The heart is a functioning muscle and needs oxygen and fuel in order to do its work. It is the job of the coronary arteries to supply the necessary oxygen and nutrients to the muscle. When one of the three major coronary arteries become narrowed or blocked, blood flow to the muscle is reduced, resulting in angina pectoris—a feeling of tightness or pressure in the chest often associated with shortness of breath. At first, angina may only be obvious during periods of exercise or emotional stress, and may go away when the activity ceases. Later, it may occur even while resting. If the blood flow to an area of the heart completely stops, heart muscle cells die, causing a heart attack, or myocardial infarction. While healing, the infarcted or damaged area forms a scar, but is no longer a functioning part of heart muscle.
Conventional medical treatments for angina include blood vessel dilators such as nitroglycerine and other nitrites and calcium channel blockers. If arteriograms show clogged coronary arteries, bypass surgery is usually recommended.
Dietary Supplements: Primary Recommendations
Those pesky little free radicals really get around. They seem to be involved in almost every cardiovascular condition, and angina is no exception.1,2 Consequently, it's not surprising that vitamin C and other antioxidants, which neutralize free radicals, are beneficial in the prevention and treatment of angina. In fact, studies have shown that men and women with lower blood levels of vitamin C have a higher risk for angina.3,4,5,6 Furthermore, research has also shown that vitamin C supplementation, with or without other antioxidants, has been able to reduce the incidence of angina.7,8,9 About 2,000 mg of vitamin C daily is recommended.
Co-enzyme Q10 is a vitamin-like substance involved in cellular energy metabolism. It is also an antioxidant, like vitamin C, that is beneficial in the prevention and treatment of angina. In a study, which reviewed the scientific literature, Co-enzyme Q10 was revealed to be used in oral form to treat various cardiovascular disorders including angina.10 In one study, patients with acute myocardial infarction experienced a significant reduction in angina, arrhythmias (abnormal heartbeat), and poor heart function when supplemented with 120 mg of Co-enzyme Q10 daily.11 Of course everyone knows that exercise is good to prevent cardiovascular disease. But in one study, patients with ischemic heart disease/effort angina were found to experience a faster loss of Co-enzyme Q10 during exercise.12 Does this mean that you shouldn't exercise if you have angina? No, it just means you should supplement with Co-enzyme Q10. In another study, 150 mg of Co-enzyme Q10 given to angina patients not only increased their blood levels of Co-enzyme Q10, but also increased their ability to exercise longer. These results lead the researchers to conclude, "This study suggests that Co-enzyme Q10 is a safe and promising treatment for angina pectoris."13 (Note: If you have acute angina, you should only exercise in accordance to a program approved by your physician.)
Vitamin E is considered by many to be the granddaddy of all antioxidant and cardiovascular support vitamins—and this reputation certainly holds true in the case of angina. As with vitamin C and Co-enzyme Q10 previously discussed, vitamin E protects against the free radical damage associated with angina. But what happens when there are inadequate levels of vitamin E? Not surprisingly, research shows that blood levels of vitamin E are significantly lower in patients with angina, and that these lower levels render them more susceptible to further cardiovascular damage.14,15,16 And what happens if vitamin E is supplemented? Various studies show that vitamin E supplementation, with or without other antioxidants, is able to successfully decrease the incidence of angina in affected patients.17,18,19 In fact, in a study, which examined vitamin use in 2313 men, vitamin E supplementation was found to have the strongest association with a reduced risk of ischemic heart disease, including angina.20 Finally, vitamin E supplementation together with conventional anti-anginal drug therapy has been found to bring a higher response and exercise improvement, as well as other positive changes, than drug therapy alone.21 About 100 –400 IU of vitamin E daily is recommended.
L-carnitine is an amino acid involved in energy metabolism. Extensive research has also shown that l-carnitine has a valuable role to play in cardiovascular disease, especially where angina is concerned. Several studies have demonstrated that supplementation with l-carnitine (2000 to 4000 mg daily) is able to reduce the incidence of anginal attacks in cardiovascular disease patients.22,23,24,25 Furthermore, in studies involving patients with angina pectoris and effort angina (i.e., angina induced by physical effort, such as exercise), supplementation with l-carnitine (2000 or 3000 mg daily) was able to improve exercise performance.26,27,28,29,30 Furthermore, in a study where l-carnitine was given to patients with effort angina along with anti-arrhythmic drugs, the l-carnitine was found to improve the action of those drugs.31
Germany's Commission E has validated the use of Hawthorn in cases of cardiac insufficiency, resulted in an improvement of subjective findings as well as an increase in heart work tolerance, and a decrease in pressure/heart rate product.32 (Although Hawthorne Berry products are often marketed, it is the Hawthorne leaves and flowers which have been so carefully researched and validated.). In one study, a 60 mg hawthorn extract taken three times per day improved heart function and exercise tolerance in angina patients.33
Typically physicians will give their angina patients a prescription for nitroglycerin tablets, which are used in case of an angina attack. Nitroglycerine works through dilation of arteries, which in turn, works through an interaction with nitric oxide, which stimulates dilation. It is interesting to note that nitric oxide is made from the amino acid arginine. Furthermore, blood cells in people with angina have been shown to make insufficient nitric oxide,34 (possibly due to abnormalities of arginine metabolism). Of greatest significance is research showing that 2 grams (2,000 mg) of arginine, three times per day for as little as three days improved the ability of angina sufferers to exercise.35 Additional research has shown that the mechanism by which arginine operates is through stimulating blood vessel dilation.36 (Note: If you have an active herpes virus, you should avoid arginine supplements since they can "feed" the virus.)
Dietary Supplements: Secondary Recommendations
The heartbeat normalizing effects of magnesium has been described repeatedly since 1935, both as a factor in human disease and in animal experiments. Nevertheless, this therapeutic effectiveness is rarely mentioned in textbooks. Both the therapeutic effect of magnesium and the correction of magnesium deficiency have been used in treatment of digitalis toxicity (a drug used to treat angina), angina, as well as in arrhythmia (abnormal heartbeat) of unknown origin. Magnesium deficiency can be caused by a number of situations. Of possible concern to the angina sufferer are the uses of drugs such as digitalis, diuretics, gentamicin, as well as cisplatinum, which appreciably enhance urinary magnesium loss. Correction of magnesium deficiency should lead to recovery.37 About 300 – 500 mg daily is recommended. Please note, however, that it may take weeks or even months of magnesium supplementation, to achieve an angina-relieving result.
Omega-3 fatty acids
The omega-3 fatty acids EPA and DHA have been studied in the treatment of angina. Some research indicates that 3 grams or more of omega-3 oils (e.g., fish oils) three times per day (providing a total of about 3 grams of EPA and 2 grams of DHA) have reduced chest pain as well as the need for nitroglycerin, a common medication used to treat angina.38 However, other research did not confirm these benefits.39 In any case, if omega-3's are used, vitamin E should be supplemented with it, since the vitamin E may protect the oils against free radical oxidation.40 Also, if you are using any type of blood-thinning medication, consult with your doctor before using omega-3 fatty acids.
Bromelain acts naturally as a blood thinner agent since it prevents excessive blood platelet from clumping together,41 which would otherwise cause "sludgy" blood. Furthermore, there have been positive reports in a few clinical trials of bromelain to decrease thrombophlebitis (inflammation of veins) and pain from angina and thrombophlebitis.42,43 About 1200–1500 mg daily (derived from at least 900 GDU/Gram material) is recommended.
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- Miwa K, et al, Cardiovasc Res (1999) 41(1):291–8.
- Miwa K, et al, Circulation (1996) 94(1):14–8.
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- Singh RB, et al, Am J Cardiol (1996) 77(4):232–6.
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- Meyer F, Bairati I, Dagenais GR, Can J Cardiol (1996)12(10):930–4.
- Pimenov LT, Churshin AD, Ezhov AV, Klin Med (1997) 75(1):32–5.
- Singh RB, et al, Postgrad Med J (1996) 72(843):45–50.
- Davini P, et al, Drugs Exp Clin Res (1992) 18(8):355–65.
- Fernandez C, Proto C, Clin Ter (1992) 140(4):353–77.
- Ferrari R, Cucchini F, Visioli O, Int J Cardiol (1984) 5(2):213–6.
- Kobayashi A, Masumura Y, Yamazaki N, Jpn Circ J (1992) 56(1):86–94.
- Cacciatore L, et al, Drugs Exp Clin Res (1991) 17(4):225–35.
- Canale C, et al, Int J Clin Pharmacol Ther Toxicol (1988) 26(4):221–4.
- Cherchi A, et al, Int J Clin Pharmacol Ther Toxicol (1985) 23(10):569–72.
- Kamikawa T, et al, Jpn Heart J (1984) 25(4):587–97.
- Mondillo S, et al, Clin Ter (1995) 146(12):769–74.
- Blumenthal, M., et al, The Complete German Commission E Monogrpahs: Therapeutic Guide to Herbal Medicines/CD version (1998) American Botanical Council, Austin, Texas.
- Hanack T, Bruckel MH, Therapiewoche (983) 33:4331–33 [in German].
- Mollace V, et al, Am J Cardiol (1994) 74:65–68.
- Ceremuzynski L, Chamiec T, Herbaczynska-Cedro K, Am J Cardiol (1997) 80:331–33.
- Egashira K, et al, Circulation (1996) 94:130–34.
- Laban E, Charbon GA, J Am Coll Nutr (1986) 5(6):521–32.
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- Mehta JL, et al, Am J Med (1988) 84:45–52.
- Wander RC, et al, J Nutr (1996) 126:643–52.
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Gene Bruno, MS, MHS
Gene Bruno is the Dean of Academics and Professor of Dietary Supplement Science for Huntington College of Health Sciences (a nationally accredited distance learning college offering diplomas and degrees in nutrition and other health science related subjects. Gene has two undergraduate Diplomas in Nutrition, a Bachelor’s in Nutrition, a Master’s in Nutrition, a Graduate Diploma in Herbal Medicine, and a Master’s in Herbal Medicine. As a 32 year veteran of the Dietary Supplement industry, Gene has educated and trained natural product retailers and health care professionals, has researched and formulated natural products for dozens of dietary supplement companies, and has written articles on nutrition, herbal medicine, nutraceuticals and integrative health issues for trade, consumer magazines, and peer-reviewed publications. Gene's latest book, A Guide to Complimentary Treatments for Diabetes, is available on Amazon.com, and other fine retailers.