Herbal medications do not require clinical studies before being
marketed to consumers or formal approval from regulatory agencies, so
their efficacy and safety are rarely proven.
In the U.S., herbal
medications can only be found unsafe by the Food and Drug Administration
after they have caused harm. Still, they remain popular among heart
disease patients for their potential cardiovascular benefits. A recent
survey said one in every five people will take an herbal or dietary
supplement in their lifetime.
‘Owing to the popularity of herbal medications and the potential for drug interactions or other safety concerns, physicians should start a conversation around herbal medication use to effectively counsel their patients.’
Physicians should be well-versed in the herbal medications heart
disease patients may take to be able to effectively discuss their
clinical implications, potential benefits and side effects - despite a
lack of scientific evidence to support their use, according to a review
paper published today in the Journal of the American College of Cardiology
Researchers in this review paper looked at 42 herbal medications
that have a possible indication for treating one or more cardiovascular
condition, including hypertension, heart failure, coronary artery
disease, dyslipidemia, thromboembolic disorders or peripheral artery
disease. They then selected 10 of the most commonly used in
cardiovascular medicine to discuss possible indications, biological and
clinical data, and safety concerns.
The researchers said that despite all the clinical evidence on
these herbal medications, there is an overall lack of evidence
available, and it is not always possible to clearly establish a
cause-effect link between exposure to herbal medications and potential
They concluded that because of the popularity of these medications
and the potential for drug interactions or other safety concerns,
physicians should start a conversation around herbal medication use to
effectively counsel their patients. Many patients don't volunteer
information on their herbal medication use to their doctor because they
do not perceive them as drugs. Physicians are also unlikely to regularly
gather correct information on their use. However, herbal medication use
has been associated with poor adherence to conventional medications,
which is a serious concern.
"Communicating with the patient is a crucial component of the
process," said Graziano Onder, senior author of the review
paper and an assistant professor in the department of geriatrics,
neurosciences and orthopaedics of the UniversitÓ Cattolica del Sacro
Cuore in Rome. "The pros and cons of specifics herbal medications should
be explained and their risk-benefit profile properly discussed."
Researchers said physician education is an important consideration
as well, since the study of alternative medicine is not part of medical
school curriculums in the U.S. Obtaining the necessary knowledge to
provide better care for patients around the use of herbal medications is
solely up to the physician.
"Physicians should improve their knowledge of herbal medications
in order to adequately weigh the clinical implications related to their
use," Onder said. "Physicians should explain that natural does not
always mean safe."
The authors have no relevant disclosures to report.