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Herbs for Cardiovascular
Disorder
Dr Deny Susanti
Congestive Heart Failure
• Congestive Heart Failure (CHF) or congestive
cardiac failure (CCF) or heart failure …
is a condition that can result from any structural
or functional cardiac disorder that impairs the
ability of the heart to fill with or pump a sufficient amount of blood throughout the body
Schmidt and Dalton Osteopathic Medicine and Primary Care 2007 1:14 doi:10.1186/1750-
4732-1-14
Erythropoietin (EPO): A hormone
produced by the kidney that
promotes the formation of red blood
cells in the bone marrow.
LVH: Left ventricular hypertrophy
CKD: chronic kidney
disease
• New York Heart Association (NYHA) Functional Classification System classify the CHF patients according to their level of disability and useful in determining of the treatment
• This system divides patients into functional class: – FC-I (patients with cardiac disease but without limitations
of physical activity)
– FC-II (patients in whom physical activity results in fatigue, palpitations, dyspnea, or angina)
– FC-III (patients who have marked limitation of physical activity)
– FC-IV (patients unable to carry on physical activity without discomfort).
Sign and symptoms
• General– Weakness
– Fatigue
– Exercise intolerance
– Increased urination at night
– Increase heart rate
– Pale appearance
– Cold, blue finger and toes
The goals of therapy in heart failure are
1. to reduce symptoms and hospitalization
2. to slow the progression of the disease process and prolong survival.
3. reduction of the work load of the failing heart can be accomplished by physical and emotional rest as well as correction of obesity.
4. restriction of dietary sodium, one of the major compensatory responses to heart failure is sodium and water retention
Treatment Option-Conventional
• The most common drug used – Vasodilators
– Nitrates
– Diuretics
– Digitalis
– -blockers
• Other drugs– Angiotensin II antagonists
– Calcium channel bolckers
– Drugs to regulate heart rhythm
Nutritional Supplementation• Coenzyme Q10 (Co-Q10)
is naturally occurring vitamin-like nutrient that helps improve function of the heart muscle
• Magnesium
In general magnesium plays a critical role in regulating the heart muscle.
• L-carnitine-plays a key role in the metabolic function of heart muscle cells
• Taurine-an amino acid that helps to protect heart muscle from a variety of damaging conditions.
• Pottasium-important nutritional mineral that help regulate the electrical activity that keeps the heart beating normally and it reduces the danger of severe disturbance in heart rhythm
• Arginine-amino acid that help to regulate some aspects of cardiovascular function. Arginine is required for the production of nitric oxide, which helps increase circulation by dilating blood vessel.
Herbal Supplementation
Herbs Containing Potent Cardioactive
Glycoside
• Digitalis purpurea L. or D. lanata (the dried
leaves).
– potent cardiac glycosides: digitoxin and digoxin.
These 2 glycosides now account for all of
digitalis prescriptions in US
• Pharmacological action
– strengthen the force of the heartbeat by increasing the amount of calcium in the heart's cells
– increasing the amount of blood being oxygenated, the blood in general circulation, as much as 30% with each beat.
– strengthens the contraction of the heart muscle
– slows the heart rate and helps eliminate fluid from body tissues
– control irregular heart rhythms (arrhythmias) by slowing the signals that start in the sinoatrial (SA) node
• The cardiac glycoside are extremely potent
drugs, the dosage of which must be carefully
adjusted to the needs of the individual patient.
In the case of phytomedicines containing them,
this is possible only with the standardized powdered digitalis.
Side Effects
• Serious side effects:– An irregular heartbeat that causes dizziness, the feeling
that your heart has skipped a beat (palpitations), shortness of breath, sweating, or fainting
– Hallucinations, confusion, and mental changes like depression
– Unusual tiredness or weakness
– Trouble with your eyesight, such as blurry eyesight, double vision, or seeing yellow, green, or white halos around objects
– A loss of appetite or an upset stomach
• Common side effects:– Erectile dysfunction
– Breast enlargement in men
• Less common side effects:– A skin rash or hives
– Headache
– A numbness or tingling sensation over your body
– Eye sensitivity to light
– Diarrhea
– Throwing up
Adonis vernalis L. Apocynum cannabium L. Helleborus niger L.
Convalaria majalis L. Nerium oleander L. Urginea maritima L.
Strophantus kombe Oliv.
Other herbs containing cardiac glycoside:
Other Herbs for Treating CHF
• Hawthorn (consist of the leaves with flowers
and/or fruits of Crataegus laevigata (Poir.) DC
and C. monogyna Jacq.)
Herbal Use:
Use to improve the pumping capacity of the heart and to reduce the patients susceptibility to cardiac angina.
• Pharmacological action
Based on the clinical studies the Hawthorn
extract are active to increase coronary blood
flow, reduce blood pressure, reduce
peripheral blood flow and reduce peripheral
resistance.
• Side-effect and toxicity
Nausea and fatigue, sweating and rash on
the hands. Acute toxicity (LD50) : 50-2600
mg/kg (by i.v. injection) and 6 g/kg (by oral)
• Contra-indication:
It should not be taken during pregnancy
and lactation cause there is a reduction
in tone and motility.
• The vasodilation effect of Hawthorn
extract have been attributed to the
oligomeric procyanidin
(tannins/proanthocyanidins) and
flavonoids constituents
Proanthocyanidins are largely responsible for the cardiovascular action of:
1. Improving blood supply to the heart by dilating coronary vessel
2. Improving metabolic process in the heart, which results in an increase in the force of contraction of the heart muscle with elimination of some types of arrhythmia
3. Inhibiting angiotension converting enzyme (ACE) effective in the treatment of high blood pressure)
Based on the pharmacology study, Hawthorn extract was equivalent to the ACE inhibitor (captopril) in terms of influence on stress tolerance.
German Commission E has approved the use of
hawthorn for cardiac insufficiency corresponding to
NYHA FC-I and FC-II patients with a feeling of
pressure and tightness in the cardiac region, as well
as for the aging heart not yet requiring cardiotonic
glycosides
The minimal daily dosage is established on the
basis of flavone (5 mg) calculated as hyperoside,
total flavonoids determined as total phenols (10 mg),
or oligomeric procyanidins calculated as epicatechin
(5 mg)
Atherosclerosis
• Atherosclerosis is a disease affecting arterial blood vessels. It is a chronic inflammatory
response in the walls of arteries, in large part to
the deposition of lipoproteins (plasma proteins
that carry cholesterol and triglycerides).
• It is commonly referred to as a "hardening" or
"furring" of the arteries. It is caused by the
formation of multiple plaques within the arteries.
Figure A shows a normal artery with normal blood flow. Figure B
shows an artery with plaque buildup.
http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=573
• Atherosclerosis is characterized by discrete
deposits of fatty substance (atheromatous
plaques) in the arteries and by fibrosis and
calcification of their inner layer.
• Atheroma plaque or fatty substance build up
over time, cause being a diet rich animal fats,
refine sugar, cigarette smoking, obesity and
inactivity
The prime targets of atherosclerosis are :
1. Aortawith the major consequences being aorta aneurysm
2. Cerebral arteries produce cerebral infarction (stroke)
Pharmacology action of the herbs that
would be beneficial in the prevention
and treatment of atherosclerosis : 1. Reduce cholesterol level
2. Enhances blood fibrinolytic activity
3. Inhibit platelet aggregation
Herbs for treatment atherosclerosis
1. Garlic (Allium sativum L.)
Constituents:
– Enzymes: Allinase, peroxidase, myrosinase, and others.
– Volatile oils: Sulfur-containing compounds including alicin (diallyl thiosulfunate), allylpropildisulfide, diallyl disulfide, ojoene, citral, geraniol, linalool, and -phellandrene.
– Other constituents: proteins, amino acids, mineral, vitamins, trace elements, lipids, prostaglandins.
• When a clove of garlic is crushed or sliced, the
compound alicin and other sulfur-containing compounds
are formed from alliin by the enzyme allinase. Alicin is
the main sulfur compound responsible for garlic’s health
benefits
Transformations and origins of bioactive
constituents of garlic
Awang, D. V. C.,2009
Herbal use:Garlic is stated to possess expectorant, antispasmodic, antiseptic, bacteriostatic, antiviral, hypotensive and anthelmentic properties and to be a promoter of leukocytosis.
Traditionally, it has been used to treat chronic bronchitis, bronchitic asthma, influenza, recurrent colds.
Modern use of garlic and garlic preparation is focused on their reputed antihypertensive, antithrombotic, antimicrobial, cancer preventive and lipid lowering effects
• The pharmacological properties
of garlic are attributed mainly to
its sulphur-containing
compounds.• cholesterol- and lipid-lowering
effects
The constituents of garlic causing
inhibition of the enzyme that
involve in biosynthesis pathway of
cholesterol. Recently, fresh garlic
extract and the constituents were
shown to inhibit human squalene
monooxygenase (an enzyme
catalysing a step in cholesterol
biosynthesis)
• Anti-artherosclerosis
The constituents of garlic
reduce: • the surface area of the thoracic
aorta covered by fatty streak
(atherosclerosis)
• hepatic triglyceride and cholesterol
concentration
• aortic lipid deposition and
atheromatous lesions
• Antithrombotic and fibrinolytic
activities
Garlic has been shown:• to increase serum fibrinogen
concentration together with a
decrease in blood coagulation time
and fibrinolytic activity.
• to inhibit platelet aggregation caused
by several inducer such as ADP,
collagen, adrenaline
The mechanism of anti-artherosclerosis
include: • inhibition of thromboxane synthesis via
cyclooxygenase and lypoxygenase inhibition.
• inhibition of membrane phospholipase activity
Allicin is a major inhibitor platelet aggregation.
Ajoenes are responsible for much of
antithrombotic properties of garlic.
Side-effect and toxicity
Garlic is generally considered to be
non toxic. Adverse effect that have
been documented in human including a
burning sensation in the mouth and
gastrointestinal tract, nausea, diarrhea
and vomiting
The German Commission E recommends 4 g
(approximately one average-size clove) of fresh garlic
as the daily dose for reducing elevated blood lipid
levels.
Assuming that fresh garlic yields, on the average,
0.37 percent allicin, the 5.4-mg allicin potential
contained in the 900 mg of garlic powder ingested
daily is equivalent to only 1.5 g of fresh garlic—less
than one-half of an average-sized clove
2. Green Tea Extract
The ingestion of green tea extract has
significantly decrease plasma cholesterol
and triglyceride concentration and the
ratio of low density lipoprotein (LDL)
cholesterol concentration to high density
lipoprotein (HDL) cholesterol
concentration
Green tea contains antioxidant polyphenol
including epicatechin, epicatechin gallate,
epigallocatechin gallate and
proanthocyanidin. These antioxidants are
important in preventing the oxidation of
LDL cholesterol, which plays a central role
in the development of atheroclerosis
Capsules containing dried green extract that
has been standardized for antioxidant
polyphenol content are available and should
be taken with food and water.
Those that are standardized to 97 percent
polyphenols are said to be equivalent to four
cups of green tea.
(-)-epigallocatechin gallate (EGCG), (-)-epicatechin gallate (ECG),
(+)-epicatechin (EC),
3. Red YeastRed yeast is the rice fermentation product of a mixture of several species of Monascus purpureus Went.In China, red yeast used in traditional medicine for the treatment of indigestion, diarrhea and improving blood circulation and the health of the spleen and stomach.The major active constituent of red yeast is monacolin K
Monacolin K is representative of a group of functionalized
hexahydronaphthalene β-hydroxy-δ-lactone compounds
formed by certain fungi and collectively termed mevinic
acids.
These compounds are inhibitors of β-hydroxy-β-
methylglutaryl CoA (HMG-CoA) reductase, the rate-limiting
enzyme in endogenous cholesterol biosynthesis
Mechanism of action of red yeast (monacolin K).
The blocking of cholesterol
biosynthesis by red yeast
(monacolin K) stimulates
hepatocytes to form a
greater number of LDL
receptors, which promotes
an increased influx of LDL
cholesterol from the plasma
to serve the precursor need
bile acid synthesis with
resulting decreased in
plasma LDL cholesterol
levels.
Awang, D. V. C.,2009
• In healthy adults who maintained their usual diet,
lovastatin produced mean reductions in serum total
and LDL cholesterol of 23–27 percent and 35–45
percent, respectively, at dosages of 6.25–50 mg
twice daily.
• The adverse effects reported in clinical trial with red
yeast were gastritis, abdominal discomfort and
elevated levels of liver enzymes.
Red yeast is available in capsules.
Red yeast is available in capsules that contain 600 mg
of a yeast–rice mixture standardized to supply 2.4 mg
of HMG-CoA reductase inhibitor. The recommended
dose is two 600-mg capsules taken twice daily with
meals (2,400 mg/day).
Thank you