Complementary Alternative Cardiovascular Medicine

28 Alternative Cardiovascular Medicine
and reperfusion, reducing plasma cholesterol levels, and/or inhibiting
low-density lipoprotien (LDL) oxidation (1,2). The monounsaturated fat
in olive oil and multiple constituents in garlic are beneficial for the cardiovascular
system when consumed as part of a healthy diet. Other botanicals,
such as hawthorn, guggul, red yeast rice, and globe artichoke, show
promise for several cardiovascular conditions.
Although the data are intriguing, outcome studies that demonstrate the
extent to which these botanicals reduce morbidity and mortality in those
with cardiovascular disease (CVD) have yet to be conducted; thus, the
formal recommendation of many of these plants is premature as primary
treatment for most cardiovascular conditions. Practitioners are cautioned
to be diligent in their care and follow-up of patients who choose to use
herbal therapies in place of prescription drug therapy. In addition, the
quality of botanical medicines available in the United States can be anywhere
from excellent to awful. Adulteration, contamination, and substitution
of herbs are not uncommon, making it imperative to choose
supplements that have proven themselves in clinical trials (usually produced
in Europe) or from companies that have gone through a quality
certification program, such as the US Pharmacopeia (USP) or the National
Sanitation Foundation (NSF), and bear the quality seal on their label.
ARTICHOKE (CYNARA SCOLYMUS)
Category 3 for Dyslipidemia
Globe artichoke leaf has been used as a treatment for dyspepsia since
ancient times. More recently, researchers have found that the leaf extract
has lipid-lowering activity. In vitro research indicates that the mechanism
of action is an indirect inhibition of 3-hydroxy-3-methylglutaryl
coenzyme A (HMG-CoA) reductase (3). Although there are likely multiple
active constituents, luteolin exerted the highest inhibitory potency
and effectively blocked the stimulation of cholesterol biosynthesis by
insulin. Artichoke extracts also enhance biliary cholesterol excretion
(4), which may also contribute to its lipid-lowering effects.
An older study of 17 outpatients with familial type IIa or IIb
hyperlipoproteinemia was conducted to determine the efficacy of an
isolated constitutent from artichoke, cynarin, for lowering lipids in this
population. The patients were treated with either 250 mg/d or 750 mg/d of
cynarin for 3 mo. There were no significant changes noted in serum cholesterol
and triglyceride levels (5). Of course, this study used an isolated
constituent from artichoke, which, at least according to recent in vitro
data, is not the main lipid-lowering agent.
A recent randomized, placebo-controlled multicenter trial examined
the efficacy and tolerability of 450 mg per tablet artichoke dry extract