It's tempting to follow the latest trend when it comes to health care, but for patients who live with heart failure, some alternative treatments could have serious consequences.
To address the issue, the American Heart Association (AHA) has published a new scientific statement covering a wide range of alternative therapies and their impact on heart failure. It also offers guidance for health care professionals and recommendations for patients.
“Patients should talk to their health care team first,” said Dr. Sheryl Chow, who was part of the AHA's writing group for the statement.
The AHA paper offers guidance on supplements such as CoQ10, vitamin D, ginkgo, devil's claw, fish oil, thiamine, hawthorn, vitamin E, blue cohosh, lily of the valley and aloe vera, while offering additional advice on alcohol, caffeine and grapefruit juice.
“Because these agents are largely unregulated by the [U.S. Food and Drug Administration], manufacturers do not need to demonstrate efficacy or safety,” explained Chow, an associate professor of pharmacy practice and administration at Western University of Health Sciences in Pomona, Calif. “It is important that both health care professionals and consumers are educated about potential efficacy and risk of harm, so that shared and informed decision-making can occur.”
The committee also reviewed yoga and tai chi, commonly suggested for relaxation.
About 6 million Americans aged 20 and up have heart failure, where their heart doesn't pump blood as well as it should. An estimated 30% of these individuals are using an alternative therapy.
“Consumers don't realize that the FDA does not regulate purity, quality and strength of OTC [over-the-counter] herbals and supplements. One product might contain very different concentrations and purity than the next, despite having the same label in the pharmacy or health food store,” Chow said.
On its list of alternative therapies that may benefit people with heart failure, the AHA said omega-3 fatty acids — also known as fish oil — have the strongest evidence of clinical benefit for people with heart failure.
These may be used in moderation after talking with a doctor, the AHA statement said. They shouldn't be used in doses of 4 grams or more because they may increase an irregular heart rhythm at higher doses.
“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,” the statement said.
Yoga and tai chi also have benefit, potentially improving a person's tolerance for exercise, plus quality of life, while decreasing blood pressure.
Despite the fact that low blood levels of vitamin D have been associated with worse heart failure outcomes, taking this supplement may be harmful if a person is also taking certain heart failure medications.
Supplements of the root of a flowering plant called blue cohosh may cause a fast heart rate, high blood pressure, chest pain and increase blood sugar levels, the statement warned.
Studies on other therapies including thiamine, alcohol, vitamin E, CoQ10 and hawthorn have mixed findings. More research and controlled trials are needed to better understand the risks and benefits, Chow said.
Although this scientific statement is focused on heart failure patients, Chow said, the guidance is equally important for people with other health issues.
The statement was published online Dec. 8 in the journal Circulation.
Dr. Michelle Kittleson, director of heart failure research in the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles, said she was delighted to see the new AHA guidance.
Though Kittleson considers herself an expert in the care of patients with heart failure, even with that level of knowledge it's easy to feel lost about the best strategy to manage patients when they're taking alternative medications, she said.
“If you look at this statement, there are 210 references. That's a meaty, heavy statement. The experts that wrote it did all the hard work, so we don't have to,” Kittleson said.
While many clinicians don't ask patients about any of these therapies, they should because of the interactions they can have with traditional heart medications, Kittleson added.
Patients will sometimes want advice on additional steps they can take to improve their own heart health, she noted.
“I think sometimes you come to your doctor and ask them about something. And the doctor's like, ‘Oh gosh, I don't know that,'" she added. "You lose a bit of trust and credibility in that patient-physician relationship.”
“This gives us a step in the right direction to say, ‘I'm so glad you asked,'” Kittleson said. “I have this incredible reference that's really compounded all the information on how this will impact your heart health. Let's review and see what's right for you."
The U.S. Centers for Disease Control and Prevention has more on heart failure.
SOURCES: Sheryl Chow, PharmD, associate professor, pharmacy practice and administration, Western University of Health Sciences, Pomona, Calif., and fellow, American Heart Association; Michelle Kittleson, MD, PhD, heart failure research, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles; American Heart Association statement, Circulation, Dec. 8, 2022, online