cardiovascular

[Oral anticoagulants: a literature review of herb-drug interactions or food-drug interactions]: J Pharm Belg. 2007; 62(3): 69-75 Bourget S, Baudrant M, Allenet B, Calop J

OBJECTIVE: To identify herbal medicines and food products which can interact with anticoagulant therapy. MATERIAL AND METHOD: Literature review using key words: "anticoagulants", "herb-drug interaction", "food-drug interaction", "drug chinese herbal", "medicine herbal", "plant preparation", "dietary supplements". Data sources: Medline (january 1966 to june 2006) and Pascal (1987 to 2006). Case reports, systematic reviews, in vitro studies, clinical studies published in french or in english (or with an english extract) have been undertaken. RESULTS: Eighty articles were selected (two both including a case report and a study): 14 systemic review, 43 case reports, 25 studies (17 studies in humans: nine randomized and controlled, three controlled), six controlled studies in animals and two in vitro studies. DISCUSSION: A wide range of herbal medicines and food products can interact with anticoagulants. Clinical relevance of these effects is difficult to characterise (nature of existing reports, contradiction between studies, difficult extrapolation to human). CONCLUSION: It is difficult to predict the incidence or severity of such interactions. However, awareness of these potential interactions is necessary to achieve optimal anticoagulation therapy: pharmacist can play a crucial role identifying such interactions in case of disturbed INR; clinicians should be informed to monitor closely the therapy, particularly when such products are started or discontinued.

[Analysis on clinical treatment in hypertension by traditional Chinese medicine for 10 years in Beijing]: Zhongguo Zhong Yao Za Zhi. 2007 Aug;32(15):1569-72 Authors: Zou ZD, Liu N, Guo P, Guo LY, Sun Y, Shi J, Wang L

To make a retrospective study of clinical treatment in hypertension by traditional Chinese medicine for 10 years in Beijing, and to mainly analyze in three facets: the study on total regularity of using Chinese herbal medicine, the study on regularity of application, and the study on differentiation of symptoms and signs. RESULT: (1) Total regularity of using Chinese herbal medicine: They are tonic herbs, expelling phlegm and stopping winding herbs, heat-clearing herbs, blood-activating and stasis-resolving herbs, damp-clearing herbs in turn. The frequently used herbs were gouteng, niuxi, tianma, fuling, baishao, zexie, chuanxiong, and so on. (2) The study on regularity of application: The 6 kinds of herbs above were abide by the total regularity and the frequently used herbs were gouteng, niuxi, fuling, tianma, chuanxiong, baishao, zexie, and so on. (3) It was showed that the common syndromes of hypertension and herbs were: The herbs such as gouteng, niuxi, baishao, tianma, chuanxiong, juhua were frequently used in liver yang ascending syndrome. Herbs such as gouqizi, niuxi, shanyao, shudihuang, fuling, mudanpi, were frequently used in symptoms of yin deficiency of liver and kidney. Herbs such as huangqin, xiakucao, gouteng, zhizi, longdancao, juhua were frequently used in syndrome of flarming liver-fire. Herbs such as fuling, banxia, jupi, baizhu, tianma, gancao were frequently used in the stagnation of phlegm. Herbs such as tianma, gouteng, baishao, shijiuming, banxia were frequently used in up-stirring of liver. Herbs such as chuanxiong, chishao, honghua, danshen, sanqi were frequently used in syndrome of blood stasis in the collateral of the brain. Herbs such as shanzhuyu, shudi, fuling, rougui, fuzi, niuxi were frequently used in both-yini-and-yang-deficiency.

PMID: 17972592 [PubMed - in process]

Biotransformation of Green Tea Polyphenols and the Biological Activities of Those Metabolites.: Mol Pharm. 2007 Oct 27; Authors: Lambert JD, Sang S, Yang CS

Green tea ( Camellia sinensis, Theaceae) and its major polyphenol constituents, the catechins, have been reported to have many health benefits including the prevention of cancer and heart disease. Many mechanisms of action have been proposed based on in vitro models; however, the importance of most of these mechanisms remains to be determined in vivo. The bioavailability and biotransformation of tea catechins play a key role in determining the importance of various mechanisms in vivo. Likewise, the biological activity and bioavailability of tea catechin metabolites, an understudied area, are important in understanding the potential beneficial effects of tea. In this article, we review the data available on the biotransformation of the tea catechins and the limited data set available on the biological activities of the catechin metabolites. Careful interpretation of available data, carefully designed animal experiments, and integration of bioavailability and biological activity data are needed if the disease preventive activity of tea is to be understood. We hope this article will spark research efforts on some of the important questions regarding tea polyphenol bioavailability, biotransformation, and the biological activities of tea catechin metabolites.

PMID: 17963356 [PubMed - as supplied by publisher]

Ginkgo biloba extract improves coronary blood flow in patients with coronary artery disease: role of endothelium-dependent vasodilation.: Planta Med. 2007 Jun;73(7):624-8 Authors: Wu Y, Li S, Cui W, Zu X, Wang F, Du J

Ginkgo biloba extract (GBE) has well-documented cardioprotective effects on coronary flow and positive effects on vasodilation through endothelium-derived nitric oxide in experimental animals, but these impacts in patients with coronary artery disease (CAD) have not yet been investigated. We designed this study to test the effects of GBE on distal left anterior descending coronary artery (LAD) blood flow and endothelium-dependent brachial artery flow-mediated dilation (FMD) in patients with CAD. Eighty CAD patients were randomly assigned to either GBE or saline (control) groups. LAD blood flow and brachial artery FMD were measured non-invasively using high-resolution ultrasound before and after intravenous administration of GBE or saline. GBE significantly increased LAD blood flow in maximal diastolic peak velocity (MDPV), maximal systolic peak velocity (MSPV) and diastolic time velocity integral (DTVI) compared with the control group (16.14 +/- 10.93 % vs. 0.28 +/- 2.14 %, 9.14 +/- 8.23 % vs. 0.79 +/- 2.56 %, and 15.23 +/- 7.28 % vs. 0.42 +/- 2.43 %, respectively, p < 0.01). Brachial artery FMD was also increased by 69.75 % (from 3.95 +/- 1.49 % to 6.55 +/- 2.51 %, p < 0.01). A linear correlation was found between the percentage changes in MDPV, MSPV, or DTVI of LAD blood flow and the percentage change in brachial artery FMD following treatment with GBE (r = 0.612, 0.486, or 0.521, respectively, p < 0.01). In summary, our data demonstrate that GBE treatment in CAD patients leads to an increase of LAD blood flow in MDPV, MSPV and DTVI, and the increase response might relate to the improved endothelium-dependent vasodilatory capacity. CAD: coronary artery disease DTVI: diastolic time velocity integral FMD: flow-mediated dilation GBE: GINKGO BILOBA extract LAD: distal left anterior descending coronary artery MDPV: maximal diastolic peak velocity MSPV: maximal systolic peak velocity NO: nitric oxide TTDE: transthoracic Doppler echocardiography.

PMID: 17564952 [PubMed - indexed for MEDLINE]

An examination of the bleeding complications associated with herbal supplements, antiplatelet and anticoagulant medications.: J Dent Hyg. 2007;81(3):67 Authors: Spolarich A, Andrews L

Dental professionals routinely treat patients taking prescription, nonprescription, and herbal medications that are known or have the potential to alter bleeding. Prescription anticoagulant and antiplatelet medications, as well as over-the-counter drugs such as aspirin, are typically taken to reduce the risk of thromboembolic events, including stroke. Herbal supplements are widely used for a variety of indications, and both patients and health care practitioners are often unaware of the anticoagulant and antiplatelet effects that occur as either predictable pharmacologic effects or adverse side effects of herbal medicines. In addition, patient use of these herbal supplements is usually undisclosed to health care providers. The purpose of this literature review is to examine the mechanisms of action of drugs and herbs that alter bleeding, and to educate dental professionals as to the proper care and management of patients using these medications. Decision-making strategies, including interpretation of laboratory tests, and when to discontinue the use of these medications are discussed. Patients undergoing routine dental and dental hygiene procedures do not need to discontinue the use of anticoagulant and antiplatelet medications. However, alterations in drug use may be required for those patients undergoing invasive surgical procedures. It is recommended that herbal supplements must be discontinued 2 weeks prior to receiving invasive surgical procedures. Dental practitioners must learn to weigh the risks of discontinuing drug therapy against the potential risks to patients, and implement risk reduction strategies to minimize adverse bleeding complications associated with dental treatment.

PMID: 17908423 [PubMed - in process]

Dietary supplements, herbs and oral anticoagulants: the nature of the evidence.: J Thromb Thrombolysis. 2007 Sep 29; Authors: Wittkowsky AK

In the US, the use of dietary supplements, including vitamins, minerals, amino acids, and herbal products, is extensive. Nonetheless, the majority of patients report that they have little information about the risks, benefits, and adverse effects of medicines, or about their potential interactions with prescription drugs. Patients taking warfarin are at particular risk of interactions with dietary supplements, yet approximately 30% use herbal or natural product supplements on a regular basis. No current governmental regulations or voluntary programs address dietary supplement interactions with prescription drugs. Case reports represent the majority of the evidence surrounding drug interactions between warfarin and dietary supplements. Those of the highest quality include, as an assessment of causality, a modification of the recently published Drug Interaction Probability Scale. Despite positive case reports, formal drug interaction studies are often negative, suggesting that numerous patient-specific influences other than the suspected interaction alone may be responsible for a particular observation. The cranberry-juice/warfarin interaction is a recent example of such a discrepancy. Healthcare providers can play an active role in improving quantity and the quality of case reports of interactions involving warfarin and dietary supplements. A registry of anticoagulant interactions with dietary supplements has been proposed, and is currently being developed through Clotcare Online Resource ( http://www.clotcare.com ). The goal of this registry is to obtain high quality case-based evidence of drug interactions between anticoagulants and dietary supplements, to define these interactions based on clinical and monitoring outcomes, and to analyze likelihood of causation using a modification of the Drug Interaction Probability Scale.

PMID: 17906915 [PubMed - as supplied by publisher]

Frequency of complementary and alternative medicine utilization in hypertensive patients attending an urban tertiary care centre in Nigeria.: BMC Complement Altern Med. 2007 Sep 28;7(1):30 Authors: Amira OC, Okubadejo NU

ABSTRACT: BACKGROUND: To study the frequency and pattern of use of complementary and alternative medicine (CAM) in patients with essential hypertension attending a tertiary hypertension clinic. METHODS: Two hundred and twenty-five consecutive hypertensive patients attending the hypertension clinic of the Lagos University Teaching Hospital over a 3-month period were interviewed. Socio-demographic data, duration of hypertension, clinic attendance, current blood pressure, and compliance to conventional medications was documented. CAM utilization was explored using both structured and open-ended questions. RESULTS: There were 90 (40%) male and 135 (60%) female patients with mean age +/- SD overall was 55.1 +/- 12.4years. 88 (39.1%) of the respondents used CAM. Herbal products were the most commonly used CAM type. Amongst the CAM users, the most common herbal product used was garlic (69.3%). Others were native herbs (25%), ginger (23.9%), bitter leaf (Vernonia amygdalina) (9.1%), and aloe vera (4.5%). 2.5% used spiritual therapy. There was no difference in the clinical characteristics, socio-economic status, and blood pressure control of CAM users and non-users. Patients who utilized CAM had higher BMI compared with those who did not, but the difference was not statistically significant (mean BMI +/- SD of 29.1 +/- 5.6 vs 27.1 +/- 5.9 kg/m2; P = 0.05). CONCLUSION: A significant proportion of hypertensive patients attending our tertiary facility and receiving conventional treatment also use CAM therapies. Clinicians need to be aware of this practice, understand the rationale for this health-seeking behaviour, proactively enquire about their use, and counsel patients regarding the potential of some of the therapies for adverse reactions and drug interactions.

PMID: 17903257 [PubMed - as supplied by publisher]

Gender- and age-related variations in blood viscosity in normal volunteers: a study of the effects of extract of Allium sativum and Ginkgo biloba.: Phytomedicine. 2007 Aug;14(7-8):447-51 Authors: Galduróz JC, Antunes HK, Santos RF

This study sought to compare the effects of age and gender on blood viscosity and to appraise the effectiveness of Ginkgo biloba and Allium sativum extracts in reducing blood viscosity. Stage 1: Our sample consisted of 80 male volunteers (40 aged 18-60 and 40 aged 61 and over) and 80 females with the same age profile. Stage 2: We studied 60 male volunteers allocated in groups: placebo, G. biloba, and A. sativum. Stage 3: We studied 25 male volunteers and in the initial, intermediate, and final evaluations, the measures of blood viscosity were repeated. Volunteers were given a clinical evaluation and submitted to laboratory tests. G. biloba led to the highest reduction in blood viscosity compared with placebo and A. sativum. In relation to the use of the two substances, G. biloba and A. sativum, dry extract of G. biloba proved to be more effective in reducing blood viscosity.

PMID: 17618098 [PubMed - indexed for MEDLINE]

Cardiovascular effects of 14-deoxy-11,12-didehydroandrographolide and Andrographis paniculata extracts.: Planta Med. 2007 Jun; 73(6): 503-11 Yoopan N, Thisoda P, Rangkadilok N, Sahasitiwat S, Pholphana N, Ruchirawat S, Satayavivad J

Andrographis paniculata has been widely used as a traditional medicine for the treatment of common cold, diarrhea and hypertension. The three major active diterpenoids are andrographolide (AP1), 14-deoxy-11,12-didehydroandrographolide (AP3) and neoandrographolide (AP4). It has been reported that AP3 has hypotensive and vasorelaxation effects. However, there is only limited information on the cardiovascular effects of the other diterpenoids and crude extracts containing different levels of AP3. Therefore, the present study investigated the effects of these diterpenoids, AP1, AP3, and AP4, isolated from A. paniculata, and different aqueous plant extracts on blood pressure, vascular and chronotropic responses by using conscious rats and their isolated aortas and right atria as the test models. Among the three major diterpenoids, AP3 was the most potent compound for inducing vasorelaxation and decreasing heart rate. In addition, Extract B (high level of AP3) had greater hypotensive effect in conscious rats than Extract A (low level of AP3). Verapamil, a Ca2+ channel blocker, also had a hypotensive effect less than that of Extract C containing a high level of AP3. At the doses and durations of Extract A and B which produced hypotension, the responses of the Extract A-treated aorta to norepinephrine, and the vascular muscarinic responses to acetylcholine of both extracts were decreased. However, repeated doses of both extracts did not alter cardiac beta-adrenoceptor and muscarinic responses of extract-treated rats to NE and ACh, respectively. The results of this study suggest that vascular smooth muscle is the major site of these hypotensive effects of both AP3 and A. paniculata extracts. Furthermore, the consumption of A. paniculata products containing high levels of AP3 may be responsible for causing hypotension in some patients taking this herbal drug.

Ayurvedic and collateral herbal treatments for hyperlipidemia: a systematic review of randomized controlled trials and quasi-experimental designs.: Altern Ther Health Med. 2007 Jul-Aug; 13(4): 22-8 Singh BB, Vinjamury SP, Der-Martirosian C, Kubik E, Mishra LC, Shepard NP, Singh VJ, Meier M, Madhu SG

BACKGROUND: Ischemic heart disease (IHD) is a leading cause of morbidity and mortality in both developing and developed countries. An underlying cause of IHD involves retention and deposit of serum lipids in coronary arteries, decreasing blood flow. Drugs (conventional and herbal) are used to lower levels of serum cholesterol to help prevent IHD. The Ayurvedic medicine pharmacopoeia identified herbs that might contribute to a decrease in cholesterol and therefore reduce the risk of IHD. METHODS: Literature searches were conducted at 3 points: 2003, 2004, and 2007. Databases searched included PubMed, the National Library of Medicine, the National Center for Complementary and Alternative Medicine, Ovid, and EBSCO Information Services, and other search strategies also were used. Each article was assessed for quality by 3 people, and discrepancies were resolved by arbitration using a fourth person, who also read and scored each article. Additional assessments of safety using a scale and determination of reported efficacy/effectiveness of the randomized controlled trials (RCTs) and quasi-experimental designs (QEDs) were made. RESULTS: RCTs generally received high quality scores and improved by decade of publication. More than 50% of garlic, more than 80% of guggul, and 100% of Arjuna RCTs reported product effectiveness. Safety scores did not improve by decade. The QEDs received medium and high quality scores, and 93% of them reported effectiveness. The QEDs had a higher mean score for safety reporting than the RCTs. CONCLUSIONS: Many studies received high quality scores and noted safety information and reported effectiveness or efficacy in a clear manner. This finding was not consistent with other systematic reviews that have found the highest reported efficacy/ effectiveness in studies of poorer quality. Ayurvedic herbs reviewed here should be considered by physicians when trying to manage hyperlipidemia in their patients.