Use of alternative pharmacotherapy in management of cardiovascular diseases

Am J Manag Care. 2002 Mar;8(3):270-85; quiz 286-8.


Objectives: To review use of alternative pharmacotherapy (AP) in patients with cardiovascular disease (CVD) and significant drug interactions between AP and traditional CVD medications.

Study design: A literature search of MEDLINE and the National Complementary and Alternative Medicine database was done using these search terms: supplements, vitamins, garlic, fish oil, L-arginine, soy, coenzyme Q10, herbs, phytosterols, chelation therapy, alternative medicine, and CVD.

Patients and methods: English human clinical trials measuring surrogate and clinical end points.

Results: Antioxidants have not been consistently proven beneficial in reducing cardiovascular mortality. Fish oils may be beneficial in patients with hypertension and hypercholesterolemia, but therapeutic doses need to be defined. Use of coenzyme Q10 in patients with heart failure has not demonstrated consistent benefits. Garlic may lower blood pressure and cholesterol levels, but also may increase bleeding, so its use in CVD patients should be monitored. Clinical studies with small sample sizes have demonstrated that L-arginine may be useful to prevent and treat CVD. The Food and Drug Administration recommends 25 g/day of soy protein as part of a diet low in saturated fats for cholesterol reduction. Plant sterols are recommended by the American Heart Association and the National Cholesterol Education Program Expert Panel as adjunct therapy to reduce low-density lipoprotein. No data support use of chelation therapy. Some APs interact with common prescription CVD medications (eg, gingko and ginseng with warfarin, St. John's Wort with digoxin).

Conclusions: The benefits of APs as part of the treatment for CVD are controversial. Routine use is not recommended.

Publication types

  • Review

MeSH terms

  • Antioxidants / administration & dosage
  • Antioxidants / therapeutic use
  • Arginine / administration & dosage
  • Arginine / therapeutic use
  • Cardiovascular Agents / adverse effects
  • Cardiovascular Agents / therapeutic use*
  • Cardiovascular Diseases / drug therapy*
  • Cardiovascular Diseases / prevention & control
  • Clinical Trials as Topic
  • Coenzymes
  • Complementary Therapies
  • Dietary Supplements*
  • Drug Interactions
  • Education, Pharmacy, Continuing
  • Fish Oils / administration & dosage
  • Fish Oils / therapeutic use
  • Garlic / adverse effects
  • Humans
  • Plant Preparations / administration & dosage
  • Plant Preparations / adverse effects
  • Plant Preparations / therapeutic use*
  • Soybean Proteins / administration & dosage
  • Soybean Proteins / therapeutic use
  • Sterols / administration & dosage
  • Sterols / therapeutic use
  • Ubiquinone / administration & dosage
  • Ubiquinone / analogs & derivatives*
  • Ubiquinone / therapeutic use


  • Antioxidants
  • Cardiovascular Agents
  • Coenzymes
  • Fish Oils
  • Plant Preparations
  • Soybean Proteins
  • Sterols
  • Ubiquinone
  • Arginine
  • coenzyme Q10