Heart patients, have you told your doctor that you use herbs or vitamin supplements?
To be safe, check in with your doctor. Anything you take into your body has an effect – whether good or bad – and herbs and vitamin supplements are no different. They could interact with your prescription medications, possibly worsening your cardiovascular problems or increasing the drugs’ side effects. By that same token, replacing prescription medications with herbs may put you at an even greater risk.“Supplements are perceived by some people as being safe, natural and pure, and prescription drugs are looked at as less safe. A lot of people believe that if it comes from nature, then it must be safe. They see all the side effects of prescription drugs listed in ads, and the bottles for supplements aren’t required to list any side effects,” says Perry J. Weinstock, M.D., FACC, Director of Clinical Cardiology at Cooper University Hospital. “The herbal supplements that patients consume can have many effects which could result in a negative impact on blood pressure, cholesterol, heart rhythm and blood clotting. “
Unlike prescription medications, herbal substances are not well-regulated. The Food and Drug Administration (FDA) considers herbs to be dietary supplements, not drugs, so the FDA cannot oversee these products to the same degree as it does with prescription and over-the-counter medications, such as aspirin. That means the potency, purity and quality of herbs cannot be guaranteed. The strength of a pill from one bottle of echinacea may not be the same as another brand’s version. You don’t have the assurance that what you are buying is entirely safe or the same from batch to batch. Contaminants such as lead, mercury and arsenic have been found in herbal supplements. In addition, you have no way of knowing what a toxic dose is.
“Many of these alternative medicines could act as an additional dose of medication, affecting the metabolism of other medication in the blood, which could lead to serious side effects. In particular, they could interact in the liver, impacting how the body uses medications such as warfarin (Coumadin®),” Dr. Weinstock says.
Most of the time herbal supplements are taken on blind faith, says Mitchell Somma, CT (ASCP), PA-C, a physician’s assistant with the Cooper Heart Institute who has authored papers about the benefits and risks of alternative medicines.
“The problem is a lot of people don’t report their use of herbs to their doctors,” Somma says. “They don’t think of it or they may not think they need to because of a perception that supplements are risk-free and safe.”
One such common but potentially potent supplement is red yeast rice, which people use to lower cholesterol. Made by fermenting red yeast on rice, the supplement contains lovastatin, the same ingredient found in one of the statin drugs lovastatin (Mevacor®). Statins lower cholesterol.
“People think it’s completely safe, but it’s a statin. It works the same way as the branded drugs,” Dr. Weinstock said. “Red yeast rice is not necessarily any safer than its prescription counterpart ‘statins.’ Patients are generally not told that red yeast rice can inflame the liver and muscles similarly to other statins. This is a case in which you should talk with your doctor.”
A good example of a supplement gaining in popularity and causing a crisis occurred a few years ago. People were taking ephedra to lose weight but it caused strokes and heart attacks resulting in several deaths. Because of the extreme health risks, the FDA banned its sale in this country.
Manufacturers of herbal supplements are not required to do extensive testing to support their claims. Prescription medications must have a number of different types of studies – many of which involve large groups of patients – before these medications are released into the market. Even after that time, manufacturers continue collecting data about the medication to monitor for side effects and efficacy.
In addition to herbs, taking vitamin supplements isn’t a good idea without first talking to your doctor. A government-sponsored study published in 2005 in the Journal of the American Medical Association showed that people taking 400 international units of vitamin E had a 13 percent increased risk of heart failure, a condition in which the heart’s ability to pump blood is weakened.
“We don’t bash supplements or universally discourage their use. We know they can be effective, but they can also be dangerous,” Somma says. “We are open to talking about supplements. Tell us what you’re taking and let us figure out together if it’s dangerous.”
Somma points to fish oil supplements as being good for your heart and something that health care providers feel comfortable recommending to patients. It raises good cholesterol – the kind that helps the body dispose of the type of cholesterol that sticks inside artery walls, causing plaque buildup. Talk to your doctor before you take anything, though.
If you are going to have surgery, be sure to tell your surgeon and anesthesiologist about any supplements you take. Many of these products can affect blood clotting and the effectiveness of anesthesia, which can produce a potentially deadly situation.
“Just because it comes from nature doesn’t mean it’s safe. Cocaine and tobacco come from nature, too,” Dr. Weinstock said.
If you would like to schedule an appointment with a Cooper University Hospital physician, please call (800) 8-COOPER.