You may know that heart failure is a condition in which the heart can’t pump enough blood to meet the body’s needs. But did you know that certain dietary supplements and over-the-counter drugs may actually cause heart failure?
A new statement from the American Heart Association, published in August 2016 in Circulation, highlights some of these drugs and supplements that are commonly used — many of which you can get without a prescription. You may be thinking that if these medications and supplements are too risky for use, they wouldn’t be easily available to the public; but they are. Here’s how they can harm your heart.
- Non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and naproxen, may increase heart failure risk. NSAIDs can increase salt and fluid retention, lower your body’s response to diuretics that help eliminate fluids, and increase your blood vessel (vascular) resistance, which makes your heart work harder.
- Vitamin E in doses of more than 400 international units (IU) per day increased risk of congestive heart failure by 21 to 50 percent (compared to a placebo) in patients with heart disease who’d had prior heart attacks, found a study published in May 2006 in the Journal of Cardiovascular Medicine. Unfortunately, many similar trials that showed this risk were designed in hopes of showing that vitamin E would actually protect the heart from coronary artery disease and, ultimately, heart failure.
- Products containing ephedra (ma huang), such as traditional Chinese herbal remedies and herbal teas, can increase heart rate, blood pressure, and the heart’s overall workload. In a weakened heart, these products can also result in life-threatening abnormal heart rhythms.
- Danshen, garlic, ginkgo, motherwort, saw palmetto, hawthorn, and licorice are complementary and alternative medicines that can impair blood platelet function. These medications can also raise the risk of severe bleeding in people with heart disease who take anticoagulant (blood-thinning) or antiplatelet drugs. Examples of blood thinners are Coumadin and Jantoven (warfarin); Pradaxa (dabigatran); Xarelto (rivaroxaban); Eliquis (apixaban); and Savaysa (edoxaban).
- Dong Quai, motherwort, and licorice may impair blood clotting. In people with heart disease who also take anticoagulant or antiplatelet drugs, these herbal products may also increase the risk of severe bleeding.
- Aconite is a poisonous plant used in traditional Chinese medicine that reduces heart rate in order to compensate for a weakened heart muscle. But research shows it also increases the risk of lethal abnormal heart rhythms — a condition called ventricular tachycardia.
- Ginseng can increase your risk of low blood pressure shortly after use, particularly when you’re taking medication to lower your blood pressure. Ginseng initially increases nitric oxide synthesis in the body, which would be healthy, but ironically chronic use increases risk of high blood pressure. Ginseng can also lower the kidneys’ response to diuretic medications used to eliminate excess fluid from the body.
- Gossypol is a toxic chemical from the cotton plant that, in small doses, increases the effects of diuretic medications. Taking gossypol can result in low blood pressure and increased risk of kidney injury.
- Gynura, a vegetable also known as longevity spinach, increases the risk of hypotension (low blood pressure) by inhibiting the body’s own angiotensin-converting enzyme (ACE), which is similar to the drug class used in heart failure: ACE inhibitors.
- Licorice raises the risk of high blood pressure and fluid retention, both of which increase the heart’s workload.
- Lily of the valley increases the risk of a slow heart rate and electrical heart block — and is similar to the medication digitalis. Lily of the valley can increase the risk of a severely slow heart rate when used with other drugs such as beta blockers, digoxin, and calcium channel blockers that also slow the heart rate.
- Yohimbine, an extract from tree bark, raises blood pressure by increasing the stress hormone norepinephrine, which can make the heart work harder and increase the risk of abnormal heart rhythms.
I wanted to share this information not as an attack on dietary supplements, but to provide information on potential risks. Even though many of these are natural products, they have drug-like effects in the body.
Finally, I want to note that the AHA statement in Circulation reports on many prescription drugs that come with heart failure risks. I haven’t discussed these here as they’re not available without a prescription, and the physician prescribing them should educate you regarding these drugs and their risks.
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