| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 1998;98:2098-2102.)
© 1998 American Heart Association, Inc.
Correspondence |
Crataegus oxyacantha and Heart Failure
Dr Willmar Schwabe Arzneimittel GmbH Karlsruhe, Germany
To the Editor:
The statement on "Phytochemicals and Cardiovascular Disease" published in the June 3, 1997, issue of Circulation1 focuses attention on the vast therapeutic possibilities found in plants. One of the 3 groups of substances mentioned, the flavonoids, is found in great abundance in standardized special extracts of Hawthorn leaves with flowers. This extract has been studied extensively in Germany and is currently being used as a treatment modality in NYHA class II heart failure. Clinical studies (double-blind and placebo controlled) have been published in German and other languages2 3 along with pharmacological and chemical studies. In a recent article,4 136 patients (NYHA class II heart failure) were randomized (double-blind) to either 160 mg Hawthorn special extract WS 1442 per day or placebo. The difference between the pressure/heart rate product (PHRP) at a 50-W load versus rest was measured before and after treatment, and the change in this parameter was defined as the primary target parameter. The group receiving active medication showed a significant improvement in the PHRP, whereas, in the placebo group, this parameter tended to deteriorate. Other surrogate parameters (patients' subjective assessment of symptoms and quality of life) also improved. The medication was excellently tolerated.
The cardioprotective qualities of Hawthorn extract WS 1442 have been demonstrated by Krzeminski and Chatterjee.5 They used the ischemia/reperfusion model in 2 groups of rats, 1 receiving 100 mg · kg-1 · d-1 of the standardized Hawthorn extract WS 1442 orally for 6 days before induction of ischemia and the other serving as a control group. Active treatment effectively protected the animals from reperfusion-induced arrhythmia, mortality, and hypotensive crisis, as observed in the control animals after 7 minutes of coronary occlusion. A better understanding of the pharmacological working principles of WS 1442 is offered by Chatterjee et al.6 They fractionated the Hawthorn extract and demonstrated that a subgroup of the flavonoids, namely, the oligomeric procyanidins, possess potent radical scavenging and human neutrophil elastase inhibitory activities. Further research is being carried out with this special Hawthorn extract to investigate its pharmacological properties and its clinical significance, not only in early but also in advanced stages of heart failure and for secondary prevention after myocardial infarction.
References
-
Howard BV, Kritchevsky D. Phytochemicals and
cardiovascular disease: a statement for healthcare
professionals from the American Heart Association.
Circulation. 1997;95:2591–2593.
[Free Full Text]
-
Leuchtgens H. Crataegus special extract WS
1442 in NYHA II heart failure: a placebo controlled randomized
double-blind study [in German]. Fortschr Med. 1993;111:352–354.[Medline]
[Order article via Infotrieve]
-
Weikl A, Noh HS. Der Einfluß von
Crataegus bei globaler Herzinsuffizienz. Herz
Gefäße. 1992;12:516–522.
-
Weikl A, Assmus KD, Neukum-Schmidt A, Schmitz J, Zapfe
G, Noh HS, Siegrist J. Crataegus special extract WS 1442:
assessment of objective effectiveness in patients with heart failure
[in German]. Fortschr Med. 1996;114:291–296.[Medline]
[Order article via Infotrieve]
-
Krzeminski T, Chatterjee SS. Ischemia and
early reperfusion induced arrhythmias: beneficial effects of an
extract of Crataegus oxyacantha L. Pharm Pharmacol
Lett. 1993;3:45–48.
-
Chatterjee SS, Koch E, Jaggy H, Krzeminski T. In vitro
and in vivo investigations on the cardioprotective effects of
oligomeric procyanidins in a Crataegus extract from leaves
with flowers. Arzneimittelforschung. 1997;79:821–825.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||