for 31 consecutive minutes. The technique was found to stabilize the heart's electrical wave patterns, which may have preventive value in heart health.
[Prayer]: Prayer has far reaching healing effects that are hard to study. Initial studies in patients with heart disease report variable effects on severity of illness, complications during hospitalization, procedure outcome, or death rates when intercessory prayer is used. Results are found only when people know that others might be praying for them.
[Psychotherapy]: Psychotherapy is an interactive process between a person and a qualified mental health professional (psychiatrist, psychologist, clinical social worker, licensed counselor, or other trained practitioner). Its purpose is the exploration of thoughts, feelings and behavior for the purpose problem solving or achieving higher levels of functioning. Alexithymia, or the inability to express one's feelings, may influence the course of coronary heart disease (CHD). Educational sessions and group psychotherapy may decrease alexithymia and reduce cardiac events.
[Quercetin]: Quercetin is one of the almost 4,000 bioflavonoids (antioxidants) that occur in foods of plant origin, such as red wine, onions, green tea, apples, berries, and brassica vegetables (cabbage, broccoli, cauliflower, turnips). Several of the effects of flavonoids that have been observed in laboratory and animal studies suggest that they might be effective in reducing cardiovascular disease risk. Studies in humans using polyphenolic compounds from red grapes showed improvement in endothelial function in patients with coronary heart disease. Antioxidant and cholesterol-lowering effects are proposed.
[Reishi]: Reishi (Ganoderma lucidum) is a mushroom that grows wild on decaying logs and tree stumps.
Reishi has been used in traditional Chinese medicine for more than 4,000 years to treat liver disorders, high blood pressure, arthritis and other ailments. A reishi supplement was reported to improve the major symptoms of coronary heart disease (e.g., angina (chest pain), palpitations, shortness of breath, blood pressure, and cholesterol) in patients. Long-term studies are needed to evaluate the efficacy and safety of reishi in coronary heart disease. Caution is advised when taking reishi supplements, as adverse effects including an increase in bleeding and drug interactions are possible. Reishi supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
[Relaxation therapy]: Relaxation techniques include behavioral therapeutic approaches that differ widely in philosophy, methodology, and practice. The primary goal is usually non-directed relaxation. Most techniques share the components of repetitive focus (on a word, sound, prayer phrase, body sensation, or muscular activity), adoption of a passive attitude towards intruding thoughts, and return to the focus.
[Resveratrol]: Resveratrol is found in over 70 plant species including nuts, grapes, pine trees, certain vines and red wine. Resveratrol is used as an antioxidant in various health conditions, including heart disease prevention. Laboratory animal studies suggest resveratrol helps restore blood flow to the heart. Well-designed clinical trials in humans using resveratrol are needed. Caution is advised when taking resveratrol supplements, as adverse effects including an increase in bleeding and drug interactions are possible. Resveratrol supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
[Tai chi]:
Tai Chi is a system of movements and positions believed to have developed in 12th century China. Tai Chi techniques aim to address the body and mind as an interconnected system, and are traditionally believed to have mental and physical health benefits to improve posture, balance, flexibility and strength. There is evidence that suggests tai chi decreases blood pressure and cholesterol as well as enhances quality of life in patients with chronic heart failure. Most studies have used elderly Chinese patients as their population. Additional research is needed before a firm conclusion can be drawn.
[Vitamin B12]: Vitamin B12 (or cyanocobalamin) is an essential water soluble vitamin that is commonly found in a variety of foods such as fish, shellfish, meats, and dairy products. Vitamin B12 is frequently used in combination with other B vitamins in a vitamin B complex formulation. Folic acid, pyridoxine (vitamin B6), and vitamin B12 supplementation can reduce total homocysteine levels (a known risk factor of CAD). However, this reduction does not seem to help with secondary prevention of death or cardiovascular events such as stroke or myocardial infarction in people with prior stroke. More evidence is needed to fully explain the association of total homocysteine levels with vascular risk and the potential use of vitamin supplementation.
[Vitamin B6]: Vitamin B6 or pyridoxine is found in cereal grains, legumes, vegetables (carrots, spinach, peas), potatoes, milk, cheese, eggs, fish, liver, meat, and flour. Mild deficiencies of this B vitamin are common. Vitamin B6 may help lower homocysteine levels. Also, decreased vitamin B6 concentrations are also associated with increased plasma levels of C-reactive protein (CRP). CRP is an indicator of inflammation that is associated with increased cardiovascular morbidity in epidemiologic studies.
[Vitamin E]: Vitamin E is a fat-soluble vitamin with antioxidant properties. Vitamin E has been suggested and evaluated in patients with angina, although possible benefits remain unclear. Vitamin E has been proposed to have a role in preventing or reversing atherosclerosis by inhibiting oxidation of low-density lipoprotein ("bad cholesterol"). Several population studies have suggested that a high dietary intake of vitamin E and high blood concentrations of alpha-tocopherol are associated with lower rates of heart disease. However, while the Cambridge Heart Antioxidant Study supported this hypothesis, the more recent prospective Heart Outcomes Prevention Evaluation (HOPE) study did not. This area remains controversial.
- Other: Other supplements that may have benefit in reducing the risk of developing coronary artery disease and heart attack include alfalfa (Medicago sativa L.), aortic acid, ashwagandha (Withania somnifera L), astaxanthin, avocado (Persea americana), ayurveda, barley (Hordeum vulgare), berberine, carob (Ceratonia siliqua), chamomile (Matricaria recutita, Chamaemelum nobile), chondroitin sulfate, coleus (Coleus forskohlii), copper, creatine, danshen (Salvia miltiorrhiza), DHEA, dong quai (Angelica sinensis), elder (Sambucas nigra L.), fenugreek (Trigonella foenum-graecum), flaxseed and flaxseed oil (Linum usitatissimum), folate (folic acid), gamma oryzanol, globe artichoke (Cynara scolymus L.), goldenseal (Hydrastis canadensis L.), grapefruit (Citrus paradisi), guggul (Commifora mukul), gymnema (Gymnema sylvestre R. Br.), honey, horny goat weed (Epimedium grandiflorum), Lactobacillus acidophilus, lemongrass (Cymbopogon spp.), lycopene, macrobiotic diet, meditation, milk thistle (Silybum marianum), nopal (Opuntia spp.), ozone therapy, pantethine (pantethenic acid), physical therapy, pomegranate (Punica granatum), probiotics, pycnogenol (Pinus pinaster ssp. atlantica), Red Clover (Trifolium pratense), rhubarb (Rheum officinale, Rheum palmatum), safflower (Carthamus tinctorius), scotch broom (Cytisus scoparius Linn.), selenium, spirulina, squill (Urginea maritima, Scilla maritima), sweet almond (Prunus amygdulus dulcis), taurine, TENS (Transcutaneous Electrical Nerve Stimulation), Traditional Chinese medicine (TCM), tribulus (Tribulus terrestris), turmeric (Curcuma longa Linn.), Vitamin D, white horehound (Marrubium vulgare), wild yam (Dioscoreaceae villosa), and zinc.
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