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Researchers: Physicians should talk to patients about herbal medications
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Physicians should understand the herbal medicines that patients with heart disease may take to be able to discuss their clinical implications, despite a lack of evidence-backed benefits, according to a review paper published in the Journal of the American College of Cardiology.
According to a press release from the American College of Cardiology, herbal medications can be marketed to consumers without approval from a regulatory agency and only after an herbal medication has caused harm can it be found to be unsafe by the FDA. A recent study found that one in five people will take an herbal or dietary supplement in their lifetime, according to the release.
Rosa Liperoti , MD, PhD, MPH, from the department of geriatrics, neurosciences and orthopedics at the A. Gemelli University Hospital in Rome, and colleagues selected 10 of the most common herbal medications — Asian ginseng, astragalus, flaxseed oil, garlic, ginkgo, grape seeds, green tea, hawthorn, milk thistle and soy — and summarized possible indications and safety concerns. The 10 medications were culled from an examination of 42 herbal agents with a possible indication for treatment of conditions including hypertension, HF, CAD, dyslipidemia, thromboembolic disorders and peripheral artery disease.
No benefit found
The researchers did not find clear evidence of benefit for any of the 10 herbal medications. Limited evidence of benefits with limited side effects was found for seven of the medications, with three of those seven (green tea, hawthorn and garlic) having a high risk for interactions with CV medications. Astragalus and Asian ginseng were found to have little to no evidence of benefit with limited side effects. Ginkgo had conflicting evidence of benefit and potential harmful side effects, including headache, nausea, diarrhea, dizziness, skin rash and increased risk for bleeding. Ginkgo and Asian ginseng also had a high risk for interacting with CV medications, according to the findings.
The researchers concluded that there was a lack of evidence supporting the benefits from the use of the herbal medications, despite the number of trials examining them. Often, the cause-effect link was hard to establish in the trials.
Liperoti and colleagues also found that 70% patients do not disclose the herbal medications they are taking and that physicians may not have the knowledge base to discuss the benefits and concerns, as alternative medicine is not taught in medical schools in the United States.
Communication crucial
“In order to deal with this issue, physicians should carry out a structured interview,” the researchers wrote. “Information on use of alternative preparations, herbal medications and actual drugs should be properly recorded, and signs and symptoms must be evaluated in accordance with the clinical story. Communicating with the patient is a crucial component of the process, where the pros and cons of specific herbal medications should be explained and their risk–benefit profile properly discussed. Eventually, the decision to withdraw or withhold a new herbal medication should be shared with the patient”
To bridge the gap in knowledge about herbal medications, the researchers recommended that physicians take it upon themselves to consult the relevant material available to better understand the benefits and clinical implications for herbal supplements. – by Cassie Homer
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Gregg C. Fonarow, MD, FACC, FAHA, FHFSA
The key findings from this evidence-based review for herbal supplements is that evidence of favorable CV effects is lacking for most herbal medications. The few studies suggesting any benefit are generally small, non-definitive and requiring confirmation.
As such, based on available evidence, no herbal medications can currently be recommended to prevent or treat any CV condition.
Cardiologists and other physicians should help educate and advise patients that there are evidence-based, guideline recommended approaches to prevent and treat CVD, but this does not include herbal medications. There are known risks with herbal medications, but no currently established CV benefits. Natural does not necessarily mean safe, effective, or beneficial.
Patients and their families should discuss potential options with their or their family member’s physician. There are also valuable resources available from the American Heart Association and the ACC regarding which lifestyle modifications and which therapies have evidence supporting their use to prevent and treat CVD.
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