Novel Support for Chronic Heart Failure, Arrhythmia and Coronary Artery BlockageFebruary 2013
By Silas Hoffman
We are losing the battle against the leading preventable cause of premature death: heart disease.
In 2005, one in eight death certificates—representing 292,214 deceased Americans—mentioned heart failure.1
Prescription drugs and surgery are routine treatments, but there remains a need for agents that modulate multiple cardiac risk factors.
The term cardiotonic refers to any compound that bolsters normal heart function even under less-than-ideal conditions. Scientists have identified two botanical extracts that deliver this cardiotonic protection!2-4
Extracts from the hawthorn leaf and flower and those from an Indian shrub called arjuna have long been used in traditional medical systems for heart and circulatory conditions.4-9
Scientific studies now demonstrate that these extracts generate a dual effect: they help to prevent —and reverse the disease-progression indicators of existing cardiovascular disease.2,10-13
Hawthorn: New Efficacy Data
Hawthorn (Crataegus) is a genus of small, flowering trees in the rose family, closely related to apples and pears.3, 4 For centuries, traditional medical systems have used the fruit, leaves, and bark for various applications on heart health.5-9
Hawthorn extracts are widely prescribed in Europe for managing mild heart failure, either alone or as add-on therapy with standard drugs. In Germany, hawthorn extracts are recognized as drugs. Hawthorn extracts are referred to as a cardiotonic because of their ability to increase the heart’s muscle tone.2
Hawthorn extracts contain dozens of biologically active molecules including flavonoids and polyphenols. The hawthorn polyphenol most thoroughly studied in humans is oligomeric procyanidins. A typical hawthorn dose provides between 30 and about 340 mg a day of procyanidins.5, 7, 14
A 2012 study identified an effect of hawthorn that enable it to suppress potentially deadly blood clotting signals within arteries.12 In addition, hawthorn displays anti-inflammatory effects in blood vessels,14 and improves the health of endothelial cells that line arteries.15 The endothelium is where oxidized LDL first accumulates, setting the stage for atherosclerosis and heart attack.
Hawthorn extracts specifically counteract many of the underlying biological responses that predispose aging humans to heart attack. Hawthorn has additional characteristics that strengthen and tone the heart muscle,2 making it a potential adjuvant therapy in the face of congestive heart failure.
Arjuna: Broad-spectrum Cardiac Protection
The arjuna tree is native to India, where its bark has been used in Ayurvedic medicine for centuries, mainly as a cardiotonic.4 Like hawthorn, arjuna extracts contain a wide variety of active biomolecules, especially polyphenols and flavonoids.4,13
Arjuna extracts exert anti-inflammatory effects that help combat the excessive immune response that leads to arterial plaque and blood vessel occlusions. 16-18 And they help restore abnormal lipid (cholesterol) profiles that contributes to plaque formation.16, 19
In addition, arjuna extracts enhance heart muscle tone, improving its “squeeze” and increasing the amount of blood it can pump each second without exhaustion.13, 20, 21
Like hawthorn, arjuna is also considered cardiotonic, that is, it bolsters normal heart function even under less-than-ideal conditions.
Coronary Artery Disease
Coronary heart disease results from narrowing of the main arteries that supply blood to the heart muscle itself. Those arteries, over time, become oxidant-damaged, chronically inflamed, and lipid-laden until their smaller diameter reduces the amount of blood that can flow to the laboring heart muscle.
That restricted blood flow impairs heart muscle cells’ pumping ability. Coronary artery occlusion is also painful, producing the symptom we call “angina,” or pain in the chest, abdomen, and/or left arm. Many people, especially women with cardiac ischemia feel no clear symptoms at all, however.
When a tiny blood clot blocks a jagged-narrowed coronary artery, the result is often a full-blown heart attack, with complete loss of blood flow to an area of heart muscle. If the damaged area is large enough, the victim dies or becomes a cardiac cripple.
If the area damaged by a coronary artery occlusion is small enough or if sufficient blood flow is restored from adjoining areas of heart muscle, the victim survives, but with scar tissue.
If oxygenated blood flow is renewed, which is essential to survival, the result is a new surge of pro-oxidant damage to already weakened muscle. This “ischemia-reperfusion injury” can complicate recovery and induce arrhythmias that take the lives of those who, with a stronger heart at baseline, might have survived the original attack.
Hawthorn extracts rich in oligomeric procyanidins have multiple direct actions on the heart before, during, and even after an ischemic event. These beneficial actions, even under challenging laboratory conditions, enhance survival.
Hawthorn scavenges reactive oxygen species (ROS) while enhancing heart muscle cells’ natural antioxidant defenses.22, 23 Animal studies reveal that hawthorn extracts boost coronary blood flow by up to 70%.24
When ischemia occurs, hawthorn extracts prevent ischemia-reperfusion injury to heart muscle cells both through antioxidant effects and by changing how protective genes are expressed in response to the threat.23, 25-28 Ischemic hearts pre-treated with hawthorn show improved function and smaller areas of dying tissue, reducing the mortality rate in animal studies five-fold. 26
Despite some theoretical interactions with cardiovascular drugs, none have been reported in the thousands of patients who have used hawthorn extracts for heart health.5,6,8,31,32
Arjuna Complements Hawthorn
Arjuna extracts can amplify and complement the properties of hawthorn in prevention of coronary artery disease. They were shown to have modest lipid-lowering effects at doses used in ancient Indian medicine.33 In animal studies, arjuna reduces total and LDL cholesterol, as well as triglycerides, raises protective HDL, and limits the size and number of atherosclerotic lesions in the aorta.19, 34, 35
Humans treated with 500 mg daily of arjuna tree bark powder experienced a total cholesterol drop of 9.7%.36 The same dose of an extract from the bark, given every 8 hours, improved endothelial function, the ability of vital arteries to dilate and increase blood flow, by 9.3% in smokers, who typically have terrible endothelial function.37
Symptoms of heart failure vary greatly, but may include fluid retention, swelling of the extremities, difficulty breathing, and, importantly, reduction in exercise tolerance.
Arjuna has exceptional efficacy in reducing episodes of angina, both alone and in combination with standard anti-angina drugs such as isosorbide mononitrate, in patients with stable angina (chest pain induced by activity with absence of prolonged pain at rest). Reductions in anginal frequency of 50% or more have been noted in patients taking 200 to 500 mg daily.10, 38-40
Studies also reveal a prolongation of exercise time before echocardiogram abnormalities on the treadmill test in subjects supplementing with arjuna extracts; all patients remained on their regular cardiac medications as well.38, 39 One dramatic study demonstrated that both arjuna and the drug, isosorbide reduced anginal attacks significantly, but only arjuna-supplemented patients had significant improvement in their hearts’ blood pumping abilities.10
Like hawthorn, arjuna extracts possess powerful cardio-protective characteristics that can save heart muscle cells during ischemia or ischemia-reperfusion injury.18
Multiple human trials with arjuna have demonstrated no serious side effects or drug interactions.38, 39