Alternative medicines for heart failure may have some benefits or even potential risks

An estimated 6 million people ages 20 and
older in the U.S. have heart failure, a condition that occurs when the heart
isn’t functioning normally. The statement, “Complementary and Alternative
Medicines in the Management of Heart Failure,” assesses the effectiveness and
safety of CAM therapies used for heart failure treatment. According to the
statement, it’s estimated that more than 30% of people with heart failure in
the U.S. use complementary and alternative medicines.

The statement defines complementary and
alternative medicine therapy as medical practices, supplements and approaches
that do not conform to the standards of conventional, evidence-based practice
guidelines. Complementary and alternative products are available without
prescriptions or medical guidance at pharmacies, health food stores and online
retailers.

There are some benefits and potentially
serious risks when people with heart failure use complementary and alternative
medicines (CAM), to manage symptoms, so involving the health care team is
important for safety, according to a new American Heart Association scientific
statement published today in the Association’s flagship, peer-reviewed journal
Circulation.

“These products are not federally regulated,
and they are available to consumers without having to demonstrate efficacy or
safety to meet the same standards as prescription medications,” said Chair of
the scientific statement writing committee Sheryl L. Chow, Pharm.D., FAHA, an
associate professor of pharmacy practice and administration at Western
University of Health Sciences in Pomona, Calif., and associate clinical
professor of medicine at the University of California in Irvine. “People rarely
tell their health care team about their use of supplements or other alternative
therapies unless specifically asked, and they may not be aware of the
possibility of interactions with prescription medicines or other effects on
their health. The combination of unregulated, readily accessible therapies and
the lack of patient disclosure creates significant potential for harm.”

Examples of complementary and alternative
therapies that heart failure patients might use include supplements such as
Co-Q10, vitamin D, Ginkgo, grapefruit juice, devil’s claw, alcohol, aloe vera
and caffeine, or practices such as yoga and tai-chi. The statement writing
group reviewed research published before Nov. 2021 on CAM among people with heart
failure.

The statement writing group advises health
care professionals to ask their patients with heart failure at every health
care visit about their use of complementary and alternative therapies and talk
about potential medication interactions, benefits and potential side effects of
CAM. In addition, they suggest that pharmacists are included in the
multidisciplinary health care team to provide consultations about the use of
complementary and alternative therapies for people with heart failure.

Alternative therapies that may benefit people
with heart failure include:

Omega-3 polyunsaturated fatty acids (PUFA,
fish oil) have the strongest evidence among complementary and alternative
agents for clinical benefit in people with heart failure and may be used
safely, in moderation, in consultation with their health care team. Omega-3
PUFA is associated with a lower risk of developing heart failure and, for those
who already have heart failure, improvements in the heart’s pumping ability.
There appears to be a dose-related increase in atrial fibrillation (an
irregular heart rhythm), so doses of 4 grams or more should be avoided.

Yoga and Tai Chi, in addition to standard
treatment, may help improve exercise tolerance and quality of life and decrease
blood pressure.

Meanwhile, some therapies were found to have
harmful effects, such as interactions with common heart failure medications and
changes in heart contraction, blood pressure, electrolytes and fluid levels:

While low blood levels of vitamin D are
associated with worse heart failure outcomes, supplementation hasn’t shown benefit
and may be harmful when taken with heart failure medications such as digoxin,
calcium channel blockers and diuretics.

The herbal supplement blue cohosh, from the
root of a flowering plant found in hardwood forests, might cause a fast heart
rate called tachycardia, high blood pressure, chest pain and may increase blood
glucose. It may also decrease the effect of medications taken to treat high
blood pressure and Type 2 diabetes.

Lily of the valley, the root, stems and flower
of which are used in supplements, has long been used in mild heart failure
because it contains active chemicals similar to, but less potent than, the
heart failure medicine digoxin. It may be harmful when taken with digoxin by
causing very low potassium levels, a condition known as hypokalemia. Lily of
the valley also may cause irregular heartbeat, confusion and tiredness.

Other therapies have been shown as ineffective
based on current data, or have mixed findings, highlighting the importance of
patients having a discussion with a health care professional about any
non-prescribed treatments:

Routine thiamine supplementation isn’t shown
to be effective for heart failure treatment unless someone has this specific
nutrient deficiency.

Research on alcohol varies, with some data
showing that drinking low-to-moderate amounts (1 to 2 drinks per day) is
associated with preventing heart failure, while habitual drinking or intake of
higher amounts is toxic to the heart muscle and known to contribute to heart
failure.

There are mixed findings about vitamin E. It
may have some benefit in reducing the risk of heart failure with preserved
ejection fraction, a type of heart failure in which the left ventricle is
unable to properly fill with blood between heartbeats. However, it has also
been associated with an increased risk of hospitalization in people with heart
failure.

Co-Q10, or coenzyme Q10, is an antioxidant
found in small amounts in organ meats, oily fish and soybean oil, and commonly
taken as a dietary supplement. Small studies show it may help improve heart
failure class, symptoms and quality of life, however, it may interact with
blood pressure lowering and anti-clotting medicines. Larger trials are needed
to better understand its effects.

Hawthorn, a flowering shrub, has been shown in
some studies to increase exercise tolerance and improve heart failure symptoms
such as fatigue. Yet it also has the potential to worsen heart failure, and
there is conflicting research about whether it interacts with digoxin.

“Overall, more quality research and
well-powered randomized controlled trials are needed to better understand the
risks and benefits of complementary and alternative medicine therapies for
people with heart failure,” said Chow. “This scientific statement provides
critical information to health care professionals who treat people with heart
failure and may be used as a resource for consumers about the potential benefit
and harm associated with complementary and alternative medicine products.”

Reference:

Sheryl L. Chow, et al,Complementary and
Alternative Medicines in the Management of Heart Failure: A Scientific
Statement From the American Heart Association, Circulation, DOI: 10.1161/CIR.0000000000001110

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