There are some potentially serious benefits and risks associated with complementary and alternative medicines (CAMs) that patients with heart failure (HF) can use to manage their symptoms, the American Heart Association (AHA) says in a new scientific statement on the subject.
For example, yoga and tai chi may be helpful for people with heart failure, and omega-3 polyunsaturated fatty acids may also provide benefits. However, there are safety concerns with other commonly used over-the-counter CAM therapies, including vitamin D, blue cohosh and thrush, according to the editorial group.
It is estimated that approximately 1 in 3 patients with HF use CAM. But patients often do not report their CAM use to their clinician, and clinicians do not routinely ask questions about CAM use or have the resources to evaluate CAM therapies, said the group’s president. writing, Sheryl L. Chow, PharmD. lecoeur.org | Cardiology Medscape.
Dr. Sheryl L. Chow
“This represents a major public health concern given that consumers frequently purchase these potentially dangerous and poorly regulated products without the advice or guidance of a healthcare professional,” said Chow, of Western University of the United States. Health Sciences, Pomona, Calif., and the University of California. Irvine.
The 27-page statement was published online December 8 at Traffic.
Common use of CAMs in HF
The statement defines CAM as medical practices, supplements, and approaches that do not conform to the standards of conventional evidence-based practice guidelines. CAM products are available without a prescription or medical advice at pharmacies, health food stores and online retailers.
“These agents are largely unregulated by the FDA and manufacturers do not need to demonstrate their effectiveness or safety. It is important that healthcare professionals and consumers improve communication regarding over-the-counter therapies and are informed about potential effectiveness and risks of harm so that discussions and risks are shared. informed decision-making can take place,” Chow said.
The writing group reviewed research published before November 2021 on CAM in people with HF.
Omega-3 polyunsaturated fatty acids (PUFAs), such as fish oil, have the strongest evidence among CAM agents for their clinical benefit in HF and can be used safely by patients in moderation and in consultation with their care team, says the editorial group.
Research has shown that omega-3 PUFAs are associated with a lower risk of developing heart failure as well as improved left ventricular systolic function in people with existing HF, they point out.
However, two clinical trials found a higher incidence of atrial fibrillation with high-dose omega-3 PUFA administration. “This risk appears to be related to the dose and increases when we exceed 2 g/d of fish oil,” indicates the editorial group.
Research suggests that yoga and tai chi, when added to standard treatment for HF, may help improve exercise tolerance and quality of life and lower blood pressure.
Inconclusive or potentially harmful CAM therapies
Other CAM therapies for HF have been shown to be ineffective based on current data, have mixed results, or appear to be harmful. The writing highlights the following examples:
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Overall evidence regarding the value of vitamin D supplementation in patients with HF remains “inconclusive” and may be harmful when taken with HF medications such as digoxin, calcium channel blockers and diuretics.
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Routine thiamine supplementation in patients with HF and without clinically significant thiamine deficiency may not be effective and should be avoided.
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Research on alcohol varies, with some data showing that drinking low to moderate amounts (one to two drinks per day) can help prevent HF, while it is known that drinking habitually or consuming higher amounts contributes to CI.
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The literature is mixed on vitamin E. It may have some benefit in reducing the risk of HF with preserved ejection fraction, but it has also been associated with an increased risk of hospitalization for HF.
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Coenzyme Q10 (Co-Q10), commonly taken as a dietary supplement, may help improve HF class, symptoms, and quality of life, but it may also interact with antihypertensive and anticoagulant medications. Co-Q10 currently remains of “uncertain” value in HF. Large-scale randomized controlled trials are needed before a definitive conclusion can be drawn.
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Hawthorn, a flowering shrub, has been shown in some studies to increase exercise tolerance and improve symptoms of IC such as fatigue. Yet it can also worsen HF, and research is conflicting about its interaction with digoxin.
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The herbal supplement blue cohosh, from the root of a flowering plant found in deciduous forests, could cause tachycardia, high blood pressure, chest pain and increased blood sugar. It could also decrease the effect of medications taken to treat high blood pressure and type 2 diabetes, they note.
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Lily of the valley, whose root, stems and flower are used in supplements, has long been used in mild FH because it contains active chemicals similar to digoxin. But taken with digoxin, it could lead to hypokalemia.
In an AHA press release, Chow says, “Overall, more high-quality research and large, randomized controlled trials are needed to better understand the risks and benefits” of CAM therapies for IC.
“This scientific statement provides essential information for healthcare professionals treating people with heart failure and can be used as a resource for consumers on the potential benefits and harms associated with complementary and alternative medicine products,” adds Chow .
The writing group encourages healthcare professionals to regularly ask their HF patients about their use of CAM therapies. They also assert that pharmacists should be included in the multidisciplinary care team to provide consultation on the use of CAM therapies for patients with HF.
The scientific statement does not include cannabis or traditional Chinese medicine, which have also been used in IC.
In 2020, the AHA released a separate scientific statement on the use of medical marijuana and recreational cannabis on cardiovascular health, as well as previously reported by lecoeur.org | Cardiology Medscape.
The scientific statement on CAM for HF was prepared by the volunteer writing group on behalf of the AHA Clinical Pharmacology Committee and the Council on Clinical Cardiology Heart Failure and Transplantation Committee; the Council of Epidemiology and Prevention; and the Cardiovascular Disease and Stroke Nursing Council.
Traffic. Published online December 8, 2022. Abstract
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