Sunday, July 23, 2006

Be Skeptical About Alternative Therapies

A number of natural therapies are promoted as treatments for heart disease, but few have lived up to the marketing hype when put to the test in scientific studies. And because herbs and other nutritional supplements are not reviewed for purity or effectiveness by the FDA, you can’t be sure that what you’re buying is effective, or even that the bottle contains the substance on the label. If you take any herbal remedies, be sure to tell your doctor.
These preparations may hinder or exaggerate the effects of prescription drugs used to manage coronary artery disease. Indeed, people with heart disease are more vulnerable than most others to adverse drug interactions.

Antioxidant supplements Some people believe that antioxidant pills provide a way to counter the biological oxidation that activates unhealthy LDL and initiates atherosclerosis. But the research hasn’t panned out.
The American Heart Association in 2004 published an analysis of 15 large trials involving thousands of volunteers who didn’t know whether they were taking an antioxidant pill (either vitamin E or beta carotene) or a placebo. The result?
For the most part, there was no evidence that antioxidant therapies lessen the risk of developing or dying from coronary artery disease. Two studies even suggest that antioxidants might make matters worse. A 2001 study of people who had undergone angiography and had a stent inserted found that those who took antioxidant supplements were more likely to experience restenosis than those who did not — even though both groups were taking statins and niacin to prevent just this occurrence.
A 2002 study found that postmenopausal women on hormone replacement therapy who also took antioxidants were more likely to die than women taking only hormones. The research into antioxidants is continuing, but for the time being the best bet is to obtain these vitamins by eating a variety of fruits and vegetables.

Carnitine This amino acid is found in many foods, especially meat, poultry, fish, and dairy products. Carnitine works with several enzymes as a sort of cellular escort service, ferrying fats into the cell to generate energy and then hauling harmful by-products out for disposal.
Proponents of carnitine believe it can help the heart to generate energy more efficiently.
A handful of clinical trials suggest that taking carnitine supplements might have a modest benefit in treating angina, heart attack, and heart failure. At this point, carnitine is in the "promising but unproven" category. If standard treatments aren’t working to keep your chest pain, leg pain, or heart failure in check, talk to your doctor about adding this supplement to your current therapy.

Chelation therapy (chelation & detoxification) uses infusions, or slow injections, of a chemical known as EDTA. This process is sometimes used to remove toxic levels of lead, iron, or other metals from the body. (The chelated metals exit the body via the urine.) Chelation therapy has also been promoted as a way to cleanse the coronary arteries.
Proponents say a series of 30 or so intravenous infusions will dissolve cholesterol-filled plaque and offer a natural way to ease angina or avoid heart surgery. But so far the research hasn’t substantiated these claims. An analysis of 22 studies found that chelation improved neither objective measures like capacity for exercise nor more subjective outcomes like symptom relief and quality of life. Chelation can also have serious side effects, such as kidney failure, dangerous heart rhythms, and convulsions.
Many experts believe chelation therapy is worthless. Yet thousands of people are paying thousands of dollars each year to receive this treatment. The last word on the subject may arrive in 2007, when the results of a randomized study, involving 100 medical centers and sponsored by the National Center for Complementary and Alternative Medicine, is completed.

Coenzyme Q10 This vitamin-like substance is found in almost every cell in the body, but it is most prevalent in tissues with high energy demands, such as the muscles or the heart. Many advocates of alternative medicine believe that it can strengthen the heartbeat by increasing the cellular fuel available to the heart muscle. And some small studies have suggested that it might help people with angina, heart failure, or other cardiovascular problems.
Other studies, however, report that coenzyme Q10 is of little benefit in these situations. For now, it appears that this supplement is safe, but there is no good evidence that it improves heart health.

Policosanol This product is marketed as a cholesterol fighter. Some small, short-term studies indicate that it lowers harmful LDL and raises helpful HDL levels about as well as a low-dose statin. It also appears to make blood platelets less sticky, thereby reducing the risk for blood clots.
However, almost all studies done on policosanol were carried out by a single research team in Cuba. And no one knows if taking this product will result in fewer heart attacks and strokes. Finally, some policosanol sold in the United States is made from beeswax, which may or may not have the same effects on cholesterol as the product used in the Cuban studies, which was derived from sugarcane wax. At this point, the better bet to control cholesterol is to eat a healthy diet, exercise regularly, and take a statin if necessary.

From the Harvard Health Publications Special Health Report,
The Healthy Heart: Preventing, Detecting, and Treating Coronary Artery Disease.
Copyright 2005 by the President and Fellows of Harvard College. I
llustrations by Harriet Greenfield, M.A., Scott Leighton, Michael Linkinhoker, and Ed Wiederer. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications.
Used with permission of StayWell.

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