Alternative Therapies for Heart Failure

Complementary and alternative medicine (CAM) is a term often used to describe herbs, vitamins, non-herbal dietary products, and various kinds of therapies that are used outside the traditional practice of medicine.¹

The use of CAM is growing and expanding. But critics of complementary and alternative medicine have expressed concern over potentially serious adverse effects and use without coordination from the treating doctor.²

As the rates of heart disease increase along with our aging population, more people are looking for options in their medical care including alternative therapies to treat and prevent further deterioration of their condition.³

For people with heart failure (HF), the complementary and alternative approaches may offer options beyond the standard HF medical regimen. However, the broad array of CAM practices may also present significant risks to people with heart conditions. There is limited research with verifiable data on the effect of these practices on clinical outcomes.^2,4

Complementary and alternative

Complementary medicine is not the same as alternative medicine. Complementary techniques are used along with traditional medicine, whereas alternative medicine is typically used instead of traditional medicine. Traditional heart failure treatments, including medications and surgical procedures, have gone through rigorous testing to ensure safety and effectiveness, but alternative therapies have not.³

Heart failure is a chronic condition characterized by the heart’s inability to pump effectively and is associated with a decreased life expectancy. HF can often be controlled for years by taking prescribed medication and by making lifestyle changes. Yet some people look for more options because they are dissatisfied or unable to comply with traditional medicine.^3,5,8

While many may find alternative therapies helpful, the techniques have not gone through the same testing and evaluation process to assure patient safety. In fact, some of these therapies can cause serious interactions with conventional cardiovascular therapies and actually be harmful if not directed by a doctor.³

Before embarking on any alternative therapies, it is important to learn about their potential safety and effectiveness, the expertise and qualifications of the provider, and to share this information with your doctor. Good communication between doctor and patient is important to prevent serious complications, particularly herb-drug interactions.^3,4

CAM therapies

CAM therapies are of diverse medical and healthcare systems, practices, and products not generally considered part of conventional medicine. They can be grouped into the following categories:^1,6

• Whole medical systems – homeopathy, ayurvedic medicine
• Mind-body interventions – yoga, tai chi, meditation, qigong, biofeedback, hypnotherapy, spirituality
• Biologically based therapies – vitamin, mineral, and herbal treatments
• Manipulative and body-based methods – massage or chiropractic therapy
• Energy therapies – Reiki, magnetic therapy

Many therapies are holistic where the health and healing of the whole person is the focus of the treatment. This approach includes therapies that can have physical, mental, emotional, and spiritual impacts. These may include a wide range, from guided imagery and acupuncture to nutritional counseling and herbal medicine.^3,4

But major medical associations warn that supplements of any kind should be discussed with your doctor before taking them. Published studies have failed to demonstrate a benefit for routine vitamin, nutritional, or hormonal supplementation in people with heart failure. There may be contraindications and interactions associated with supplements and your prescribed medication regimen. People with heart failure often take multiple medications, including blood-thinning and blood pressure drugs that can have dangerous side effects if taken with certain supplements.^5,7

Always ask your doctor before taking a supplement if you have heart failure.⁵
Some examples:

Magnesium

Magnesium is a key element in heart health. It has a role in maintaining normal heart rhythm and is often used to treat irregular heartbeat (arrhythmia). Magnesium can interact negatively with some heart medications.

Carnitine

Carnitine is a nutrient that helps the body convert fatty acids into energy, which is used in muscular activities of the body. It may affect thyroid medication or interact with blood-thinning medications, such as coumadin, aspirin, and others.

Coenzyme Q10 (CoQ10)

CoQ10 supplements can help reduce swelling in the legs, enhance breathing by reducing fluid in the lungs, and improve exercise capacity in some people with heart failure. It may negatively interact with blood-thinning medications, blood pressure medications, and chemotherapy agents.

Amino acids

Amino acids such as arginine can lower blood pressure, so it may be unsafe when taking blood pressure medications. It can have negative interactions with other drugs that increase blood flow, such as nitrates, and those used to treat erectile dysfunction.

Taurine

Taurine helps the heart muscle contract but can interact with lithium, causing it to be unsafe in some people, including those with bipolar disorder.

Herbs

Herbs have been used for thousands of years to strengthen the body and treat illness. They can have side effects and interact with other herbs, supplements, or medications. Like other supplements, they should be used only under the supervision of a cardiologist and a doctor who is knowledgeable about contraindications and interactions with traditional medications.

Hawthorn

Hawthorn is from the rose family and has been used since the early 1800s to treat circulation and respiration (breathing) problems. There is not enough research to suggest its successful use to treat irregular heartbeat, high blood pressure, chest pain, atherosclerosis (hardening of the arteries), and heart failure.

Berberine

Berberine is an active ingredient in goldenseal and is a vasodilator. It may improve heart function and quality of life but can potentially interact with a number of medications.

Chelation therapy

Chelation therapy is a treatment commonly used to rid the body of heavy metals. It can lead to serious complications, including kidney failure, low blood pressure, seizures, and difficulty breathing, even death.⁸

CBD use

Although smoking marijuana can cause the heart to work harder and may cause chest pain to develop more quickly in people with existing heart failure, new research on CBD, a non-psychoactive cannabinoid, suggests that its anti-inflammatory and antioxidative properties may be beneficial for people at risk for heart disease.^9,10

Although CBD has a good safety profile, if you don’t know the quality or source you may not be getting the expected product. Like other alternative therapies, CBD can interact with medications you already take. It may interfere with certain liver enzymes, which can affect the way drugs are metabolized. New research is investigating a new cannabinoid delivery mechanism that would improve the delivery of the active ingredients to improve its effectiveness and limit its elimination by the liver. Remember to talk to your doctor about any potential drug interactions before taking CBD.¹¹

Recommendations

The ACCF/AHA Guidelines for the Management of Heart Failure field warn about the use of supplements and other therapies without integration with your cardiologist. The potential for possible adverse effects and drug interactions of nutritional supplements, vitamins, or hormones should be part of any heart failure educational program for both doctors and their patients. Doctors should always ask their patients about anything they take that has not been prescribed by them.⁷

Treatments addressing the mind/body relationship, including relaxation techniques, stress management, and meditation, may have demonstrated valuable effects over the years and have begun to be integrated into traditional medical care. They are now part of cardiac rehab programs having demonstrated a reduction of cortisol and blood pressure levels, improved mood and cognition, and decreased pain.⁵

However, herbs or supplements should not be used by people with HF without seeking medical advice. The use of CAM continues to grow despite limited scientific support.^5,7