Angina supplements

  • The main function of L-carnitine is to transfer long-chain fatty acids in the form of their acyl-carnitine esters across the inner mitochondrial membrane before beta-oxidation. In humans, it is synthesized in the liver, kidney, and brain and actively transported to other areas of the body. For example, 98% of the total body L-carnitine is confined to the skeletal and cardiac muscle at concentrations approximately 70 times higher than in the blood serum. Supplementation may be necessary in rare cases of primary carnitine deficiency, which may be caused by a defect in carnitine biosynthesis, a defect in carnitine active transport into tissue, or a defect in renal (kidney) conservation of carnitine. Known conditions of secondary deficiency of carnitine (insufficiency), in which L-carnitine is effective, include chronic stable angina and intermittent claudication characterized by distinct tissue hypoxia (low oxygen levels). Another condition that may benefit from carnitine supplementation is decreased sperm motility. Although use in preterm infants suggests carnitine supplementation may aid in maintaining or increasing plasma carnitine levels and possibly weight gain, carnitine is not routinely added to preterm total parenteral nutrition (TPN). However, soy-based infant formulas are fortified with carnitine to levels found in breast milk. In 1986, the U.S. Food and Drug Administration (FDA) approved L-carnitine for use in primary carnitine deficiency. D-carnitine or DL-carnitine may cause secondary L-carnitine deficiency and should not be used.
  • Vitamin E is a fat-soluble vitamin with antioxidant properties. Vitamin E exists in eight different forms ("isomers"): alpha, beta, gamma, and delta tocopherol; and alpha, beta, gamma, and delta tocotrienol. Alpha-tocopherol is the most active form in humans. Dosing and daily allowance recommendations for vitamin E are often provided in Alpha-Tocopherol Equivalents (ATE) to account for the different biological activities of the various forms of vitamin E, or in International Units (IU), which food and supplement labels may use. Vitamin E supplements are available in natural or synthetic forms. The natural forms are usually labeled with the letter "d" (for example, d-gamma-tocopherol), whereas synthetic forms are labeled "dl" (for example, dl-alpha-tocopherol). Vitamin E has been proposed for the prevention or treatment of numerous health conditions, often based on its antioxidant properties. However, aside from the treatment of vitamin E deficiency (which is rare), there are no clearly proven medicinal uses of vitamin E supplementation beyond the recommended daily allowance. There is ongoing research in numerous diseases, particularly in cancer and heart disease. Recent concerns have been raised about the safety of vitamin E supplementation, particularly in high doses. An increased risk of bleeding has been proposed, particularly in patients taking blood-thinning agents such as warfarin, heparin, or aspirin, and in patients with vitamin K deficiency. Recent evidence suggests that regular use of high-dose vitamin E supplements may increase the risk of death (from "all causes") by a small amount, although a different study found no effects on mortality in women who took vitamin E daily. Caution is warranted.
  • Hawthorn, a flowering shrub of the rose family, has an extensive history of use in cardiovascular disease, dating back to the 1 st Century. Flavonoids and other compounds found in hawthorn may synergistically improve performance of the damaged heart muscles, and further, may prevent or reduce symptoms of coronary artery disease. Hawthorn is widely used in Europe for treating New York Heart Association (NYHA) Class I-II heart failure, with standardization of its leaves and flowers. Overall, hawthorn appears to be effective, safe and well tolerated, and in accordance with its indication, best used under the supervision of a medical professional. The therapeutic equivalence of hawthorn extracts to drugs considered standard-of-care for heart failure (such as angiotensin converting enzyme inhibitors, diuretics, or beta-adrenergic receptor blockers) remains to be established, as does the effect of concomitant use of hawthorn with these drugs. Nonetheless, hawthorn is a potentially beneficial therapy for patients who cannot/will not take prescription drugs, and may offer additive benefits to prescription drug therapy.
  • Coenzyme Q10 (CoQ10) is produced by the human body and is necessary for the basic functioning of cells. CoQ10 levels are reported to decrease with age and to be low in patients with some chronic diseases such as heart conditions, muscular dystrophies, Parkinson's disease, cancer, diabetes, and HIV/AIDS. Some prescription drugs may also lower CoQ10 levels. Levels of CoQ10 in the body can be increased by taking CoQ10 supplements, although it is not clear that replacing "low CoQ10" is beneficial. CoQ10 has been used, recommended, or studied for numerous conditions, but remains controversial as a treatment in many areas.
  • Two parts of the safflower are primarily used: the flower itself and safflower seeds. There are two types of safflower oil with corresponding types of safflower varieties: those high in monounsaturated fatty acid (oleic) and those high in polyunsaturated fatty acid (linoleic). Currently, the seed varieties that produce oil high in oleic acid and very low in saturated fatty acids predominate in the United States market. High oleic safflower oil is lower in saturates and higher in monounsaturates than olive oil. In the U.S. diet, safflower oil has been frequently substituted for oils with higher saturated fat content, as monounsaturated fat may have a beneficial effect on the risk of coronary heart disease. Some clinical studies have shown that safflower oil supplementation may be helpful in patients with cystic fibrosis, Friedreich's ataxia, and neurotoxicity from lithium. However, more study is needed in these areas before a firm conclusion can be drawn. In traditional Chinese medicine, safflower is used to invigorate the blood, dissipate stasis, amenorrhea (absence of menstruation), pain, and traumatic injuries. It is also used to "calm" a live fetus and abort a dead fetus, and is therefore used cautiously during pregnancy.
  • Danshen ( Salvia miltiorrhiza ) is widely used in traditional Chinese medicine (TCM), often in combination with other herbs. Remedies containing danshen are used traditionally to treat a diversity of ailments, particularly cardiac (heart) and vascular (blood vessel) disorders such as atherosclerosis ("hardening" of the arteries with cholesterol plaques) or blood clotting abnormalities. The ability of danshen to "thin" the blood and reduce blood clotting is well documented, although the herb's purported ability to "invigorate" the blood or improve circulation has not been demonstrated in high-quality human trials. Because danshen can inhibit platelet aggregation and has been reported to potentiate (increase) the blood-thinning effects of warfarin, it should be avoided in patients with bleeding disorders, prior to some surgical procedures, or when taking anticoagulant (blood-thinning) drugs, herbs, or supplements. In the mid-1980s, scientific interest was raised in danshen's possible cardiovascular benefits, particularly in patients with ischemic stroke or coronary artery disease/angina. More recent studies have focused on possible roles in liver disease (hepatitis and cirrhosis) and as an antioxidant. However, the available research in these areas largely consists of animal studies and small human trials of poor quality. Therefore, firm evidence-based conclusions are not possible at this time about the effects of danshen for any medical condition.
  • Dietary sources of omega-3 fatty acids include fish oil and certain plant/nut oils. Fish oil contains both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), while some nuts (e.g., English walnuts) and vegetable oils (e.g., canola, soybean, flaxseed/linseed, and olive oil) contain alpha-linolenic acid (ALA). Evidence from several studies has suggested that amounts of DHA and EPA in the form of fish or fish oil supplements lowers triglycerides, slows the buildup of atherosclerotic plaques ("hardening of the arteries"), lowers blood pressure slightly, as well as reduces the risk of death, heart attack, dangerous abnormal heart rhythms, and strokes in people with known heart disease. However, high doses may have harmful effects, such as an increased risk of bleeding. Although similar benefits are proposed for alpha-linolenic acid, scientific evidence is less compelling, and beneficial effects may be less pronounced. Some species of fish carry a higher risk of environmental contamination, such as with methylmercury.
  • Kudzu originated in China and was brought to the United States from Japan in the late 1800s. It is distributed throughout much of the eastern United States and is most common in the southern part of the continent. Kudzu has traditionally been used in China to treat alcoholism, diabetes (high blood sugar), gastroenteritis (inflamed stomach or intestine), and deafness. Evidence suggests kudzu may improve signs and symptoms of unstable angina (chest pain), improve insulin resistance, and have a positive effect on cognitive function in postmenopausal women. However, most studies have suffered from methodological weaknesses and small sample sizes. Chinese healers have used kudzu to treat high blood pressure and chest pain and to minimize alcohol cravings. Research indicates that puerarin (a constituent of kudzu) may increase blood flow to the heart and brain which helps explain certain traditional uses.
  • Dong quai ( Angelica sinensis ), also known as Chinese Angelica, has been used for thousands of years in traditional Chinese, Korean, and Japanese medicine. It remains one of the most popular plants in Chinese medicine, and is used primarily for health conditions in women. Dong quai has been called "female ginseng," based on its use for gynecological disorders (such as painful menstruation or pelvic pain), recovery from childbirth or illness, and fatigue/low vitality. It is also given for strengthening xue (loosely translated as "the blood"), for cardiovascular conditions/high blood pressure, inflammation, headache, infections, and nerve pain. In the late 1800s, an extract of Dong quai called Eumenol became popular in Europe as a treatment for gynecological complaints. Recently, interest in Dong quai has resurged due to its proposed weak estrogen-like properties. However, it remains unclear if Dong quai has the same effects on the body as estrogens, blocks the activity of estrogens, or has no significant hormonal effects. Additional research is necessary in this area before a firm conclusion can be drawn. In Chinese medicine, Dong quai is most often used in combination with other herbs, and is used as a component of formulas for liver qi stasis and spleen deficiency. It is believed to work best in patients with a yin profile, and is considered to be a mildly warming herb. Dong quai is thought to return the body to proper order by nourishing the blood and harmonizing vital energy. The name Dong quai translates as "return to order" based on its alleged restorative properties. Although Dong quai has many historical and theoretical uses based on animal studies, there is little human evidence supporting the effects of Dong quai for any condition. Most of the available clinical studies have either been poorly designed or reported insignificant results. Also, most have examined combination formulas containing multiple ingredients in addition to Dong quai, making it diff...
  • Numerous controlled trials have examined the effects of oral garlic on serum lipids. Long-term effects on lipids or cardiovascular morbidity and mortality remain unknown. Other preparations (such as enteric-coated or raw garlic) have not been well studied. Small reductions in blood pressure ( Numerous case-control/population-based studies suggest that regular consumption of garlic (particularly unprocessed garlic) may reduce the risk of developing several types of cancer, including gastric and colorectal malignancies. However, prospective controlled trials are lacking. Multiple cases of bleeding have been associated with garlic use, and caution is warranted in patients at risk of bleeding or prior to some surgical/dental procedures. Garlic does not appear to significantly affect blood glucose levels.
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