Complementary Alternative Cardiovascular Medicine

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102 Alternative Cardiovascular Medicine bidity. There is widespread public interest in the use of alternative medicine to prevent and treat these diseases. The cardiovascular system is more susceptible to free radical oxidative stress and premature aging than any other body system. Certain herbal and dietary factors have antioxidant, anti-inflammatory, and antiproliferative properties. Therefore, select supplements may play a preventive and therapeutic role in CVD. Conflicting reports in the biomedical literature and lack of information from health care professionals have led to the misunderstanding about supplements’ roles in patients with CVDs. This chapter reviews the most commonly used nutrachemicals. L-ARGININE L-arginine is an essential amino acid and is required for protein synthesis. It is found in red meat, fish, poultry, and dairy products. Nitric oxide synthase (NOS) converts L-arginine to nitric oxide (NO) in vascular endothelial cells. NO is also known as the endothelial-derived relaxation factor (EDRF). NO is a potent vasodilator and modulates a significant portion of endothelial function in coronary and peripheral circulations. These beneficial effects can be jeopardized if there is impaired NO production. It is postulated that a reduction in available L-arginine, in part because of the presence of endogenous inhibitors, will result in impaired NO production and endothelial dysfunction. Therefore, L-arginine administration could enhance endogenous NO production, which could result in favorable clinical outcomes. Role in CVD Studies have shown beneficial effects of L-arginine supplementation in a relatively small number of patients with coronary artery disease (CAD). Lerman et al. (1) reported the beneficial effects of oral supplementation of L-arginine in 26 patients with small-vessel CAD. Coronary blood flow (CBF) reserve in response to acetylcholine was assessed at baseline and at 6-mo intervals. In this small, blinded, controlled trial, the L-arginine group demonstrated a significant increase in CBF compared with placebo (149 ± 20% vs 6 + 9%, p < 0.05). This finding was also associated with decreased plasma endothelin level, which is a potent vasoconstrictor. It has been postulated that increased NO production may inhibit the endothelin production through a cyclic guanosine monophosphate (cGMP) dependent pathway. Blum et al. (2) illustrated the benefits of oral L-arginine therapy (9 g/d for 3 mo) in a crossover, doubleblind study of 10 patients with intractable class IV angina, despite treatment with aspirin, calcium channel blockers, nitrates, and high-dose
Chapter 7 / Nutrachemicals and CVD 103 beta-blockers. L-arginine therapy resulted in clinical improvement in seven patients (from angina pectoris class IV to class II). These patients also showed reduction in proinflammatory cytokines (interleukin [IL]- 1-, IL-6) and downregulation of cell adhesion molecules (P-selectin, E-selectin, and intercellular adhesion molecule [ICAM]). In another prospective, double-blind, randomized crossover study (3) of 10 young men with CAD, the endothelial-dependent vasodilation and reduction in monocyte adhesion to endothelial cells were evident by the third week of supplementation with L-arginine (7 g three times/d). Bednarz et al. (4) assessed the effects of L-arginine on electrocardiographic changes in 25 patients with CAD. Oral supplementation of L-arginine had no effect on QT intervals, QT dispersion, or ST depression. There was a significant increase in exercise tolerance (p
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Complementary and Alternative Cardi
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CONTEMPORARY CARDIOLOGY CHRISTOPHER
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© 2004 Humana Press Inc. 999 River
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vi Preface physician or other healt
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viii Contents 10 Massage Therapy an
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x Contributors ERIN L. OLIVO, PhD
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Chapter 1 / CAM and CVD 1 1 Complem
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Chapter 1 / CAM and CVD 3 patients
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Chapter 1 / CAM and CVD 5 The crite
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Chapter 1 / CAM and CVD 7 disease c
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Chapter 1 / CAM and CVD 9 analyses,
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Chapter 3 / Botanical Medicine and
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Chapter 4 / Herb and Dietary Supple
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Chapter 10 / Massage Therapy and CV
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Chapter 11 / Acupuncture and CVD 16
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Chapter 16 / A Guide for Physicians
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Index 279 INDEX A N-Acetylcysteine
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Index 281 taurine studies, 106 Conj
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Index 283 Homeopathic medicine, see
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Index 285 funding of studies, 148 g
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Contemporary Cardiology COMPLEMENTA
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Complementary Alternative Cardiovascular Medicine

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