The purpose of the statement was to look at the effectiveness and safety of complementary and alternative medicines — defined by the committee as any medical practice, supplement, or approach that does not conform to conventional medicine — based on research published before November 2021. “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 Sheryl L. Chow, PharmD, chair of the scientific statement committee, in a press release. Dr. Chow is associate professor of pharmacy practice and administration at Western University of Health Sciences in Pomona, California, and associate clinical professor of medicine at the University of California in Irvine. About six million people in the United States have heart failure, a condition in which the heart doesn’t pump blood efficiently through the body, according to the Centers for Disease Control and Prevention. Life expectancy after heart failure depends on the cause of your condition, as well as other factors, such as genetics and age. Still, about half of people who develop heart failure die within five years of diagnosis, the Heart Failure Society of America reports. So it’s no surprise that people would also turn to home remedies like herbal medicines, dietary supplements, and homeopathic products, to help treat their disease. The AHA estimates that more than 30 percent of people with heart failure in the United States use complementary and alternative medicines. Here’s a breakdown of what type therapies are safe to use and which to limit or avoid all together. Supplements that might not mix well with standard proven treatments include: Lily of the Valley The roots, stems, and flowers of this plant have long been used to treat mild heart failure because they contain elements similar to the heart failure drug digoxin. If taken along with digoxin, lily of the valley may lead to low potassium levels. It can also raise the risk of irregular heartbeat, confusion, and tiredness. Blue Cohosh This traditional remedy has been used for hot flashes and other menopausal symptoms, as well as painful periods. It was found to possibly decrease the effect of medications taken to treat high blood pressure and Type 2 diabetes. Plus, it could contribute to increased heart rate (called tachycardia), high blood pressure, chest pain, and higher blood glucose. Vitamin D The AHA statement noted that low blood levels of vitamin D are associated with worse heart failure outcomes, but taking vitamin D may be harmful when taken with heart failure medications such as digoxin, calcium channel blockers, and diuretics. Dr. Bozkurt cautioned that proven medical therapies today are having a critical impact on survivorship for people with heart failure, and it’s a myth that “significantly marketed” herbal or alternative therapies should ever be used in place of these standard treatments, which are proven to improve cardiovascular death and heart failure hospitalizations.
Studies Have Been Mixed Regarding Some Therapies
Another statement author, Barry Bleske, PharmD, professor and chair of the department of pharmacy practice and administrative sciences at University of New Mexico Health Sciences in Albuquerque, admits that some research has been mixed about certain supplements. A study published in 2016 in the Journal of the American College of Cardiology, for example, found that regular high-dose vitamin D3 supplementation improved cardiac function in heart failure patients, but did not elaborate on interactions with other drugs. The research involved 229 people with heart failure who had left ventricular systolic dysfunction (LVSD). For a year, participants were either given a daily 100-microgram supplement of D3 or a placebo. After 12 months, echocardiogram measures showed that patients who took vitamin D had greater improvement in left ventricle function and structure than patients who took a placebo. Other over-the-counter heart therapies that have produced mixed results include: Thiamine Taking this vitamin (also called B1) hasn’t demonstrated benefit unless the patient had a vitamin deficiency. The statement authors cited a study published in 2019 in the American Journal of Clinical Nutrition, which found that daily oral thiamine supplementation in heart failure patients with reduced ejection fraction had no differences in quality-of-life scores, six-minute walk distance, peptide levels (that indicate the heart isn’t pumping as much blood as the body needs), or left ejection fraction after six months, compared with those who did not receive the vitamin. Vitamin E Studies vary with some suggesting that vitamin E can help reduce 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). Other research has linked the vitamin to higher likelihood of hospitalization. The statement authors referenced a paper published in 2005 in JAMA that showed that the risk for heart failure hospitalization was greater in 552 patients randomly assigned to receive a daily dose of vitamin E compared with 586 who received a placebo over an average of seven years. Hawthorn While this flowering shrub has boosted exercise tolerance and improved heart failure symptoms such as fatigue, other evidence has found that it may worsen heart failure. Research in the European Journal of Heart Failure found that hawthorn provided no benefit in 120 heart failure patients who either received 450 milligrams of hawthorn twice daily or placebo for six months. A follow-up study indicated that use of the supplement appeared to increase the early risk of heart failure progression. CoQ10 (Coenzyme Q10) This antioxidant, found in small amounts in organ meats, oily fish, and soybean oil, is commonly marketed as a dietary supplement. While small studies show it may help improve heart failure symptoms and quality of life, some sources say it may not interact well with blood pressure-lowering and anti-clotting medicines. According to Mount Sinai Hospital, there have been reports that CoQ10 may make medications such as warfarin (Coumadin) or clopidigrel (Plavix) less effective at thinning the blood. Based on review of evidence so far, the scientific statement concluded that “CoQ10 supplementation remains of uncertain value in heart failure at this time.” Dr. Bleske stresses, however, that he has seen positive results in some of his patients who have used CoQ10, and response from such therapies may vary from patient to patient. “If the supplement appears to be safe and produces no significant drug interactions in the patient, it can be okay to take it,” says Bleske. “In that case, the supplement could possibly help the patient in some regard. I have patients who’ve been on coenzyme Q who say it’s the best thing they’ve ever taken.” In some instances, alternative medicines may not even provide a benefit, but instead produce a placebo effect where patients improve simply because they believe the product is working. “The mind is a powerful thing,” adds Bleske. “If people believe something works and it improves their life, that all goes in to making it a positive therapy.” For Bleske, the bottom line is some alternative medications that have had mixed results in studies may still produce positive outcomes, but patients need to consult with their doctor to monitor effects and determine best ways to use these products as part of their heart health regimen.
Omega-3s, Yoga, and Tai Chi Get a Thumbs Up
According to the statement, the strongest evidence of clinical benefit has been found in omega-3 polyunsaturated fatty acids (PUFA), adding that it may be used safely when taken in moderation and if you get an okay from your physician. 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. Among the research supporting the statement’s conclusion was an analysis published in Clinical Nutrition of 176,441 subjects from seven studies that confirmed a lower risk of heart failure with intake of marine omega-3 fatty acids. The AHA warned the risk of atrial fibrillation (an irregular heart rhythm) could increase if you take too much, so doses of 4 grams or more should be avoided. For yoga and tai chi, these exercises were shown to promote exercise tolerance (a person’s capacity to endure exercise) and improve quality of life and decrease blood pressure. In randomized trials of yoga in combination with standard medical therapy, improvements in exercise tolerance and quality of life and reduction in inflammation were found. A 12-week group-based tai chi program resulted in improvements in mood and exercise self-efficacy, according to a study involving 100 systolic heart failure patients, published in the Archives of Internal Medicine. The guideline concluded that patients may want to incorporate yoga and tai chi into their lifestyle as “adjunctive wellness approaches” — additional treatment that may enhance the effectiveness of primary heart failure therapy.
Patient-Doctor Communication Is Critical
When it comes to alternative therapies, the statement advises communication and collaboration between patients and health care professionals to “promote transparency and improve outcomes.” Healthcare practitioners should know what type of alternative medicines their patients are taking so they can better counsel them and work with them as partners on their health. Figuring out how to talk to patients about alternative medicine, however, can be challenging, noted Prateeti Khazanie, MD, who also contributed to the scientific statement and specializes in advanced heart failure and transplant cardiology at the UCHealth Heart Failure Clinic at the Anschutz. “Some of the complementary and alternative medications come in tea form or in some other supplement that they’re taking and they don’t really think of it as a medicine,” Dr. Khazanie says. Plus, some patients want to feel empowered by their decision to take something natural as opposed to “unnatural,” so Khazanie says that healthcare providers need to learn to communicate in such as way that doesn’t undervalue a patient’s opinion. Sometimes patients are unaware of the exact ingredients in herbal remedies, she explains. Having an open dialogue with a patient can make a difference. Khazanie shared the story of a patient who had been regularly drinking herbal tea, which happened to contain a lot of licorice root. Too much licorice can lower a person’s potassium levels and disrupt normal heart function. “He was probably drinking 5 to 10 cups of this tea a day, and his blood pressure was incredibly high,” says Khazanie. “But we were able to take him off the licorice root tea and found that his blood pressure went down and he didn’t need as much medication.” This is why reading product labels and communication is so important, she says.
Pharmacists May Play an Important Role
The AHA recognizes that doctors may not always have the time to discuss alternative therapies at length with patients. But involving pharmacists could prove useful and helpful for patients who use alternative medicine. “Pharmacists in the community have access to prescribed medications and are in a unique position to counsel and assess patients who select CAM,” the statement reads. “Although this critical intervention is not routinely done because of time constraints, it should still be encouraged.” Because these supplements and herbal medicines are sold at pharmacies, William Baker, PharmD, statement author and associate professor of pharmacy practice at the University of Connecticut in Storrs, says that pharmacists can educate consumers on these products. “Pharmacists may be more readily available than a physician and they may be able to give expert advice on whether a product may be good for a patient,” says Dr. Baker. “I’ve worked in retail pharmacy and there are many times that people would ask for my opinion. Many people just assume a supplement will work because it’s sold in the store, but I might advise them if I’m uncertain if the product is going to be of any benefit or if it may cause harm.”
