Natural treatments for heart attacks

• DEFINITION: Treatment of the acute condition caused by blocked blood flow to the heart.
• PRINCIPAL PROPOSED NATURAL TREATMENTS: Natural treatments for atherosclerosis, high cholesterol, high blood pressure, and high homocysteine
• OTHER PROPOSED NATURAL TREATMENTS: Antioxidants (vitamins A, C, E, and beta-carotene), arginine, coenzyme Q₁₀, fish oil, garlic oil, glycine, hawthorn, inosine, L-carnitine, lipoic acid, red yeast rice, selenium, lifestyle modifications
• PROBABLY INEFFECTIVE TREATMENTS: Chelation therapy, magnesium

Introduction

As an active muscle, the heart needs a continuous supply of oxygen, which it receives through the coronary arteries. These arteries have a difficult job because they undergo intense compression every time the heart beats. This job becomes even more difficult when the arteries are damaged by atherosclerosis (commonly, though not quite accurately, called hardening of the arteries) in a condition called coronary artery disease.

In coronary artery disease, the passages inside the coronary arteries become narrowed by plaque deposits, which decreases blood flow. When the blood flow is decreased to a sufficient extent, pain caused by oxygen deprivation occurs. This pain is known as angina pectoris. Angina tends to wax and wane, generally worsening with exercise.

A heart attack may occur after years of angina or with no warning. Most heart attacks occur when a blood clot (thrombus) forms on the roughened wall of an atherosclerotic coronary artery. Such a blood clot may lead to a sudden and complete blockage of the artery. More rarely, a spasm of a coronary artery may cut off blood flow. In either case, the cells of the heart fed by that artery begin to die. The region of dead cells is called an infarct, leading to the technical name for a heart attack: myocardial infarction (MI).

The classic symptom of a heart attack is intense, central chest pressure. Other common symptoms include pain or heaviness in the left arm, nausea, shortness of breath, increased perspiration, and a feeling of impending doom. Many people who have had an MI describe chest discomfort or pain in the jaw, teeth, arm, or abdomen. Women are more likely than men to feel pain in their backs. Often, symptoms appear gradually and are intermittent or vague. One-quarter of people, more often women and people with diabetes, experience no symptoms.

When a heart attack occurs, emergency treatment at a hospital can minimize the extent of permanent damage to the heart. “Clot busting” drugs, if given soon enough, can open the coronary arteries, allowing blood to flow again. Other methods of restoring blood flow include procedures known as angioplasty, stenting, and bypass surgery. The aim is to save those heart cells in danger of dying. Heart attack recovery depends on the extent of heart damage. If only a small portion of the heart has died, or if it is in a relatively less important region, symptoms may be slight. More severe damage can cause the heart to pump improperly, leading to congestive heart failure.

During the first several days following a heart attack, the heart tends to lose its normal rhythm and fall into a dysfunctional pattern of beating that does not properly circulate blood. Treatment aimed to prevent or treat this condition, called an arrhythmia, is conducted in a cardiac intensive care unit.

Long-term treatment to reduce the risk of heart attacks generally involves aspirin to prevent blood clots and treatments to slow, stop, or reverse atherosclerosis. The latter is accomplished by using medications that keep cholesterol and blood pressure within normal limits, increasing exercise, and improving other aspects of one’s lifestyle.

Principal Proposed Natural Treatments

The most important contribution of natural medicine in the realm of heart attacks is prevention, not treatment. Atherosclerosis, which causes most heart attacks, is accelerated by high blood pressure and high cholesterol and possibly by high levels of homocysteine in the blood. Natural treatments used for these conditions are worth considering. However, natural therapies for high blood pressure and high cholesterol are generally less effective than the conventional approaches. People interested in using natural treatments should consult a physician to determine how long it is safe to experiment. If natural therapies have not controlled the heart condition within the prescribed time, it may be better to use conventional therapies.

Other Proposed Natural Treatments

Several natural treatments have shown promise for use with conventional treatment in the period following a heart attack. Note, however, that people who have recently had a heart attack should not use any herbs or supplements except under the supervision of a physician. Furthermore, none of these treatments can substitute for standard care; at most, they might be helpful if used in addition to it.

Coenzyme Q₁₀. The supplement coenzyme Q10 (CoQ₁₀) is thought to improve heart function. In a double-blind trial, 145 people who had recently experienced a heart attack were given either a placebo or 120 milligrams (mg) of CoQ₁₀ daily for twenty-eight days. Participants receiving CoQ₁₀ experienced significantly fewer heart-related problems, episodes of angina pectoris or arrhythmia, or recurrent heart attacks. CoQ₁₀ taken with the mineral selenium has also shown promise for people who have survived a heart attack. Low concentrations of CoQ₁₀ have been linked to an increased risk of cardiometabolic disorders, so supplementation may be beneficial for individuals who experience this deficiency.

L-carnitine. The amino acid L-carnitine has shown potential value during the first few weeks after an MI. A double-blind, placebo-controlled study that followed 101 people for one month after a heart attack found that using L-carnitine, in addition to standard care, reduced the size of the infarct (area of dead heart tissue). Other complications associated with heart attacks were also reduced. Similar benefits were seen in a one-year, controlled study of 160 people who recently experienced a heart attack, but its results are unreliable because this study was not double-blind.

In the months following a severe heart attack, the heart often enlarges and loses function. L-carnitine has shown some potential for helping the first of these complications but not the second. In a twelve-month, double-blind, placebo-controlled study of 472 people who had just experienced a heart attack, using 6 grams daily significantly decreased the rate of heart enlargement. However, heart function was not improved. A three-month, double-blind, placebo-controlled study of sixty people who had just had a heart attack also failed to find improvements in heart function with L-carnitine. (Heart enlargement was not studied.)

Results consistent with those of the foregoing studies were seen in a six-month, double-blind, placebo-controlled study of 2,330 people who had just had a heart attack. Carnitine failed to produce significant reductions in mortality or heart failure (serious decline in heart function) over six months. However, it did find reductions in early death. (This finding is statistically questionable because it was a secondary endpoint rather than a primary one.)

Further research found that L-carnitine supplementation may be harmful for some individuals with heart conditions. Additionally, there may be a difference in the function of L-carnitine between sexes, but further research is needed to confirm this finding.

Fish oil. Fish oil contains healthy fats in the omega-3 fatty acid category. Incomplete evidence suggests that fish oil supplements may help prevent heart attacks and prevent sudden death after a heart attack. This benefit may come from several actions of fish oil, including preventing dangerous heart arrhythmias and reducing heart rate. However, other research found fish oil supplements used by healthy people were associated with an increased risk of first-time cardiovascular disease. Individuals who already had heart conditions saw improvements with supplementation, but healthy participants experienced the opposite impact.

Garlic. In one study, 432 people who had had a heart attack were given either garlic oil extract or no treatment for three years. The results showed a significant reduction in second heart attacks and about a 50 percent reduction in death rate among those taking garlic. People who take aspirin to prevent heart attacks should not take garlic supplements, as the combination could lead to excessive bleeding. Additionally, blood thinners, cholesterol-lowering drugs, and blood pressure drugs may also interact negatively with garlic supplementation.

Red yeast rice. Because of its purported ability to lower cholesterol, red yeast rice (made by fermenting a type of yeast called Monascus purpureus over rice) has been studied in people with heart disease. A double-blind study in China compared an alcohol extract of red yeast rice (Xuezhikang) with a placebo in almost five thousand people with heart disease. In the four-year study, the use of the supplement reportedly reduced the heart attack rate by about 45 percent compared with the placebo, and total mortality was reduced by about 35 percent. At least three other studies, all from the original population of participants, found similar results in people with diabetes with heart disease and in people with a previous heart attack, with surprisingly large reductions in the rates of coronary events (such as heart attack) and mortality. These levels of reported benefit, however, are so high and similar as to raise questions about their reliability.

Antioxidants. Antioxidant supplements help neutralize free radicals—dangerous, naturally occurring chemicals that may accelerate heart cell death following a heart attack (among many other harmful effects). In a double-blind, twenty-eight-day trial, people who recently experienced a heart attack received either a placebo or a mixture of antioxidants (vitamins A, C, E, and beta-carotene). The results indicated that using antioxidants minimized the extent of heart cell damage.

Magnesium. The mineral magnesium is sometimes suggested for stabilizing the heart after a heart attack, but one study found a negative effect. In this one-year, double-blind, placebo-controlled trial of 468 people who had just experienced a heart attack, the use of a magnesium supplement at a dose of 360 mg daily failed to prevent heart-related events (defined as heart attack, sudden cardiac death, or need for cardiac bypass) and may have increased the risk slightly.

Arginine. The supplement arginine has been proposed for aiding recovery from a heart attack. In one double-blind study, arginine did not cause harm, and it showed potential modest benefit. However, in another study, arginine failed to prove helpful and possibly increased the death rate of those who had a heart attack.

Other herbs and supplements. Other herbs and supplements that are sometimes said to be useful after a heart attack but that lack reliable substantiation include glycine, hawthorn, inosine, and lipoic acid.

Lifestyle modifications. Evidence suggests that intensive lifestyle modification involving a low-fat diet, exercise, and stress reduction can reverse coronary artery disease in people who have had or are at high risk for heart attacks. It is not clear whether less ascetic approaches can achieve similar effects. However, there is evidence that less intensive low-fat and Mediterranean-style (low-fat plus high fish oil) diets can decrease the risk of recurrent heart attacks and similar cardiac events in individuals who have experienced a heart attack.

Chelation therapy. Some alternative medicine physicians recommend using intravenous infusions of ethylenediaminetetraacetic acid to clear out the arteries of the heart, a method called chelation therapy. This method is based on an outmoded understanding of atherosclerosis, and it is likely ineffective.

Herbs and Supplements to Use with Caution

The American Heart Association recommends focusing on consuming a heart-healthy diet rather than taking supplements to fill dietary and nutritional gaps. Numerous herbs and supplements may interact adversely with drugs used to prevent or treat heart attacks. For example, St. John's wort, licorice, Gingko biloba, bitter orange, and ginseng interfere with blood pressure medications. It is important to seek medical advice from a medical professional before beginning a supplement regimen.

Bibliography

Glass, G. F., and Brady. "Acute Coronary Syndrome." Rosen's Emergency Medicine: Concepts and Clinical Practice, edited by R. M. Walls, 10th ed., Elsevier, 2023.

“Heart Attack First Aid.” Icahn School of Medicine at Mount Sinai, www.mountsinai.org/health-library/injury/heart-attack-first-aid. Accessed 1 Oct. 2024.

"Heart Attack (Myocardial Infarction)." Cleveland Clinic, 15 Feb. 2024, my.clevelandclinic.org/health/diseases/16818-heart-attack-myocardial-infarction. Accessed 1 Oct. 2024.

Lu, Z., et al. “Effect of Xuezhikang, an Extract from Red Yeast Chinese Rice, on Coronary Events in a Chinese Population with Previous Myocardial Infarction.” American Journal of Cardiology, vol. 101, 2008, pp. 1689-93.

McDermott, Annette. "Home Remedies for Heart Pain: What Works?" Healthline, 5 June 2023, www.healthline.com/health/home-remedies-for-heart-pain. Accessed 1 Oct. 2024.

Mozaffarian, D. “Fish and N-3 Fatty Acids for the Prevention of Fatal Coronary Heart Disease and Sudden Cardiac Death.” American Journal of Clinical Nutrition, vol. 87, 2008, pp. 1991S-6S.

Schimelpfening, Nancy. "Fish Oil Supplements May Raise Your Risk of Heart Disease and Stroke If You’re Healthy." Healthline, 21 May 2024, www.healthline.com/health-news/fish-oil-heart-disease-stroke-risk. Accessed 1 Oct. 2024.

Tuttle, K. R., et al. “Comparison of Low-Fat versus Mediterranean-Style Dietary Intervention after First Myocardial Infarction (from the Heart Institute of Spokane Diet Intervention and Evaluation Trial).” American Journal of Cardiology, vol. 101, 2008, pp. 1523-30.

Walls, Ron. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10 ed., Elsevier Health Sciences, 2023.

Zhao, Jie V., et al. “L-Carnitine, a Friend or Foe for Cardiovascular Disease? A Mendelian Randomization Study.” BMC Medicine, vol. 20, Sept. 2022, p. 272, doi:10.1186/s12916-022-02477-z.

Zozina, Vladlena I., et al. “Coenzyme Q₁₀ in Cardiovascular and Metabolic Diseases: Current State of the Problem.” Current Cardiology Reviews, vol. 14, no. 3, 2018, pp. 164-74, doi:10.2174/1573403X14666180416115428.