SAGINAW TOWNSHIP – People ask Dr. Susan Sallach for options “off the beaten path,” and she’s happy to oblige them.
Sallach, a cardiologist with MidMichigan Physicians Group, was the opening speaker Friday morning in the 19th annual Women’s Health Initiative. In “Non-traditional Cardiac Therapies: The Road Less Traveled” she reviewed traditional and proven therapies for coronary artery disease, then described the role of nontraditional approaches and reviewed the evidence supporting their use.
“It’s not just having a positive effect on the blood pressure number, on the LDL (cholesterol), the HDL,” she said. “It’s translating that into a positive outcome.”
Folic acid, for example, lowers homocysteine, an amino acid associated with atherosclerosis. However, that alone doesn’t reduce mortality levels, so folic acid is described as having no proven benefit.
That’s true even with traditional physician-prescribed therapy, she noted, reviewing promising and upcoming anti-anginal therapies. For example, Ivabradine lowers heart rate, increases exercise time and reduces angina — helpful, but not the end goal. “Again, symptom control, not affecting mortality.”
People interested in what some would call alternative therapies have a lot of sources of information and need to be careful in evaluating them, she said, noting for example that some websites touting willow bark as an aspirin alternative say it is completely broken down in the stomach. “That’s actually not true. It has all the same negative aspects as aspirin and whether it has all the positive aspects, we don’t know.” So while it can provide fever and pain relief when chewed, it also can cause kidney injury, gastrointestinal bleeding and allergic reactions.
Fish oil has been proven effective for its anti-arrhythmic effects and lowering of the resting heart rate, she said. While some people are content to take Omega 3 supplements to gain this benefit, anyone who wants to obtain it through diet can do so through one or two weekly servings of oily fish.
“Anything you do should be in moderation, even the fish oil,” she cautioned, moving on to another popular alternative therapy: cinnamon, specifically cassia cinnamon. Again, there is no research that indicates lower morbidity. “It will not save lives, however we have noticed some people with an improved lipid profile.”
Sallach asked whether attendees had seen garlic tablets and described a randomized clinical trial of 200 adults and three forms of garlic.
“Compared to a placebo there was absolutely no change,” she said. “So not harmful, but not helpful.”
At this point, she said, “Everyone is disappointed, right?”
Just because she calls something unproven doesn’t mean it won’t be helpful in the future, she said. “When I say unproven, I don’t mean detrimental, I just mean it doesn’t have the data behind it to support its use.”
The “not recommended” list included guggulipid and policosanol, and while protein- and fiber-rich soy can slightly reduce LDL cholesterol, it is not recommended for reducing lipids or cardiovascular risk.
Red yeast rice doesn’t have any long-term safety data, but its active ingredient lovastatin has drawn attention.
“I actually do recommend this at times in my statin-intolerant patients,” Sallach said. “The reduction you see in cholesterol is similar to what you would see in statins.”
Green tea is good for LDL but has no effect on HDL, she said. “This one is kind of on the fence.”
Because alternative therapies are not regulated to the same level as prescription medicines, users must be more careful in reading labels, she said. Some herbs, such as ginger and bayberry, have been shown to increase blood pressure. “I think you need to read these long lists of ingredients in supplements to find some of these things.”
While cardiac health was the day’s main focus and some people take flax seed oil to decrease risk, she asked if anyone was taking it for another reason: hot flashes. Two women raised their hands to say they do and it works for them and Sallach smiled, noting plant estrogen in the oil.
“Eating a lot of nuts may be beneficial,” because of their polyunsaturated fatty acids, she said. “But you also need to balance that against the high fat content.”
Striking a balance was a continuing theme, whether it was preventive aspirin and measuring risk of heart-related events against bleeding risk, keeping one or two daily cups of coffee in your diet if you feel fine — “Two or three pots a day is not a good idea” — or whether women older than 65 should avoid statins because of the increased risk of diabetes.
“I wouldn’t not take a statin because of it. If you don’t need to be on a statin, don’t take a statin,” Sallach said to the last point.
She also stressed common sense when considering whether a daily regimen should include herbs with no proven cardiac benefit, such as hawthorn. “They claim to be a cure-all for everything, and we know it’s not true or we’d all be taking them.”
• flax seed oil
• nuts containing PUFAs
• artichoke extract
• soluble fiber
Herbs with hypertensive effects (raise blood pressure)
• blue cohosh
• ginseng, panax