Coronary Heart Disease

 

Coronary heart disease or Coronary Artery Disease (CAD) is a condition wherein the blood vessels that supply blood and oxygen to heart narrow as a result of plaque buildup. It is a big killer in different countries. Since the disease develops over years and take time to manifest, it may go unnoticed until a person experiences a heart attack. ^{[1] [2]}

Causes

Coronary arteries are vital structures since these blood vessels bring oxygen and blood to the heart. CAD is proposed to start from damage to the inner layer of these arteries. This injury may be brought about by several factors such as smoking, high cholesterol, high blood pressure, diseases like diabetes and radiation therapy localized to the chest. Once there is damage, fatty deposits or plaques composed of cholesterol and waste products from cellular processes mount up at the site. This buildup causes narrowing of the arteries which consequently compromises the blood and oxygen supply to the heart.

There are several factors that increase a person’s chance of having a heart disease. Some of the non-modifiable ones are increasing age, being male, being a post-menopausal, family history of CAD and being African-American, Mexican American, American Indian or Hawaiian. Modifiable risk factors are smoking, high cholesterol diet, diabetes, sedentary lifestyle, stress and high alcohol intake. ^{[1] [2]}

Signs and Symptoms

In the early stages of the disease, there may be no observable symptoms at all. The most frequently encountered symptom is chest pain or discomfort. The pain may radiate to other parts of the body like the neck, arms or back. Heavy activity or emotional stress may trigger it. The patient may also have fatigue, generalized body weakness and shortness of breath. ^[1]

Diagnosis

After getting the patient’s medical history and performing a physical examination, the physician often requests laboratory exams to be done on the patient. These tests may include electrocardiogram (ECG), coronary angiography, stress tests and CT scan. ^[1]

Treatment

Treatment usually includes one or more medications that cater to different situations like high blood pressure or high cholesterol level. When there is a need, the patient is referred to a cardiac rehabilitation program. Depending on the case, a surgical procedure may be recommended such as coronary artery bypass surgery. Lifestyle modification is important like controlling the diet and avoiding triggers like stress. ^[1]

 

References:

1.      http://www.nlm.nih.gov/medlineplus/ency/article/007115.htm

2.      http://www.mayoclinic.com/health/coronary-artery-disease/DS00064

3.      http://www.medicalnewstoday.com/articles/184130.php

 

 

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Vitamin E [1, 42, 43, 44, 45, 46, 47]:

Please note, this management does NOT treat the condition itself. It may mildly help in preventing some of the symptoms, and even then has insufficient evidence to back up this claim at present. Please note, this acts as a PREVENTATIVE treatment, and not necessarily symptomatic relief.  This vitamin can have harmful effects if taken in doses higher than 100% of the recommended daily allowance.

Recommendation: No recommendation (There is no evidence to support claims that vitamin E supplements can help prevent the risk of developing heart disease.)

Grade of Evidence: Low quality of evidence

Strychnos Nux-Vomica (Maqianzi, Poison Nut) [1, 39, 40, 41]:

WARNING! This substance is HIGHLY POISONOUS. The seeds contain Strychnine, which may cause convulsions, breathing difficulties and death, even if as little as 5 milligrams is ingested

Recommendation: Strongly against (There is no evidence in the form of clinical trials which reports the effectiveness of Strychnos Nux-Vomica, because it is highly poisonous to humans, and is not recommended.)

Grade of Evidence: Very low quality of evidence

Selenium Supplement [1, 30, 31, 32, 33, 34, 35, 36, 37, 38]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. IMPORTANT: Selenium is toxic in high doses. Massive overdoses can cause kidney failure, breathing difficulty and death. Selenium should only be taken at healthy levels which the body is able to tolerate.

Recommendation:  No recommendation (Available evidene does not support claims that selenium helps to prevent or treat coronary heart disease)

Grade of Evidence: Very low quality of evidence

Pine Bark Extract [1, 27, 28, 29]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Weakly in favor  (Early studies indicate potential for Pine bark extract in the treatment of coronary disease, but more clinical studies need to be done)

Grade of Evidence: Low quality of evidence

Phytochemicals (Antioxidants) [1, 24, 25, 26]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (There is insufficient evidence to support claims that phytochemical supplements can prevent or treat coronary disease. More studies are needed. A balanced diet with fruit, vegetables, and grain is recommended to prevent illness until further research into supplements is done.)

Grade of Evidence: Low quality of evidence

Pau D'Arco (Lapachol, Tabebuia Impetiginosa, Tabebuia Heptaphylla) [1, 23]:

Please note, this treatment has potentially serious side effects. Some of the chemicals in the plant are known to be toxic. High doses are known to cause liver and kidney. Even at low doses, chemicals in the plant may interfere with blood clotting, causing excess bleeding and anaemia. Pau D'Arco should be avoided, especially by pregnant or breastfeeding women.

Recommendation: Strongly against (There is insufficient evidence to support claims that Pau D'arco helps to treat coronary heart disease. This, combined with its potentially harmful side effects if taken without supervision from a doctor or pharmacist gives enough reason to avoid this treatment.)

Grade of Evidence: Very low quality of evidence

Megavitamin Therapy (Multivitamin, Vitamin Supplements) [1, 17, 18, 19, 20, 21, 22]:

Please Note that while supplements are effective in correcting deficiencies in the body, their long-term usage is not helpful in preventing diseases like cancer and heart disease. To prevent these illnesses one should eat the natural foods which these vitamins and minerals come from. Replacing natural sources with artificial supplements actually increases the risk of heart disease, cancer, and other diseases. Supplements should be taken only as a balanced multivitamin supplement that contains no more than 100% of the recommended daily allowance. It would be most helpful in people with restricted food intakes, pregnant women and women of childbearing age.

Recommendation: Weakly against. (There is no evidence that Megavitamin therapy can prevent or treat coronary heart disease. In fact, long term therapy can lead to increased risk)

Grade of Evidence: Moderate quality of evidence

Oleander Leaf (Nerium Oleander) [1, 13, 14, 15, 16]:

WARNING: This plant is toxic! Not to be ingested. Causes nausea, appetite loss, vomiting, drowsiness, bloody diarrhoea, seizures, irregular heartbeat, heart failure, respiratory depression and death. The plant and any of its extracts should be strictly avoided, especially by children and pregnant women.

Recommendation: Strongly against (There is insufficient evidence to prove the effectiveness of Oleander in coronary heart disease. Please note, this plant and its extracts are poisonous, even when ingested in dry form. Many people have died of heart or respiratory failure after eating parts of the plant or its extracts.)

Grade of Evidence: Low quality of evidence

Green Tea [1, 8, 9, 10, 11, 12]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Weakly in favor (There is insufficient evidence to support claims that Green Tea helps to treat coronary heart disease in any way. Although reports are positive, more studies are needed.)

Grade of Evidence: Low quality of evidence

Folic Acid [1, 5, 6, 7]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (There is insufficient evidence to support claims that folic acid helps to treat or prevent heart disease)

Grade of Evidence: Very low quality of evidence

Copper [1, 3, 4]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: No recommendation  (There is insufficient evidence to support claims that copper helps to treat coronary heart disease in any way)

Grade of Evidence: Very low quality of evidence

Cats Claw (Uncaria Tomentosa) [1, 2]:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: No recomendation (insufficient evidence to support claims that Cats Claw can help to treat acute coronary heart disease)

Grade of Evidence: Very low quality of evidence

Red Pepper (Capsaicin):

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (Available evidence does not support claims that Red Peppers help to treat or prevent coronary disease in any way)

Grade of Evidence: Low quality of evidence

Calcium Gluconate:

Please note, this management does NOT treat the condition itself. It is proposed only as a preventative or supportive management, not as a treatment.

Recommendation: Weakly in favor (Early studies show that calcium supplements may be effective in reducing the risk of coronary heart disease)

Grade of Evidence: Moderate quality of evidence

Calcium Supplements:

Please note, this management does NOT treat the condition itself. It is proposed only as a preventative or supportive management, not as a treatment.

Recommendation: Weakly in favor (Early studies show that calcium supplements may be effective in reducing the risk of coronary heart disease)

Grade of Evidence: Moderate quality of evidence

Black Walnut (Juglans Nigra):

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: Weakly in favor (Available evidence supports claims that walnut helps to reduce the risk for coronary heart disease, but more study is needed)

Grade of Evidence: Low quality of evidence

Astragalus (Astragalus Membranaceus):

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (There is insufficient evidence to support claims that Astragalus helps to treat coronary heart disease)

Grade of Evidence: Very low quality of evidence

Neural Therapy:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (there is insufficient evidence to show that Neural Therapy can help treat Heart Disease in any way)

Grade of Evidence: Very low quality of evidence

Hyperbaric Oxygen Therapy (HBOT):

Recommendation: No recommendation (research is being done on whether or not HBOT helps to treat coronary heart disease, but as of yet, no evidence supports this claim)

Grade of Evidence: Very low quality of evidence

Chiropractic:

Recommendation: No recommendation (there is insufficient evidence to show that chiropractic can help treat Heart Disease in any way)

Grade of Evidence: Very low quality of evidence

Yoga:

Recommendation: Weakly in favor (There is some evidence that yoga, when used with conventional medicine, can help relieve symptoms related to heart disease)

Grade of Evidence: Low quality of evidence

Fish Oil Supplements [48, 49, 50, 51]:

Recommendation: Weakly in favor (Current studies have yielded mixed results on the level of efficacy of fish oil supplements as a treatment for heart disease. There is little risk in taking fish oil supplements. More studies are needed)

Grade of Evidence: Low quality of evidence

Fish Liver Oil [52, 53, 54]:

Recommendation: Weakly in favor (Current studies have yielded mixed results on the level of efficacy of fish liver oil as a treatment for heart disease. There is little risk in taking fish liver oil. More studies are needed)

Grade of Evidence: Low quality of evidence

Tai Chi:

Recommendation: Weakly in favor (There is insufficient evidence to support claims that tai chi may be able to help those with coronary heart disease, although regular exercise is recommended)

Grade of Evidence: Very low quality of evidence

* www.gradeworkinggroup.org

 

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. http://www.nutrasanus.com/cats-claw.html

3. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/copper

4. http://www.nlm.nih.gov/medlineplus/ency/article/002419.htm

5. http://www.nlm.nih.gov/medlineplus/ency/article/002092.htm

6. http://www.nlm.nih.gov/medlineplus/folicacid.html

7. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/folic-acid

8. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/green-tea

9. http://www.ncbi.nlm.nih.gov/pubmed/16968850

10.  http://www.denverpost.com/nationworld/ci_4326770

11. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-green_tea.html

12. http://nccam.nih.gov/health/greentea/index.htm

13.http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/oleander-leaf

14. http://www.nerium.com/index-2.html

15. http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/EnforcementActivitiesbyFDA/WarningLettersandNoticeofViolationLetterstoPharmaceuticalCompanies/UCM165406.pdf

16. http://www.inchem.org/documents/pims/plant/pim366.htm

17. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/orthomolecular-medicine

18. http://archpedi.ama-assn.org/cgi/reprint/163/2/192.pdf

19. http://www.quackwatch.org/01QuackeryRelatedTopics/ortho.html

20. http://pediatrics.aappublications.org/cgi/content/abstract/72/5/707

21. http://www.ama-assn.org/ama/no-index/about-ama/13638.shtml

22. http://www.ncbi.nlm.nih.gov/pubmed/17327526

23. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/pau-d-arco

24. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/phytochemicals

25. http://www.fda.gov/Food/LabelingNutrition/LabelClaims/QualifiedHealthClaims/ucm073992.htm

26. http://www.ncbi.nlm.nih.gov/pubmed/20216418

27. http://www.clinicaltrials.gov/ct/show/NCT00214032

28. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/pine-bark-extract

29. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-pycnogenol.html

30. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/selenium?sitearea=ETO

31. http://www.cancer.gov/Templates/doc.aspx?viewid=ED8AD8E8-6AE5-458D-8091-393F4CB73F0D

32. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-selenium.html

33. http://www.ncbi.nlm.nih.gov/pubmed/9290116

34. http://www.ncbi.nlm.nih.gov/pubmed/9829869

35. http://www.ncbi.nlm.nih.gov/pubmed/10335455

36. http://www.ncbi.nlm.nih.gov/pubmed/2136228

37. http://www.springerlink.com/content/v0r644v4ju5153k2/

38. http://jnci.oxfordjournals.org/cgi/content/full/101/5/283

39. David Michael Wood et al. Case report: Survival after deliberate strychnine self-poisoning, with toxicokinetic data. Critical Care October 2002 Vol 6 No 5

40. Arnold, M.D., Harry L. (1968). Poisonous Plants of Hawaii. Tokyo, Japan: Charles E. Tuttle Co.. p. 20. ISBN 0804804745.

41. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/strychnos-nux-vomica

42. http://nccam.nih.gov/news/alerts/vitamine/vitamine.htm

43. http://nccam.nih.gov/research/results/spotlight/070106.htm

44. http://www.nlm.nih.gov/medlineplus/vitamine.html

45. http://www.ajcn.org/cgi/content/full/76/4/703

46. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2586922/?tool=pmcentrez

47. http://ods.od.nih.gov/factsheets/vitamine.asp#h3

48. http://consumer.healthday.com/vitamins-and-nutrition-information-27/dietary-fat-health-news-301/daily-fish-oil-supplement-may-not-help-your-heart-studies-685879.html

49. http://ajcn.nutrition.org/content/65/4/1083.full.pdf

50. http://circ.ahajournals.org/content/94/9/2337.full

51. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217043/

52. http://www.nutraingredients.com/Research/Fish-liver-oil-better-than-fish-for-heart-disease-risk

53. http://www.ncbi.nlm.nih.gov/pubmed/11507963

54. http://www.ncbi.nlm.nih.gov/pubmed/3191596