Complementary Alternative Cardiovascular Medicine

Chapter 3 / Botanical Medicine and CVD 29
(drug/extract ratio 25–35/1, aqueous extract, CY450) vs placebo for the
treatment of hyperlipidemia. The study enrolled 143 adult patients with
initial total cholesterol of greater than 280 mg/dL and randomized them
to receive either 1,800 mg artichoke dry extract per day or placebo for
6 wk. Changes of total cholesterol and LDL cholesterol from baseline to
the end of treatment showed a statistically significant superiority (p =
0.0001) of artichoke dry extract over placebo. The decrease of total
cholesterol in the CY450 group was 18.5%, compared to 8.6% in the
placebo group. The LDL cholesterol decrease in the CY450 group was
22.9% and 6.3% for placebo. LDL/high-density lipoprotein (HDL) ratio
showed a decrease of 20.2% in the CY450 group and 7.2% in the placebo
group. No adverse events were noted in the study (6).
The adverse effect profile for artichoke in the literature is good. The
only contraindication at this time is for use in those who have a bile duct
obstruction because of the choleretic activity of the extract. Given the
short duration of the English trial and the lack of confirmatory studies,
the true effectiveness of globe artichoke leaf for the treatment of hyperlipidemia
is currently not known.
BISHOP’S WEED (AMMI VISNAGA)
Class 3 for Mild Angina
The fruit of this plant has been used since ancient times for its medicinal
properties. Papyrus writings from Egypt describe the use of Ammi
visnaga to treat asthma, painful kidney stones, and angina. In more
modern times, there has been a growing body of research on the
furanochromones and coumarin derivatives and their effects on the cardiovascular,
respiratory, and gastrointestinal (GI) systems.
Visnagin, a constituent of bishop’s weed, has demonstrated
vasodilating activity in vitro and in animal studies (7), likely by inhibiting
phosphodiesterase (8). Intravenous administration of visnagin resulted
in dose-related decreases in blood pressure, with no significant changes in
heart rate (9).
Khellin accounts for much of the antispasmodic effects of Ammi
visnaga, relaxing vascular smooth muscle through a nonspecific inhibition
of calcium flux (10). This is in contrast to visnadin, which preferentially
inhibits contractile responses mediated by Ca 2+ entry through
L-type Ca 2+ channels (11), resulting in peripheral and coronary vasodilation.
Both Ammi visnaga and the isolated constituent visnadin are still
used in Europe to treat angina pectoris (12). The German Commission
E approved the use of Ammi visnaga to treat mild anginal symptoms.
Standardized preparations of this herb may prove useful for mild angina,
especially in those patients who cannot tolerate nitroglycerin.