Congestive Heart Failure
• Arginine, Creatine, Fish Oil, L-Carnitine, Magnesium, Ribose, Tai Chi, Taurine, Transcendental Meditation, Yoga
When the heart sustains injury that weakens its pumping ability, a complicated physiological state called congestive heart failure (CHF) can develop. Fluid builds up in the lungs and lower extremities, the heart enlarges, and many symptoms develop, including severe fatigue, difficulty breathing while lying down, and altered brain function.
Medical treatment for this condition is quite effective and sophisticated, consisting of several drugs used in combination.
Principal Proposed Natural Treatments
Note : CHF is too serious a condition for self-treatment. The supervision of a qualified healthcare professional is essential. However, given medical supervision, some of the following treatments may be quite useful. The herb hawthorn appears to be effective for mild CHF and may be helpful for more severe CHF, as well. However, while standard drugs have been shown to help reduce hospitalizations and mortality associated with CHF, there is no similar evidence as yet for hawthorn.
Also, adding the supplement coenzyme Q 10 to standard treatment may improve results. Finally, the supplement vitamin B 1 (thiamin) may be helpful for individuals who take loop diuretics (such as furosemide) for CHF.
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. 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
It is not clear whether one can safely combine hawthorn with other drugs that affect the heart.
For more information, including dosage and safety issues, see the full Hawthorn article.
Coenzyme Q 10 (CoQ 10 )
People with CHF have significantly lower levels of CoQ 10 in heart muscle cells than healthy people. 42 This fact alone does not prove that CoQ 10 supplements will help CHF; however, it prompted medical researchers to try using this supplement as a treatment for heart failure.
In the largest study, 641 individuals with moderate to severe CHF were monitored for 1 year. 2 Half were given 2 mg/kg of body weight of CoQ 10 daily; the rest were given placebo. Standard therapy was continued in both groups. The participants treated with CoQ 10 experienced a significant reduction in the severity of their symptoms. No such improvement was seen in the placebo group. The people who took CoQ 10 also had significantly fewer hospitalizations for heart failure.
Similarly positive results were also seen in other double-blind studies involving a total of more than 270 participants. 37-38,58
However, two recent and very well-designed double-blind studies enrolling a total of about 85 individuals with CHF failed to find any evidence of benefit. 3,41 The reason for this discrepancy is not clear.
For more information, including dosage and safety issues, see the full CoQ 10 article.
Vitamin B 1
Evidence suggests that the strong diuretics (technically, loop diuretics such as furosemide) commonly used to treat CHF may interfere with the body’s metabolism of vitamin B 1 (thiamin). 14,43,44
Since the heart depends on vitamin B 1 for proper function, this finding suggests that taking a supplement may be advisable; in fact, preliminary evidence suggests that thiamin supplementation may indeed improve heart function in individuals with CHF. 15,45,46
For more information, including dosage and safety issues, see the full Vitamin B 1 article.
Other Proposed Natural Treatments
A large Italian trial involving almost 7,000 subjects found that fish oil may modestly reduce the risk of death or admission to the hospital for cardiovascular reasons in patients suffering from congestive heart failure. 67 And, a smaller study involving 138 patients showed similarly beneficial results. 68
Another treatment for CHF that has some evidence is the expensive supplement L-carnitine , especially when given in the special form called propionyl-L-carnitine. 24-28 Carnitine is frequently combined with CoQ 10 .
Three small, double-blind studies enrolling a total of about 70 individuals with CHF found that the supplement arginine significantly improved symptoms of CHF, as well as objective measurements of heart function. 29-31
Combination therapy with several of the supplements mentioned above may also be helpful. A double-blind trial of 41 individuals found that use of a supplement containing taurine, CoQ 10 , creatine, and carnitine, as well as other nutrients, improved objective measures of heart function. 47
There is some evidence that supplementing with magnesium may be helpful for individuals taking both digoxin and diuretics; diuretics can deplete the body of magnesium and this in turn may increase risk of digoxin side effects. 48-52 One study found that use of magnesium (as magnesium orotate) may improve exercise capacity and reduce heart arrhythmias in people with CHF who have just undergone bypass graft surgery. 57 Additionally, in a well-designed trial involving 79 patients with severe congestive heart failure, magnesium orotate significantly improved survival and clinical symptoms after one year compared to a placebo. 63
In addition, it is important to pay attention to all the general considerations that bring health to the heart, such as those described in the article on Atherosclerosis .
Weak evidence suggests that relaxation therapy (specifically Transcendental Meditation) 60 and yoga66 may improve functional capacity and quality of life in people with congestive heart failure. Tai Chi, a Chinese martial art focusing on rhythmically gentle movements, may also be beneficial in improving the quality of life in people with congestive heart failure.65,69,70
Various other herbs and supplements may interact adversely with drugs used to treat congestive heart failure. For more information on these potential risks, see the individual drug article in the Drug Interactions section of this database.
2. Morisco C, Trimarco B, Condorelli M. Effect of coenzyme Q 10 therapy in patients with congestive heart failure: a long-term multicenter randomized study. Clin Investig . 1993;71(8 suppl):S134- S136.
7. 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.
12. 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.
15. Shimon I, Almog S, Vered Z, et al. Improved left ventricular function after thiamine supplementation in patients with congestive heart failure receiving long-term furosemide therapy. Am J Med. 1995;98:485-490.
21. Azuma J, Takihara K, Awata N, et al. Beneficial effect of taurine on congestive heart failure induced by chronic aortic regurgitation in rabbits. Res Commun Chem Pathol Pharmacol. 1984;45:261-270.
27. Pucciarelli G, Mastursi M, Latte S, et al. The clinical and hemodynamic effects of propionyl-L-carnitine in the treatment of congestive heart failure [in Italian; English abstract]. Clin Ther . 1992;141:379-384.
28. Loster H, Miehe K, Punzel M, et al. Prolonged oral L-carnitine substitution increases bicycle ergometer performance in patients with severe, ischemically induced cardiac insufficiency. Cardiovasc Drugs Ther. 1999;13:537-546.
29. Hambrecht R, Hilbrich L, Erbs S, et al. Correction of endothelial dysfunction in chronic heart failure: additional effects of exercise training and oral L-arginine supplementation. J Am Coll Cardiol . 2000;35:706-713.
36. Rietbrock N, Hamel M, Hempel B, et al. Efficacy of a standardized extract of fresh Crataegus berries on exercise tolerance and quality of life in patients with congestive heart failure (NYHA II) [in German; English abstract]. Arzneimittelforschung . 2001;51:793-798.
40. 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.
43. Hardig L, Daae C, Dellborg M, et al. Reduced thiamine phosphate, but not thiamine diphosphate, in erythrocytes in elderly patients with congestive heart failure treated with furosemide. J Intern Med. 2000;247:597-600.
44. Yue QY, Beermann B, Lindstrom B, et al. No difference in blood thiamine diphosphate levels between Swedish Caucasian patients with congestive heart failure treated with furosemide and patients without heart failure. J Intern Med. 1997;242:491-495.
47. Jeejeebhoy F, Keith M, Freeman M, et al. Nutritional supplementation with MyoVive repletes essential cardiac myocyte nutrients and reduces left ventricular size in patients with left ventricular dysfunction. Am Heart J. 2002;143:1092-1100.
52. Bashir Y, Sneddon JF, Staunton A, et al. Effects of long-term oral magnesium chloride replacement in congestive heart failure secondary to coronary artery disease. Am J Cardiol . 1993;72:1156-1162.
54. 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.
55. Omran H, Illien S, MacCarter D, et al. D-Ribose improves diastolic function and quality of life in congestive heart failure patients: a prospective feasibility study. Eur J Heart Fail . 2003;5:615-619.
57. Branea I, Gaita D, Dragulescu I, et al. Assessment of treatment with orotate magnesium in early postoperative period of patients with cardiac insufficiency and coronary artery by-pass grafts (ATOMIC). Rom J Intern Med . 2004;37:287-296.
59. Nightingale AK, Crilley JG, Pegge NC, et al. Chronic oral ascorbic acid therapy worsens skeletal muscle metabolism in patients with chronic heart failure. Eur J Heart Fail . 2006 Oct 3. [Epub ahead of print]
60. Jayadevappa R, Johnson JC, Bloom BS, et al. Effectiveness of Transcendental Meditation on functional capacity and quality of life of African Americans with congestive heart failure: a randomized control study. Eth Dis. 2007;17:72-77.
61. 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.
64. 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.
67. Gissi-Hf Investigators. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet. 2008 Aug 29. [Epub ahead of print]
68. Nodari S, Triggiani M, Campia U, et al. Effects of n-3 polyunsaturated fatty acids on left ventricular function and functional capacity in patients with dilated cardiomyopathy. J Am Coll Cardiol. 2011;57(7):870-879.
70. Barrow DE, Bedford A, Ives G, O'Toole L, Channer KS. An evaluation of the effects of Tai Chi Chuan and Chi Kung training in patients with symptomatic heart failure: a randomised controlled pilot study. Postgrad Med J. 2007;83(985):717-721.
Last reviewed June 2011 by EBSCO CAM Review Board
Last updated Updated: 6/27/2011
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