Congestive Heart Failure (CHF)
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Congestive Heart Failure (CHF) and Hawthorn

Written by ColleenO, FoundHealth.

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During the Middle Ages, the herb hawthorn was used for the treatment of dropsy, a condition we now call congestive heart failure. Based on modern research evidence, hawthorn appears to be effective for mild congestive heart failure (CHF) and may also be helpful for more severe CHF.

Effect of Hawthorn on Congestive Heart Failure (CHF)

Like other treatments used for CHF, hawthorn improves the heart's pumping ability. However, it may offer some important advantages over certain conventional drugs used for this condition. Digoxin, as well as other medications that increase the power of the heart, also make the heart more susceptible to dangerous irregularities of rhythm. In contrast, preliminary evidence indicates that hawthorn may have the unusual property of both strengthening the heart and stabilizing it against arrhythmias.6-8 It is thought to do so by lengthening what is called the refractory period. This term refers to the short period following a heartbeat during which the heart cannot beat again. Many irregularities of heart rhythm begin with an early beat. Digoxin shortens the refractory period, making such a premature beat more likely, while hawthorn seems to protect against such potentially dangerous breaks in the heart's even rhythm.

Read more details about Hawthorn.

Research Evidence on Hawthorn

There is a significant amount of promising research on the use of hawthorn for congestive heart failure (CHF).

At least nine double-blind, placebo-controlled trials, involving a total of about 750 participants have found hawthorn helpful for the treatment of mild to moderate congestive heart failure.53,54

In one of the best of these studies, 209 people with relatively advanced congestive heart failure (technically, New York Heart Association [NYHA] class III) were given either 900 mg or 1,800 mg of standardized hawthorn extract or matching placebo.40 The results after 16 weeks of therapy showed significant improvements in the hawthorn groups as compared to the placebo groups. Benefits in the high-dose hawthorn group included a reduction in subjective symptoms, as well as an increase in exercise capacity. Subjective symptoms improved to about the same extent in the lower-dose hawthorn group, but there was no improvement in exercise capacity.

In an analysis that mathematically combined the results of 10 controlled trials involving 855 patients, hawthorn extract was found to be significantly better than placebo for improving exercise tolerance, decreasing shortness of breath and fatigue, and enhancing the physiologic function of an ailing heart in mild to moderate congestive heart failure.62

In another study, however, researchers found that patients with mild to moderate CHF taking a special extract of hawthorn, 900 mg daily, were more likely to experience an initial worsening of their condition compared to those taking a placebo. But, by the end of six months, there was no difference in the two groups. In light of numerous other studies supporting the safety and effectiveness of hawthorn in CHF, the results of this special extract study need to be repeated before drawing any firm conclusions.64

A comparative study suggests that hawthorn extract (900 mg) is about as effective as a low dose of the conventional drug captopril, an ACE inhibitor.12 However, while captopril and other standard drugs in the same family have been shown to help reduce hospitalizations and mortality associated with CHF, there is no similar evidence for hawthorn.

Like other treatments used for CHF, hawthorn improves the heart's pumping ability. However, it may offer some important advantages over certain conventional drugs used for this condition.

Digoxin, as well as other medications that increase the power of the heart, also make the heart more susceptible to dangerous irregularities of rhythm. In contrast, preliminary evidence indicates that hawthorn may have the unusual property of both strengthening the heart and stabilizing it against arrhythmias.6-8 It is thought to do so by lengthening what is called the refractory period. This term refers to the short period following a heartbeat during which the heart cannot beat again. Many irregularities of heart rhythm begin with an early beat. Digoxin shortens the refractory period, making such a premature beat more likely, while hawthorn seems to protect against such potentially dangerous breaks in the heart's even rhythm.

Another advantage of hawthorn involves toxicity. With digoxin, the difference between the proper dosage and the toxic dosage is dangerously small. Hawthorn has an enormous range of safe dosing.9

However, keep in mind that digoxin is itself an outdated drug. There are a great many newer drugs for CHF (such as ACE inhibitors) that are much more effective than digoxin. Many of these have been proven to prolong life in people with severe CHF. There is as yet no reliable evidence that hawthorn offers the same benefit. (Although, one large study found tantalizing hints that it might.)61

How to Use Hawthorn

The usual dosage of hawthorn is 300 to 600 mg 3 times daily of an extract standardized to contain about 2% to 3% flavonoids or 18% to 20% procyanidins. Studies indicate that full effects may take up to 6 months to develop, although some improvement should be apparent much sooner.

The studies discusses here involved higher doses of hawthorn extract, such as 900 mg and 1,800 mg daily, and benefits were seen in fewer than six months.

Types of Professionals That Would Be Involved with This Treatment

  • Integrative MD
  • Naturopathic doctor
  • Herbalist

Safety Issues

Hawthorn appears to be generally safe. Germany's Commission E lists no known risks, contraindications, or drug interactions with hawthorn, and mice and rats have been given very large doses without showing significant toxicity. 1 In clinical trials, reported side effects were relatively rare and nonspecific, consisting primarily of mild dizziness, stomach upset, headache, and occasional allergic reactions (skin rash). 2 Perhaps the biggest risk with hawthorn is that using it instead of conventional treatment might increase risk of death or other complications of CHF. In addition, it is not known whether hawthorn can be safely combined with other drugs that affect the heart. Therefore (to reiterate), do notself-treat CHF with hawthorn. A physician's supervision is essential.

Safety in young children, pregnant or nursing women, or those with severe liver, heart, or kidney disease has not been established.

Interactions You Should Know About

  • If you are taking any medications that affect the heart: It is possible that taking hawthorn could cause problems. It is not clear whether one can safely combine hawthorn with other drugs that affect the heart.

References

  1. Ammon HPT, Handel M. Crataegus, toxicology and pharmacology. Parts I, II and III [translated from German]. Planta Med. 1981;43:105-120, 209-239, 313-322.
  2. Daniele C, Mazzanti G, Pittler MH, Ernst E. Adverse-event profile of Crataegus spp.: a systematic review. Drug Saf. 29(6):523-35.
  1. Popping S, Rose H, Ionescu I, et al. Effect of a hawthorn extract on contraction and energy turnover of isolated rat cardiomyocytes. Arzneimittelforschung. 1995;45:1157-1161.
  2. Joseph G, Zhao Y, Klaus W. Pharmacologic action profile of crataegus extract in comparison to epinephrine, amirinone, milrinone and digoxin in the isolated perfused guinea pig heart [in German; English abstract]. Arzneimittelforschung. 1995;45:1261-1265.
  3. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physicians' Guide to Herbal Medicine. 3rd ed. Berlin, Germany: Springer-Verlag; 1998:91-94.
  4. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physicians' Guide to Herbal Medicine. 3rd ed. Berlin, Germany: Springer-Verlag; 1998:91-94.
  5. Tauchert M, Siegel G, Schulz V. Hawthorn extract as plant medication for the heart; a new evaluation of its therapeutic effectiveness [translated from German]. MMW Munch Med Wochenschr. 1994;136(suppl 1):S3-S5.
  6. Tauchert M. Efficacy and safety of crataegus extract WS 1442 in comparison with placebo in patients with chronic stable New York Heart Association class-III heart failure. Am Heart J. 2002;143:910-915.
  7. Pittler MH, Schmidt K, Ernst E. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. Am J Med. 2003;114:665-74.
  8. Degenring FH, Suter A, Weber M, et al. A randomised double blind placebo controlled clinical trial of a standardised extract of fresh Crataegus berries (Crataegisan®) in the treatment of patients with congestive heart failure NYHA II. Phytomedicine. 2003;10:363-9.
  9. Berkrot, B. RTRS-Herbal extract promising in heart failure: study. Reuters website. Available at: http://www.reuters.com/article/health-SP-A/idUSN2720388620070327. Accessed March 27, 2007.
  10. Pittler M, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev. 2008;CD005312.
  11. Zick SM, Gillespie B, Aaronson KD. The effect of Crataegus oxycantha special extract WS 1442 on clinical progression in patients with mild to moderate symptoms of heart failure. Eur J Heart Fail. 2008 May 17.

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