Heart patients, have you told your doctor that you take herbal or vitamin supplements?
To be safe, let your doctor know. 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 supplements 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 over-the-counter supplements aren’t required to list any side effects,” said Perry J. Weinstock, MD, FACC, Head of the Division of Cardiovascular Disease and 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,” Dr. Weinstock said. Unlike prescription medications, herbal substances are not well-regulated. The U.S. Food and Drug Administration (FDA) considers herbs to be dietary supplements, not drugs, so the FDA does not oversee these products to the same degree as it does with prescription medications. 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 dose may be toxic.
“Many of these alternative medicines could act as an additional dose of medication by altering the metabolism of other medications in the blood, which could lead to serious adverse events. In particular, they could interact in the liver, impacting levels of certain very critical medications such as warfarin (Coumadin®),” Dr. Weinstock said.
Supplement use on the rise
Americans are using complementary alternative medicine (CAM) at record levels. Conservative estimates suggest that 29 percent of the U.S. population has used some form of CAM in the past, and at least 12 percent uses herbal medicines annually.
Currently, the CAM marketplace is valued at $24 billion with a growth rate close to 15 percent per year. While herbal and nutritional supplements may have some utility, there is increasing evidence of potentially dangerous interactions when combined with prescription drugs.
In a recent study evaluating 52 supplements for safety, 13 (25 percent) contained traces of steroids and 11.5 percent contained banned stimulants. In 2007, the American Heart Association released updated guidelines for cardiovascular disease-prevention in women and advised that antioxidant supplements such as vitamins C, E and beta carotene, as well as folic acid supplements, are of no benefit for preventing heart disease.
“For most individuals, these supplements are taken in good faith that the manufacturer’s claims will be delivered but without any valid proof that safe or effective results will occur,” said 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 or supplements to their doctors,” Somma said. “Either they don’t think of it, or they may not think they need to report it because of a perception that supplements are risk-free and safe.”
Risks and benefits
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 is, in fact, a statin. It works the same way as the prescription 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. Vitamin E has also been linked to a rise in serious bleeding in the brain, as well as reducing circulating levels of HDL (good) cholesterol.
“We don’t dislike supplements or universally discourage their use. We know they can be effective, but they often are not subjected to the same rigorous safety testing as prescription medications. Furthermore, some supplements have proven to be quite dangerous,” Somma said. “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 healthcare providers feel comfortable recommending to patients. It reduces triglycerides, one of the substances in the body that together with cholesterol can stick inside artery walls, causing plaque buildup. Fish oil also may reduce the incidence of certain types of abnormal heart rhythms. Thus, fish oil is potentially beneficial. However, fish oil does slightly increase the risk of bleeding. It is strongly advised that patients talk to their doctors before taking any type of non-prescription supplements to minimize the chance of unintended harm.
In addition, recent data has suggested that Vitamin D supplements can be beneficial and safe. Several studies have demonstrated reductions in heart disease and certain types of cancer in vitamin D deficient individuals who were given this supplement. However, too much Vitamin D can be toxic.
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.
Remember, “Just because a supplement comes from nature doesn’t mean it is safe. Lead and arsenic come from nature, too,” Dr. Weinstock said. “Be careful with whatever you put in your body.”
Below are some commonly used vitamin and herbal supplements, and their known cardiac risks.
Herb / Supplement | Uses | Cardiac Dangers |
Vitamin D | Previously believed to promote cardiac health and protect against cancer, but recent studies have largely debunked these claims. | When used with warfarin, a blood-thinning medication, the supplement increases the risk of bleeding. |
Echinacea | Protects against colds and shortens their duration. | Evidence so far says it does not work. May interact with warfarin, affecting blood clotting. |
Ginko | Treats peripheral vascular disease (a painful condition caused by clogged arteries in the legs) and used to improve memory. | Increased risk of bleeding. Several cases of people bleeding inside their heads while taking ginko. May increase the risk of bleeding when used with blood thinners such as warfarin, heparin, clopidogrel, aspirin, ibuprofen and naproxen. |
Ginseng | Provides energy. | May affect blood clotting. |
Chromium picolate | Treats high blood pressure, diabetes, cholesterol. | There have been reports of fast, irregular heart rhythms and liver dysfunction from too much chromium. |
Glucosamine Chondroitin | Treats joint pain caused by osteoarthritis. | May increase the potency of warfarin and nonsteriodal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Reports of allergic reactions in individuals allergic to shellfish or iodine. |
St. John’s Wort | Treats depression and anxiety. | Interferes with levels of drugs such as digoxin and warfarin. |
Bugleweed | Treats nervousness, insomnia, hyperthyroidism and heart failure. | Can affect the results of cardiac stress testing. |
Pomegranate Juice | Rich in antioxidants and believed to promote vascular health. | May cause severe allergic reactions, raise potency of statins as well as potassium levels, avoid in pregnancy. |
Red Yeast Rice | Reduces cholesterol (due to statin like properties). | Essentially is a statin and therefore requires regular blood testing to monitor for potential side effects. In both 2007 and 2008, was recalled due to potency issues and contamination. |
Information in this chart was provided by Cooper University Hospital’s Perry J. Weinstock, MD, FACC, Head of the Division of Cardiovascular Disease and Director of Clinical Cardiology; and Mitchell Somma, CT (ASCP), PA-C, Director of Clinical Education, physicians assistant with the Cooper Heart Institute.
Related Links
- Perry J. Weinstock, MD, FACC, Chief, Division of Cardiovascular Disease and Director of Clinical Cardiology
- Cooper Heart Institute