Complementary Alternative Cardiovascular Medicine

Chapter 3 / Botanical Medicine and CVD 39
Extract LI132 (Lichtwer Pharma GmbH) contains 95 mg hawthorn leaf,
55 mg hawthorn fruit, and 45 mg hawthorn flower, plus 30 mg dry cold
macerate 5:1 (w/w) of hawthorn leaf with flower per tablet.
Hawthorn has a low risk of toxicity when used appropriately. No
organ toxicity was noted at 100 times the human dose of a hawthorn
extract standardized to 18.76% oligomeric procyanidins (75). Hawthorn
is considered to be quite safe when used appropriately; however, practitioners
should be aware that hawthorn preparations may potentiate the
activity of cardiac glycoside medications, such as digitalis (60).
HORSE CHESTNUT (AESCULUS HIPPOCASTANUM)
Class 2 for Chronic Venous Insufficiency
Horse chestnut tree seeds and bark have been used as traditional
medicines in Europe for at least the past four centuries. The seed was
primarily used for the treatment of varicose veins, hemorrhoids, phlebitis,
neuralgia, and rheumatic complaints. The seeds contain several active
constituents, including flavonoids and a combination of approx 30
unique pentacyclic triterpene diester glycoside saponins, collectively
referred to as escin.
Horse chestnut seed extracts (HCSE) likely work through numerous
mechanisms. In vitro research indicates that the extract inhibits the activity
of elastase and hyaluronidase, which are enzymes involved in
degrading the proteoglycan matrix, which comprises part of the capillary
endothelium (76). Animal data suggest that HCSE shifts the balance
away from degradation and toward proteoglycan synthesis, thus reducing
vascular permeability and leakage (77).
A recent systematic review was published that examined 16 randomized
controlled trials using HCSE for the treatment of chronic venous
insufficiency (CVI). Eight of the studies were considered to be of good
quality. Side effects noted in clinical trials included pruritus, nausea, and
gastric complaints. Although the authors note that none of the studies
was flawless, they do conclude that their critical literature review suggests
that HCSE is an effective therapy for CVI (77).
HCSE are widely used in Europe, with a low incidence of adverse
effects. Esculin exerts antithrombin activity and may lead to an increased
bleeding time (78). Although the clinical significance of this interaction
is not known when patients use therapeutic doses of the extract, practitioners
should be mindful of patients who are taking anticoagulant medications.
Standardized HCSE contains 16–20% triterpene glycosides,
calculated as escin. The usual recommended daily dose is 100–150 mg
of escin equivalent, or approx 500–750 mg HCSE containing 20% escin.