CCoommpplleemmeennttaarryy AAlltteerrnnaattiivvee aanndd CCaarrddiioovvaassccuullaarr MMeeddiicciinnee EEddiitteedd bbyy RRiicchhaarrdd AA.. SStteeiinn,, MMDD MMeehhmmeett CC.. OOzz,, MMDD C A OMPLEMENTARY AND LTERNATIVE C M ARDIOVASCULAR EDICINE C C ONTEMPORARY ARDIOLOGY CHRISTOPHER P. CANNON, MD SERIES EDITOR CT of the Heart: Principles and Platelet Glycoprotein IIb/IIIa Inhibi- Applications,editedbyU. tors in Cardiovascular Disease, Joseph Schoepf, MD, 2004 SecondEdition,edited by A. Cardiac Transplantation: The MichaelLincoff,MD, 2003 Columbia University Medical Heart Failure: A Clinician’s Guide to Center/New York-Presbyterian Ambulatory Diagnosis and Treat- Hospital Manual,editedby ment,edited by Mariell L. Jessup, Niloo M. Edwards, MD, Jonathan MD, and Evan Loh, MD, 2003 M. Chen, MD, and Pamela A. Management of Acute Coronary Mazzeo, 2004 Syndromes, Second Edition, edited by Christopher P. Can- Heart Disease and Erectile Dysfunction,editedbyRobert non,MD, 2003 Aging, Heart Disease, and Its Manage- A. Kloner, MD,PhD, 2004 ment:Facts and Controversies, Coronary Disease in Women: Evidence-Based Diagnosis and edited by Niloo M. Edwards, MD, Treatment,editedbyLeslee J. Mathew S. Maurer, MD, and Shaw,PhD, and Rita F. Redberg, Rachel B. Wellner, MPH, 2003 Peripheral Arterial Disease: Diagno- MD,FACC, 2004 sis and Treatment, edited by Complementary and Alternate Jay D. Coffman, MD, and Robert Cardiovascular Medicine, edited T. Eberhardt, MD, 2003 byRichard A. Stein, MD and Cardiac Repolarization: Bridging Basic Mehmet C. Oz, MD, 2004 and Clinical Science, edited by Nuclear Cardiology, The Basics: Ihor Gussak, MD,PhD, Charles How to Set Up and Maintain a Antzelevitch,PhD, Stephen C. Laboratory,byFrans J. Th. Hammill,MD, Win K. Shen, MD, Wackers,MD,PhD, Wendy Bruni, and Preben Bjerregaard, MD, BS,CNMT, and Barry L. Zaret, DMSc, 2003 MD, 2004 Essentials of Bedside Cardiology: Minimally Invasive Cardiac Surgery, With a Complete Course in Second Edition, edited by Heart Sounds and Murmurs on Daniel J. Goldstein, MD, and CD, Second Edition, byJules Mehmet C. Oz, MD, 2004 Constant,MD, 2003 Cardiovascular Health Care Primary Angioplasty in Acute Economics,edited by William S. Myocardial Infarction, edited Weintraub,MD, 2003 byJames E. Tcheng, MD, 2002 C OMPLEMENTARY A AND LTERNATIVE C ARDIOVASCULAR M EDICINE Edited by R A. S , ICHARD TEIN MD Associate Chairman of Medicine Beth Israel Medical Center; Chief of Medicine The Singer Division of Beth Israel Medical Center New York, NY and M C. O , EHMET Z MD Cardiovascular Institute Columbia Presbyterian Medical Center New York, NY © 2004 Humana Press Inc. 999 Riverview Drive, Suite 208 Totowa, New Jersey 07512 www.humanapress.com For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel.: 973-256-1699; Fax: 973-256-8341, E-mail: [email protected]; or visit our website: www.humanapress.com All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. All articles, comments, opinions, conclusions, or recommendations are those of the author(s), and do not necessarily reflect the views of the publisher. Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the information published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, as new research, changes in government regu- lations, and knowledge from clinical experience relating to drug therapy and drug reactions constantly occurs, the reader is advised to check the product information provided by the manufacturer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recom- mended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. 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For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Humana Press Inc. The fee code for users of the Transactional Reporting Service is: [1-58829- 186-3/04 $25.00]. e-ISBN: 1-59259-728-9 Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Complementary and alternative cardiovascular medicine / edited by Richard A. Stein, Mehmet C. Oz. p. ; cm. -- (Contemporary cardiology) Includes bibliographical references and index. ISBN 1-58829-186-3 (alk. paper) 1. Cardiovascular system--Diseases--Alternative treatment. [DNLM: 1. Cardiovascular Diseases--therapy. 2. Complementary Therapies--methods. WG 166 C737 2004] I. Stein, Richard A., M.D. II. Oz, Mehmet, 1960- III. Series: Contemporary cardiology (Totowa, N.J. : Unnumbered) RC684.A48C65 2004 616.1'06--dc22 2003027924 P REFACE As health care providers, we spend our lives searching for treatments that reduce suffering and lengthen the lives of our patients. Sometimes we find solutions in surprising places. Although we all have hopes for advancements in technology, the future of medicine is also about challenging preconceptions as we change our healing biases. In many ways, this is the natural evolution of “global medicine.” We have global communications and global banking; however, until recently medicine has remained remarkably provincial. Traditionally, healers arose from their local culture with the same biases as their patients. As a result, only recently have Western physicians become aware of the mysteries and opportunities of Eastern approaches. Yet, in the context of our honest commitment to evidence-based medical care, our reaction is to view these options with skepticism, because the important “gold standard” of proof, the large randomized clinical trial, is not accessible to us. Nevertheless, patients are experimenting already with many unconventional treatments. The increasing use of complementary and alternative medical (CAM) therapies by patients to prevent or treat cardiovascular disease and the ineffective communication between patient and physicians in this regard are documented by repeated population surveys in the United States. The finding that less than one half of the more than 50% of our patients who use CAM therapies share this information with their doctor is the basis for an increasing concern. How can we prevent or even monitor potential adverse events and poor clinical outcomes resulting from drug–supplement interactions or failure by the patient to comply with traditional medical care? Even more provocatively, how will we learn about the benefits of CAM approaches if we are unaware of their use? We, as health care providers, are chal- lenged to acquire the knowledge base to be effective communicators and counselors to our patients. Complementary and Alternative Medicine in Cardiovascular Disease addresses these challenges for cardiovascular medicine. The charge given to each expert author was to address, where relevant, history, theoretical basis, philosophy, practical application and the specific therapies, pharmaceuticals, diets and supplements of the selected CAM therapy or practice. In addition, each author was directed to review and critique, as appropriate, the relevant clinical evidence. The guiding principal was to provide information regarding CAM that the v vi Preface physician or other health care provider “should know” in caring for and counseling patients with, or at risk of, cardiovascular diseases. The topics covered in Complementary and Alternative Medicine in Cardiovascular Disease range from the more commonly encountered use of herbs, vitamins and other supplements, dietary and supplemental fats and oils, meditation, prayer, and acupuncture to less familiar areas such as homeopathy, massage, chelation therapy, aromatherapy, and energy therapies. We also asked committed practitioners to describe their fields to allow readers to acquire the “flavor” of their patient’s CAM experience. Our goal was to provide a resource that would form the basis of an ever-increasing personal knowledge base in CAM and cardiovascular disease for the physician, nurse, and other health care provider. The quality of the chapters contributed by the authors has permitted us to produce a remarkable text that we are confident will be of continued value to the reader. Richard A. Stein, MD Mehmet C. Oz, MD C ONTENTS Preface..................................................................................................v Contributors........................................................................................ ix Value-Added eBook/PDA ................................................................. xi 1 Complementary and Alternative Medicine in the Prevention and Treatment of Cardiovascular Disease: An Introduction..........1 Richard A. Stein and Mehmet C. Oz 2 History, Regulation, Integrity, and Purity of Herbs and Supplements...................................................11 Robert S. McCaleb and Fredi Kronenberg 3 Botanical Medicine and Cardiovascular Disease..........27 Tieraona Low Dog 4 Herb and Dietary Supplement Interactions With Cardiovascular Drugs..................................49 Dennis V. C. Awang 5 Vitamin Therapy for Cardiovascular Disease ...............59 Wahida Karmally 6 Oils and Fats in the Prevention and Treatment of Cardiovascular Disease....................................73 Penny M. Kris-Etherton, Kari D. Hecker, Terry D. Etherton, and Valerie K. Fishell 7 Nutrachemicals in the Prevention and Treatment of Cardiovascular Disease..................................101 Arshad M. Safi, Cynthia A. Samala, and Richard A. Stein 8 Meditation and Cardiovascular Disease .....................121 Erin L. Olivo 9 Prayer and Cardiovascular Disease..............................137 Jonathan E. E. Yager, Suzanne W. Crater, and Mitchell W. Krucoff vii viii Contents 10 Massage Therapy and Cardiovascular Disease ...........153 Patricia Cadolino 11 Acupuncture in Cardiovascular Disease......................167 Soeren Ballegaard 12 Chelation Therapy for Cardiovascular Disease...........189 Steven C. Halbert 13 Energy Medicine, Energy Therapies, and Cardiovascular Disease ...............................201 Glen Rein and Maria Syldona 14 Homeopathy and Cardiovascular Disease ...................215 Woodson C. Merrell and Amy Rothenberg 15 Aromatherapy and Cardiovascular Disease.................239 Jane Buckle 16 A Physician’s Guide to CAM and Cardiovascular Disease on the World Wide Web.......................255 Jacqueline C. Wootton Index.................................................................................................279 C ONTRIBUTORS DENNIS V. C. AWANG,PhD,FCIC • MediPlant Consulting, Inc., White Rock, BC, Canada SOEREN BALLEGAARD, MD • The Ballegaard Acupuncture Center, Hellerup, Denmark JANE BUCKLE,PhD,RN • R. J. Buckle Associates, LLC PATRICIA CADOLINO,LMT,CIMI • Massage Therapy Services, Stony Brook University Hospital, Stony Brook, NY SUZANNE W. CRATER,RN,ANP-C • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC TERRY D. ETHERTON,PhD • Dairy and Animal Science Department, The Pennsylvania State University, University Park, PA VALERIE K. FISHELL,MS • Department of Nutritional Science, The Pennsylvania State University, University Park, PA STEVEN C. HALBERT,MD • Director of Protocol Development, Jefferson Center for Integrative Medicine; and Department of Medicine, Thomas Jefferson University, Philadelphia, PA KARI D. HECKER,PhD,RD • Department of Nutritional Science, The Pennsylvania State University, University Park, PA WAHIDA KARMALLY,PhD,RD,CDE• The Irving Center for Clinical Research, Columbia University, New York, NY PENNY M. KRIS-ETHERTON,PhD,RD • Department of Nutritional Science, The Pennsylvania State University, University Park, PA FREDI KRONENBERG,PhD• Richard and Hinda Rosenthal Center for Complementary and Alternative Medicine, Department of Rehabilitation Medicine, College of Physicians & Surgeons, Columbia University, New York, NY MITCHELL W. KRUCOFF, MD, FACC • Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC TIERAONA LOW DOG,MD • Executive Advisory Board, NIH National Center for Complementary and Alternative Medicine; Department of Medicine, Program in Integrative Medicine, University of Arizona, Tucson, AZ ROBERT S. MCCALEB• Herb Research Foundation, Boulder, CO WOODSON C. MERRELL,MD • Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, NY ix