CV CAM-specific topics- Krinsky

focuses on the "green" highlighted in his excel

Artichoke has evidence of helping what 2 conditions?

upset stomach and dyslipidemia

What lifestyle modifications can be made to help decrease HTN?

• smoking cessation

• exercise

• weight loss

• limit alcohol

What type of diets can help with HTN?

DASH DIET!!!!!!!!!

• also Mediterranean / vegan diet

“DASH” diet stands for

dietary approaches to stop hypertension

In the dash diet you increase/decrease eating what?

increase- fruits, veggies, grains

decrease- fat

What supplements have potential hypotensive effects?

• CoQ10

• garlic

• I-arginine

• omega-3FA

• psyllium

What supplements have potential hypertensive effects?

• caffeine

• licorice

• green tea

Cannabis has significant ___ effects including ___________ BP.

Cannabis has significant CV effects including increased BP.

What are the nonpharmalogic options for pts with Heart Failure?

• don’t drink or smoke

• manage stress

  • acupuncture, therapy

• eat well

  • anti-inflammatory or dash diet

• exercise physically, mentally, and spirtually

• avoid NSAIDs

• get vaccines for lung diseases

To slow the progression of HF, what herbals and supplements can be used?

• Foxglove

  • digoxin’s “natural cousin”

• CoQ10

• L-carnitine

• iron, vit D, vit E

• ginger, green tea, hawthorn

Ginger interacts with __________________ and at high doses may affect what?

• interacts with anticoagulants

• high doses may affect heart rate or rhythm

What type of lifestyle modifications helps coronary and peripheral artery disease?

• nutrition- mediterranean diet

  • eat foods full of whole grains, fish, and nuts

• exercise

• smoking cessation

• manage stress/anxiety

  • mind body therapy (yoga, mediation, etc.)

For arrhythmias what food/drinks can be triggers?

• alcohol

• caffeine

  • can be hidden

• food allergies

• high sugar foods

• greasy foods

• high sodium foods

• large meals

• ginkgo

  • can be hidden

What herbal supplement has evidence of bleeding/antiplatelet properties?

willow bark

• like a natural aspirin

Patients on warfarin should be cautious with what vitamin?

vitamin K (phytonadione)

For patients using warfarin, they MUST be cautioned about ____________________.

multivitamins!!

• each multivitamin has dif ingredients, they need to watch the vit K content

For dyslipidemia, what is the #1 lifestyle modification we should make?

weight management

What diet has been shown to be #1 best approach for reducing cholesterol in pts. with dyslipidemia?

“portfolio diet”

• like a vegetarian version of the mediterranean diet

What herbals/supplements may lower cholesterol?

• artichoke

• berberine

• fiber/psyllium

• garlic

• omega-3 FA/ fish oil

• red yeast rice extract

• tumeric/curcumin

What herbals/supplements may interact with statins?

• black cohosh

• cannabis

What are the evidence-based uses of berberine?

• diabetes

• dyslipidemia

What are the main interactions with black cohosh?

• statins

• cisplatin

Cannabis interactions with what medications?

• anticoagulants/antiplatelets

  • warfarin

• depressants

• many CYP substrates!!

  • 3A4, 2E1

• anything to do with estrogen

  • hormones, contraceptives

Cannabis should be used in caution with what conditions?

• CVD

• compromised immune fxn

• respiratory problems

• seizure disorders

• undergoing surgery

What are the evidence-based uses of caffeine?

• migraine

• mental alertness

• weight loss

• HYPOTENSION

What are the evidence-based uses of CoQ10?

• myalgia

• HTN

• immune function

• heart health

What are the interactions with Ephedra?

• ALL HEART RATE AND HTN meds!

• caffeine

• all stimulants

What supplement is banned in the USA because of it’s cardiotoxicity?

Ephedra

What are the evidence based uses of garlic?

• dyslipidemia

  • arthrosclerosis

• common cold

• HTN

Ginkgo, Ginger, Glucosamine, garlic, green tea AND Ginseng interact with what kind of drugs?

anticoagulant/antiplatelet drugs

• especially WARFARIN

(For this module, EVERY HERBAL that starts with “G” interacts with anticoags)

• also think: if interacts with anticoags every “G” herbal should be used in caution with anything to do with bleeding disorders!!

Ginkgo should be avoided or used in caution in patients that have what?

• history of seizures!

• pts. attempting to conceive

  • aka make a baby

• diabetes

• bleeding disorders

What are the side effects of green tea?

Think: due to the caffeine content!

• HA

• irritation

• nervousness

• anxiety

• increased HR

What are the evidence-based uses of L-arginine?

• angina

• HTN

What are the side effects of licorice supplements?

• N/V

• angina

Licorice supplements interact with what drugs?

• antihypertensives

  • caution in heart disease

Omega 3 fatty acids/fish oil have what evidence-based uses?

• dyslipidemia

• neuropathy

• HTN

Policosanol has what evidence-based uses?

• anticoagulation

• leg cramps (intermittent claudication)

Probiotics have what evidence-based uses?

• IBD

• constipation

• allergic rhinitis

Psyllium has what evidence-based uses?

• dyslipidemia

• CAD

• HTN

• IBD

Red Yeast/ Red Yeast Rice has what evidence-based use?

• dyslipidemia

Soy has what evidence-based uses?

• dyslipidemia

• menopause

• memory