Cardio

Health Concerns Herbalist

Alternatives to Vioxx (rofecoxib)
By Andrew Gaeddert

Recently the manufacturer withdrew Vioxx, a popular pain medication, after finding it doubled the risk of heart attack and strokes in patients who took the medication 18 months or longer. The results stemmed from a study researching the effects of Vioxx for potential colon cancer prevention.

Vioxx belongs to a class of mediations called Cox-2 inhibitors. Other medications in the class include Celebrex and Bextra. The manufacturer of Celebrex and Bextra have stated that Bextra is associated with increase in heart attacks and strokes in two studies. The effects of Celebrex on heart disease are unknown. While the company states that Celebrex is safer than Vioxx and Bextra, some experts feel that the entire class of drugs may be unsafe for heart patients. It is already known that Cox-2 inhibitors can lead to kidney and liver disorders, and gastrointestinal bleeding. These drugs typically do not provide better pain relief than NSAIDs, which are considerably cheaper.

There are several herbal alternatives. Collagenex was developed to provide support to the collagen matrix thus leading to stronger joints muscles and tendons. Full-spectrum grape extract in Collagenex contains resveratrol, a natural Cox-2 inhibitor. This potent botanical extract is known to have antioxidant activity and inhibits the destruction of collagen. In addition, it possesses cardio protective effects and contains unique flavonoids known as procyanidolic oligomers (OPCs), which are known to have anti-inflammatory effects. Our grape extract is assayed to contain no less than 95 percent OPCs.

Channel Flow is modern herbal formula which is currently under study by a major medical university. This formula is comprised of an alkaloid-rich extract of Corydalis (yan hu suo) in combination with supportive herbs to provide pain relief and restore blood flow. Channel Flow also has relaxing properties. It has been useful for helping to wean patients off opiates and other strong pain relieving medications.

Typically the formulas mentioned above are used as adjuncts to TCM formulas such as AC-Q (for muscle and joint pain), Mobility 2 (for inflammatory pain), and Mobility 3 (for wind, cold, damp pain). By matching the correct herbal formula to the patient’s TCM presentation, it is possible to achieve superior pain relief without pharmaceutical side effects.

Broken Heart Syndrome (stress cardiomyopathy)
By Andrew Gaeddert

Broken Heart Syndrome is characterized by a tragic or shocking event that can stun the heart and produce heart attack symptoms including chest pain, shortness of breath, and fluid in the lungs. Triggers include the loss of a loved one, robbery, and other stressful events. MRI’s show that patients have not suffered heart attacks despite having the classic symptoms. The conclusion from a recent Johns Hopkins study is that emotional stress can precipitate severe, though reversible ventricular dysfunction in patients without coronary heart disease. Johns Hopkins doctors were able to document how a surge of adrenaline and other stress hormones can last for days, and that this causes a decline in the heart’s pumping capacity. It is likely that the hormones cause tiny heart blood vessels to contract.1

Of course, it is important for clients with chest pain to be referred for conventional medical tests.

One formula that has been proven useful for these conditions is Ease Plus, (chai ju long gu mu li tang). Ease Plus is traditionally used for fullness in the chest, irritability, and palpitations. It is typically used in Western clinical settings for panic attacks, helping to withdraw from addictive substances, and headaches. According to Formulas and Strategies, this formula may be used in the treatment of neurosis, hysteria, epilepsy, gastritis, post-concussion syndrome, and certain presentations of hypertension. I often use Ease Plus as part of the general stress protocol that uses Calm Spirit with Ease Plus for excessive patients, and Calm Spirit with Ease 2 for clients with deficient constitutions.

Notes

  • 1. http://www.hopkinsmedicine.org

Caution on Aspirin
By Andrew Gaeddert

For years, many middle-aged people have taken aspirin in hopes of reducing the chance of a heart attack or stroke. Now, Public-health officials are scaling back official recommendations to focus on a narrower group of patients who are at risk of a heart attack or stroke. The concern is that aspirin’s side effects, which can include bleeding ulcers, might outweigh the potential benefits when taken by many healthy or older people. Aspirin is currently recommended for men forty-five and over with risk factors for heart disease, assuming no history of ulcers or other bleeding disorders, and women fifty-five and older with risk factors for stroke, and no history of bleeding danger. Aspirin is not recommended for men younger than forty-five, women younger than fifty-five, and anyone eighty or older.1

Aspirin inhibits clotting, which is believed to account for much of its benefit of protecting against heart attacks and strokes. But that same action, along with a tendency to deplete the stomach’s protective lining, can lead to a danger of gastrointestinal bleeding and possibly bleeding in the brain. One alternative to aspirin is fish oil.

EPAQ has demonstrated superior results at half the dosage when compared to standard fish oil products.2 The results of an independent risk modification analysis of the hyperlipidemia study data, based on the Framingham model, have shown that patients treated with EPAQ can achieve a significantly reduced risk for cardiovascular events, and significantly higher chance to prevent cardiovascular events over a 10-year period, when compared to those treated with fish oil or for the statin resistant patients treated with low dose statin. It is a powerful combination of Omega 3 fatty acids, phospholipids, antioxidants, and choline that is free from the undesired effects of standard fish oil products such as burping, heartburn or indigestion. EPAQ also contains naturally occurring astaxanthin, an antioxidant which is good for the heart.

If you want to figure out if the newest guidelines recommend aspirin for you, here’s where to check: At ahrq.gov, type ‘aspirin and prevention’ into the search box, and the new guidelines will come up in the results. Click on ‘clinical summary’ for a table that explains what people of different ages should do, and includes links to online calculators to help you figure out your risk of heart attack or stroke.

References

  • 1 Protas, Jon. Wall Street Journal Online. http://online.wsj.com/article/SB10001424052748704511304575075701363436686.html. Accessed on 3/10/10.
  • 2 Gaeddert, Andrew. Health Concerns Professional Newsletters- Vol. 13 No.4: EPAQ™ Krill Oil: A New, Improved Fish Oil and Vol. 14 No. 1: EPAQ™ Krill Oil Part II: Commonly Asked Practitioner Questions.

Formulas for a Healthy Heart
By Andrew Gaeddert

Researchers have found that healthy people prone to anger, hostility and depression have higher levels of C-reactive protein (CRP). CRP is released in the body in response to inflammation caused by stress, infection and certain immune disorders, and has been linked to cardiovascular disease (CVD) risk. It is estimated that one in five Americans has at least one form of CVD, including 50 million people with hypertension, 13.2 million with coronary heart disease (CHD) and 5 million with congestive heart failure (CHF). CVD is not just one disease but a host of interrelated conditions affecting the heart, blood vessels, and blood cells. Degenerative conditions include atherosclerosis, CHF, CHD and hypertension. These are contributing factors to acute conditions such as stoke and myocardial infarction (heart attack). Regular exercise, stress reduction, and a fruit and vegetable rich diet are protective against developing CVD. Fish oil, soy and nuts also have protective benefits.

Herbs and supplements that may have beneficial effects include EPAQ™, Flavonex, Astra Garlic and Polilipid. EPAQ contains EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) which have antiarrhythmic, antithrombotic, antiatherosclerotic blood pressure and triglyceride lowering effects. In a Canadian study, EPAQ was found to lower CRP and to have greater benefits than a standard fish oil preparation. In addition EPAQ contains the carotenoid astaxanthin, which has been shown to have antioxidant effects and may protect the heart by reducing infarct areas in laboratory experiments1.

Flavonex is a flavonoids-rich herbal formula. Flavonoids have several mechanisms of cardiovascular protection including inhibiting LDL oxidation, reducing thrombosis, and reducing inflammation2. Included in Flavonex is ginkgo biloba extract (GBE). In a study conducted at the University of Texas, San Antonio, researchers found 120 mg of ginkgo per day (in six capsules Flavonex) to reduce collagen mediated platelet aggregation and increased fasting insulin. In vitro studies conducted in China have found that ginkgo increased cell viability after exposure to oxidative stress3, and increased the number and efficacy of endothelial progenitor cells4.

Astra Garlic is a TCM approach to cardiovascular disease. It contains odorless garlic which has numerous heart benefits including modestly reducing LDL cholesterol in open and double blind studies. Garlic also has antihypertensive and vasodilatory effects and inhibits platelet aggregation5.

Astra Garlic also contains crataegus (hawthorn, shan zha), which increases coronary blood flow and myocardial circulation, protects the heart from ischaemia, and promotes vasorelaxation. Clinical studies suggest that crataegus may be helpful in patients suffering from congestive heart failure; the herbal extract increased exercise tolerance, reduced palpitations, ankle edema, and tended to reduce blood pressure. Additional ingredients reduce lipid levels, support the heart and improve blood circulation. For clients who have hyperlipidemia it is recommended to take Astra Garlic with Polilipid®, containing policosanol and Sytrinol, a combination of citrus and palm fruit extracts shown to reduce total cholesterol by up to 30 percent; reducing LDL cholesterol by up to 27 percent, and triglyceride levels by 34 percent within four to twelve weeks6. The abovementioned products are suitable and recommended for long term usage.

Notes

  • 1. Gross GJ, Lockwood SF. Cardioprotection and myocardial salvage by a disodium disuccinate astaxanthin derivative (Cardax™). Life sciences [serial online]. 2004; 75:215-24. Available from Science Direct [database online] at: http://www.sciencedirect.com. Accessed July 2005.
  • 2. Sano J, Inami S, Seimiya K et al. Effects of green tea intake on the development of coronary artery disease. Circ J. 2004;68(7):665-70.
  • 3. Ren de C, Du GH, Zhang JT. Protective effect of ginkgo biloba extract on endothelial cell against damage induced by oxidative stress. Journal of Cardiovascular Pharmacology [serial online]. 2002;40(6):809-14. Available from LWW Online [database online] at: http://www.cardiovascularpharm.com. Accessed July 2005.
  • 4. Chen J et al. Effects of Ginkgo biloba extract on number and activity of endothelial progenitor cells from peripheral blood. Journal of Cardiovascular Pharmacology [serial online]. 2004; 43(3):347-52. Available from LWW Online [database online] at http://www.cardiovascularpharm.com.
  • 5. E/S/C/O/P Monographs, second edition. New York: Thieme Medical Publishers; 2003:14-25.
  • 6. Gaeddert, A. Health Concerns Clinical Handbook, 4th edition. Oakland, CA: Professional Health Concerns.2005:Polilipid.

Heart Health: Pain Medications
By Andrew Gaeddert

As I have reported in previous writings, and it has been widely reported elsewhere, increased heart attacks and strokes have now been associated not only with COX-2 drugs, such as Vioxx and Celebrex, but may involve other NSAIDs as well. Recently, Aleve (naproxen) has been shown to increase the risk of cardiovascular problems by 50 percent. As many of the older NSAIDs, such as ibuprofen, are available over the counter, there is no incentive to conduct post market safety studies of these powerful agents. It is imperative that our clients who take these drugs do so as directed. Some of the chronic pain clients we have seen maintain dosages four times the recommended amount.

As mentioned in our last health professional letter, preliminary research indicates Channel Flow® has powerful anti-inflammatory effects. It contains Tang Kuei (dang gui) which not only reduces pain but also is thought to benefit the heart. Of course, in the treatment of chronic pain conditions, traditional arthritis formulas such as Mobility 2 for inflammatory pain, Mobility 3 for pain that worsens in cold damp weather, or AC-Q for joint and muscle pains are usually combined with Channel Flow. In an earlier letter, we discussed Collagenex as another complementary therapy, which improves the joint matrix and has anti-inflammatory effects. Typically, Channel Flow is combined with Collagenex and/or the abovementioned TCM Formulas.

NSAIDS linked to Heart Disease
By Andrew Gaeddert 

A panel of drug advisors recently advised that Celebrex, and Bextra should remain on the market. It is likely that Vioxx will be reintroduced. It is widely assumed that the abovementioned COX-2 drugs cause heart disease. In December, the National Institutes of Health concluded a large trial that indicated Celebrex tripled the risk of heart disease. The COX-2 drugs have never been proven in clinical studies to be more efficacious at treating pain than older over the counter NSAIDS. According to Dr. Curt Furberg, an epidemiologist at Wake Forrest University, “Fifty patients a day die from these drugs, and who is speaking for the patients”? According to an article published in the New York Times, ten out of thirty-two advisors have ties to the pharmaceutical industry.1

Anti-inflammatory drugs caused a higher rate of serious and fatal side effects than any other class of medication. It is estimated that 16,000 deaths and 70,000 hospitalizations have been linked to anti-inflammatory drugs each year. Safer options include herbs and supplements. For example, Channel Flow® has powerful anti-inflammatory effects and has been shown in laboratory experiments to be as potent as some medications. Typically, Channel Flow is combined with classic TCM formulas such as Mobility 2, for inflammatory pain; Mobility 3, for wind, cold, damp pain; and AC-Q for joint and muscle pain. The supplement Collagenex helps rebuild the joint, tendon, ligament matrix and includes natural anti-inflammatory grape extract.

Notes

  • 1. http://www.nytimes.com

NSAIDS linked to Heart Disease: Alternatives
By Andrew Gaeddert

An observational study involving 9218 patients in the U.K., found NSAIDs (non-steroidal anti-inflammatory drugs) significantly increased the risk of heart attack in those who took the drug in the three months before their attack. The risk for heart attack was 24 percent higher for those taking ibuprofen (Advil/Motrin), 32 percent higher for those taking Vioxx (rofecoxib) and 21 percent for those taking Celebrex (celecoxib); Voltaren (diclofenac) increased the risk of heart attack by 55 percent, compared with non-users of NSAIDs. Findings were adjusted to allow for several other heart attack risk factors including age, obesity and smoking. “Our most important consistent finding was a significantly increased risk of myocardial infarction (heart attack), in patients taking three specific drugs– rofecoxib, diclofenac, and ibuprofen” according to University of Nottingham Research Julia Hippisley-Cox, M.D.

This follows a Canadian study on 2,256 patients diagnosed with congestive heart failure (CHF). Increased death or hospitalization for CHF was significantly greater for those taking Vioxx and Celebrex, and other NSAIDS. In a survey published in JAMA stated that 80 percent of Americans take over the counter pain medication at least once per week1. While occasional or short term use of NSAIDs may not increase the risk of developing congestive heart failure, or heart attack, other dangers of NSAIDs include gastrointestinal bleeding, hypertension, kidney and liver toxicity, as well as digestive and skin reactions. Ibuprofen and other NSAIDs may also interfere with the cardio protective properties of aspirin2.  

What are the alternatives?  I believe the best approach is to treat herbally on the basis of TCM (pattern) differentiation, using Channel Flow, topicals for pain, and anti-inflammatory supplements as necessary. For example Mobility 3 is an empirical formula based on several Chinese herbal formulas for joint pain and numbness that worsens in cold damp weather. Mobility 2 is a traditional formula which is used to treat inflammatory pain and edema; it is typically combined with Clear Heat in the event of joints that are hot to touch, elevated body temperature, fast pulse. AC-Q is typically administered for joint and muscle pain and therefore is often beneficial for those who have Fibromyalgia. These formulas should be taken for three to four weeks at the recommended dosage to expect pain relief.

For best results the abovementioned formulas may be combined with Channel Flow for quicker therapeutic response; for acute pain, Channel Flow may be used by itself. In the Health Concerns pharmacopia effective topicals include Resinall K used for pain relief and to improve circulation, and Tamu™ oil which is traditionally used for nerve pain.

Notes

  • 1.  Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA 2002;287:337-44.
  • 2.  Catella-Lawson F, Reilly MP, Kapoor SC, Cucchiara AJ, DeMarco S, Tournier B, et al. Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl J Med 2001;345:1809-17.
Back to blog