Nutrition for Heart Health (Getting to the Heart of the Matter: Part I)

Heart disease is the number one cause of death in Americans. High blood pressure is the “silent killer.” High homocysteine levels are considered by some researchers to be as dangerous as high cholesterol levels. Also, an aging heart is less efficient and more likely to develop disease. Fortunately, certain nutrients and specialty compounds may help promote healthy blood pressure, homocysteine levels and heart function, ultimately exerting a positive, mediating impact on heart disease.

One of the most significant remedies in Traditional Chinese Medicine (TCM), Salvia miltiorrhiza (SM), also known as Dansheng or Dan Shen, has historically been associated with the circulatory and cardiovascular systems and, consequently, has been recommended for conditions surrounding the blood and heart. One research review noted, “The demonstration of beneficial effects of Salvia miltiorrhiza (Dan Shen) on ischemic diseases has revolutionized the management of angina pectoris, myocardial infarction (MI) or stroke in Chinese society. Experimental studies have shown that Dan Shen dilated coronary arteries, increased coronary blood flow, and scavenged free radicals in ischemic diseases, so that it reduced the cellular damage from ischemia and improved heart functions. Clinical trials also indicated that Dan Shen was an effective medicine for angina pectoris, MI and stroke.”¹

Studies have shown SM can improve the ischemic state of the myocardium by dilating the coronary vessels, as well as decreasing serum lipid peroxides and increasing levels of superoxide dismutase (SOD) in patients with coronary heart disease.² These effects may be associated with SM’s ability to inhibit platelet aggregation, reduce blood viscosity, improve myocardial ischemia and protect the cytomembrane.³ SM has even been found to effectively improve and protect myocardial ischemia in patients with coronary heart disease (CHD) undergoing non-heart surgery.⁴

MSV 60®, from TSI Health Sciences, a patented, 60-percent standardized extract of SM’s active compounds, has shown remarkable promise in various research and development innovations. In animal research, MSV 60 effectively improved ischemia by reducing infarction areas when coronary flow was hindered by an obstruction.⁵ MSV 60 has also been shown to enhance heart muscle strength under hypoxic conditions⁶ and inhibit platelet aggregation at a level twice that of aspirin.^7,8 It may also promote liver detoxification,⁹ and increase SOD activity under ischemic conditions.¹⁰

In terms of drug interactions, research has shown salicylates in therapeutic concentration can significantly decrease free SM concentrations, and SM can displace salicylate.¹¹ Also, because of both pharmacokinetic and pharmaco-dynamic interactions, SM should be avoided in patients taking warfarin.¹²

Hawthorn has been used traditionally as a cardiac tonic, and current uses include treatment for angina, hypertension, arrhythmias and congestive heart failure (CHF).¹³ Furthermore, research indicates it may improve cardiac muscular contractions¹⁴ and blood flow in coronary arteries.¹⁵ Germany’s Commission E has validated the use of hawthorn in cases of cardiac insufficiency, reporting hawthorn improves subjective findings as well as increases heart work tolerance, and decreases blood pressure/heart rate.¹⁶ Likewise, clinical research has confirmed hawthorn is beneficial in treating stage II (mild) CHF.^17,18,19,20 As a matter of fact, it has been shown to be as effective as the drug captopril (Capoten®) for treating patients with early-stage CHF.²¹ With regard to angina, hawthorn extract taken three times per day improved heart function and exercise tolerance in angina patients.²²

Garlic also has significant contributions to make toward cardiovascular health. First are garlic’s lipid-lowering effects. Six randomized, double blind, placebo-controlled trials, as well as two double blind, multi-center studies, support the use of garlic in treating elevated lipid conditions including hyperlipidemia and hypercholesterolemia.²³ Two meta-analyses on the effect of garlic on total cholesterol found a statistically significant reduction in total cholesterol levels.^24,25

Garlic also has an anti-hypertensive effect. Two randomized, double blind, placebo-controlled studies and one randomized, open, parallel group, comparison study (n=159) demonstrated garlic’s antihypertensive effects.²⁶ A systematic review and meta-analysis of randomized controlled trials was conducted to determine the effect of garlic on blood pressure.²⁷ Of the seven trials comparing the effect of garlic to a placebo, three demonstrated a significant reduction in systolic blood pressure and four in diastolic blood pressure.

Next is garlic’s anti-platelet effect. One randomized, double blind, placebo-controlled, crossover study and two double blind, placebo-controlled studies involving a total of 214 subjects indicate the potential use of garlic as a coronary disease preventive due to its positive impact on platelet function.²⁸

Finally, in the longest clinical trial on garlic to date, garlic’s ability to prevent and possible reverse atherosclerosis was tested in a randomized, double blind, placebo-controlled, four-year study.²⁹ The subjects (n=152) possessed significant plaque buildup and at least one additional cardiovascular risk factor. After four years, garlic subjects had an average 2.6-percent reduction in plaque volume while the placebo group’s plaque increased 15.⁶ percent. Researchers concluded garlic has a preventive and possibly curative role in arteriosclerosis therapy.

Another botanical, cayenne, has a history of traditional use as a circulatory stimulant, especially in cases of poor peripheral circulation. Cayenne was traditionally used as a catalyst herb in herbal combination formulas; the concept was that cayenne’s stimulant effects speed circulation and thus aid absorption.³⁰ A modern explanation of this traditional use is the fact that capsaicin, an active constituent in cayenne, has been shown to inhibit platelet aggregation.³¹

Editor’s Note: See the July 2008 issue of Natural Products Marketplace for Part II of this look at nutrition for heart health.

1. Ji XY, Tan BK, Zhu YZ. Salvia miltiorrhiza and ischemic diseases. Acta pharmacologica Sinica 2000; 21(12):1089-94.

2. Wang J, Wang Z, Tang G. TCM treatment of extrasystole with huanglian shengmai yin--a report of 357 cases.  Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan 2003; 23(1):35-7.

3. Xing ZQ, Zeng XC, Yi CT. [Effect of Salvia miltiorrhiza on serum lipid  peroxide, superoxide dismutase of the patients with coronary heart disease]. Zhongguo zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese  journal of integrated traditional and Western medicine 1996; 16(5):287-8.

4. Zhou S, Shao W, Duan C. [Observation of preventing and treating effect of Salvia miltiorrhiza composita on patients with ischemic coronary heart disease undergoing non-heart surgery] Zhongguo zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine / Zhongguo Zhong xi yi jie he xue hui, Zhongguo Zhong yi yan jiu 1999; 19(2):75-6.

5. Xu Y, Wang Y. Therapeutic effect of Dansheng extract on dog cardiac infraction induced by blockage of coronary circulation. Shanghai Institute of Materia Medica, ChineseAcademy of Sciences, pp5-1 to 5-9.

6. Xu Y. Methods for identification, purification, and manufacturing of the active constituent in Salvia miltorrhiza (Dansheng) and the appliation of the product in enhancing the cardiovascular function.  Patent pending, 1999.

7. Shen D. The inhibition effect of Dansheng extract on platelet aggregation. Ph.D. Thesis, 1997.

8. Xu Y, Wang Y. Evaluation of Dansheng extract on platelet anti-aggregation. Shanghai Institute of Materia Medica, ChineseAcademy of Sciences, pp5-29 to 5-31.

9. Yokozawa T, et al. Renal Response to Magnesium Lithospermate B in Rates with Adenine-induced Renal Failure. Phytotherapy Research 1993; 7:235-239.

10. Xu Y, Wang Y. Evaluation of Dansheng extract on heart muscle oxygen consumption; in vivo and in vitro. Shanghai Institute of Materia Medica, ChineseAcademy of Sciences, pp5-24 to 5-28.

11. Gupta D, Jalali M, Wells A, Dasgupta A. Drug-herb interactions: unexpected suppression of free Danshen   concentrations by salicylate.  Journal of clinical laboratory analysis 2002; 16(6):290-4.

12. Chan TY. Interaction between warfarin and danshen (Salvia miltiorrhiza). Annals of pharmacotherapy 2001; 35(4):501-4.

13. Miller AL. Botanical influences on cardiovascular disease. Altern Med Rev 1998; 3(6):422-31.

14. Weikl A, Noh HS. The influence of Crataegus on global cardiac insufficiency. Herz Gefabe 1993; 11:516-24.

15. Rewerski VW, Piechoscki T, et al. Some pharmacological properties of oligomeric procyanidin isolated from hawthorn (Crataegus oxyacantha). Arzneim-Forsch Drug Res 1967; 17:490-1.

16. Blumenthal, M., et al. The Complete German Commission E Monogrpahs: Therapeutic Guide to Herbal Medicines / CD version.  Austin, Texas: American Botanical Council; 1998.

17. Weihmayr T, Ernst E. Therapeutic effectiveness of Crataegus. Fortschr Med 1996; 114(1-2):27-9 [in German].

18. Schmidt U, Kuhn U, Ploch M, Hübner W-D. Efficacy of the Hawthorn (Crataegus) preparation LI 132 in 78 patients with chronic congestive heart failure defined as NYHA functional class II. Phytomed 1994; 1(1):17-24.

19. Leuchtgens H. Crataegus special extract WS 1442 in heart failure, NYHA II. A placebo-controlled randomized double-blind study. Fortschr Med 1993; 111:352-4.

20. Weikl A, Assmus KD, Neukum-Schmidt A, et al. Crataegus special extract WS 1442: Objective proof of efficacy in patients withy cardiac insufficiency (NYHA II). Fortschr Med 1996; 114:291-6.

21. chert M, Ploch M, Hübner W-D. Effectiveness of hawthorn extract LI 132 compared with the ACE inhibitor Captopril: Multicenter double-blind study with 132 patients NYHA stage II. Münch Med Wochenschr 1994; 132(suppl):S27-33.

22. Hanack T, Bruckel MH. The treatment of mild stable forms of angina pectoris using Crataegutt® novo. Therapiewoche (983) 33:4331–33 [in German].

23. Blumenthal M (ed), et al. The ABC Clinical Guide to Herbs. Austin, Texas: American Botanical Council; 2003:161.

24. Silagy CA, Neil HA. A meta-analysis of the effect of garlic on blood pressure. J Hypertens 1994; 12(4):463.8.

25. Warshafsky S, Kamer RS, Sivak S. Effect of garlic on total serum cholesterol---a meta-analysis.  Ann Intern Med 1993; 119(7 Pt 1):599-605.

26. Blumenthal M (ed), et al. The ABC Clinical Guide to Herbs. Austin, Texas: American Botanical Council; 2003:161.

27. Silagy CA, Neil HA. A meta-analysis of the effect of garlic on blood pressure. J Hypertens 1994; 12(4):463.8.

28. Blumenthal M (ed), et al. The ABC Clinical Guide to Herbs. Austin, Texas: American Botanical Council; 2003:161.

29. Koscielny J, Klüssendorf D, Latza R, et al. The antiatheroslerotic effect of Allium sativum. Atherosclerosis 1999; 144(1):237-49.

30. Pederson M. Nutritional Herbology. Bountiful, Utah: Pedersen Publishing; 1987:105.

31. Tsuchiya H. “Biphasic membrane effects of capsaicin, an active component in Capsicum species.”  J Ethnopharmacol. 2001;75(2-3):295-9.