Abstract
The aim of this meta-analysis was to assess the evidence from rigorous clinical trials
of the use of hawthorn extract to treat patients with chronic heart failure. We searched
the literature using MEDLINE, EMBASE, the Cochrane Library, CINAHL, CISCOM, and AMED.
Experts on and manufacturers of commercial preparations containing hawthorn extract
were asked to contribute published and unpublished studies. There were no restrictions
about the language of publication. Two reviewers independently performed the screening
of studies, selection, validation, data extraction, and the assessment of methodological
quality. To be included, studies were required to state that they were randomized,
double-blind, and placebo controlled, and used hawthorn extract monopreparations.
Thirteen trials met all inclusion criteria. In most of the studies, hawthorn was used
as an adjunct to conventional treatment. Eight trials including 632 patients with
chronic heart failure (New York Heart Association classes I to III) provided data
that were suitable for meta-analysis. For the physiologic outcome of maximal workload,
treatment with hawthorn extract was more beneficial than placebo (weighted mean difference,
7 Watt; 95% confidence interval [CI]: 3 to 11 Watt; P < 0.01; n = 310 patients). The pressure–heart rate product also showed a beneficial
decrease (weighted mean difference, −20; 95% CI: −32 to −8; n = 264 patients) with
hawthorn treatment. Symptoms such as dyspnea and fatigue improved significantly with
hawthorn treatment as compared with placebo. Reported adverse events were infrequent,
mild, and transient; they included nausea, dizziness, and cardiac and gastrointestinal
complaints. In conclusion, these results suggest that there is a significant benefit
from hawthorn extract as an adjunctive treatment for chronic heart failure.
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References
- The booming US botanical market.Herbalgram. 1998; 44: 33-48
- Market report.Herbalgram. 2001; 51: 69
- The Desktop Guide to Complementary and Alternative Medicine: An Evidence Based Approach. Mosby, Edinburgh, UK2001
- Hawthorn.J Clin Pharmacol. 2002; 42: 605-612
- Phytotherapy in heart failure.Phytomedicine. 1997; 4: 267-271
- Wirksamkeit und Verträglichkeit von Crataegus-Extrakt WS®1442 bei herzinsuffizienten Patienten mit eingeschränkter linksventrikulärer Funktion.Perfusion. 2001; 14: 212-217
- Herbs and dietary supplements in the prevention and treatment of cardiovascular disease.Prev Cardiol. 2000; 3: 24-32
- Crataegus (common hawthorn) extracts in cardiac failure–are there new promising results and outlooks?.Perfusion. 2000; 13: 495-498
- Therapie kardiovaskulärer Erkrankungen mit Phytopharmaka.Biol Med. 2001; 30: 56-60
- Professional’s Handbook of Complementary and Alternative Medicines. Springhouse, Philadelphia, Pennsylvania1999: 324-326
- The Encyclopedia of Popular Herbs. Prima, Rocklin, California2000: 256-265
- Evidence-Based Herbal Medicine. Hanley & Belfus, Philadelphia, Pennsylvania2002: 231-235
- The Complete Commission E Monographs. American Botanical Council, Austin, Texas2000: 142-144
- Herbal Medicine: Expanded Commission E Monographs. American Botanical Council, Austin, Texas2000: 182-192
- Review of the usefulness of contacting other experts when conducting a literature search for systematic reviews.BMJ. 1998; 317: 1562-1563
- Assessing the quality of reports of randomised clinical trials.Control Clin Trials. 1996; 17: 1-12
- Variance imputation for overviews of clinical trials with continuous response.J Clin Epidemiol. 1992; 45: 769-773
Alexander, A. Klinische Wirkung des Crataegus Extraktes LI132 bei der Therapie der Herzinsuffizienz im Stadium II der New York Heart Association. Eine randomisierte, plazebokontrollierte Doppelblindstudie an n=73 Patienten [unpublished]
- Efficacy and safety of crataegus extract WS®1442 in comparison with placebo in patients with chronic stable New York Heart Association class-III heart failure.Am Heart J. 2002; 143: 910-915
- Clinical efficacy of Crataegus extract WS®1442 in congestive heart failure NYHA class II.Phytomedicine. 2001; 8: 262-266
- Objective confirmation of the efficacy of a special crataegus extrakt WS1442 in patients with cardiac insufficiency (NYHA II).Fortschr Med. 1996; 114: 291-296
- Effectiveness of hawthorn extract at a dosage of 3 × 100 mg per day. Multicentre double-blind trial with 85 NYHA stage II heart failure patients.Münch Med Wschr. 1994; 136: S7-S11
- The crataegus special extract WS 1442 in patients with cardiac insufficiency NYHA II. A placebo-controlled double-blind study.Fortschr Med. 1993; 111: 352-354
- Behandlung älterer, multimorbider Patienten mit stenokardischen Beschwerden. Eine placebokontrollierte crossover-Doppelblindstudie mit Crataegutt® novo.Therapiewoche. 1987; 37: 3587-3600
- Treatment of decreasing cardiac performance (NYHA stages I to II) in advanced age with standardized crataegus extract.Fortschr Med. 1986; 104: 805-808
- Behandlung von leichten stabilen Formen der Angina pectoris mit Crataegutt novo.Therapiewoche. 1983; 33: 4331-4333
- Therapeutic effect of crataegus pinnatifida in 46 cases of angina pectoris–a double blind study.J Tradit Chin Med. 1984; 4: 293-294
- Crataegus-extract vs. methyldidoxin.Münch Med Wschr. 1994; 136: S35-S38
- Effectiveness of the hawthorn extract LI 132 compared with the ACE inhibitor captopril.Münch Med Wschr. 1994; 136: S27-S33
- Zur kardialen Wirksamkeit von low-dose digitoxin (0.07 mg) and crataegus.Med Welt. 1987; 38: 1023-1028
- Der Einfluss von Crataegus bei globaler Herzinsuffizienz.Herz Gefässe. 1992; 12: 516-524
- Crataegus-Extrakt hilft dem Patienten mit NYHA II-Herzinsuffizienz.Therapiewoche. 1989; 39: 3288-3296
- Hawthorn/passion flower extract and improvement in physical exercise capacity of patients with dyspnoea class II of the NYHA functional classification.Acta Ther. 1994; 20: 47-66
- Effects of an herbal crataegus-campher combination for the symptoms of functional cardiovascular disorders.Arzneimittelforschung. 2000; 50: 613-619
- Klinische Untersuchungen mit einem Knoblauch-Lezithin-Präparat.Ärztezeitschrift Naturheilverfahren. 1996; 37: 126-136
- Efficacy of a standardized extract of fresh Crataegus berries on exercise tolerance and quality of life in patients with congestive heart failure (NYHA II).Arzneimittelforschung/Drug Res. 2001; 51: 793-798
- Randomized placebo-controlled study with crataegus on exercise tests and challenge by catecholamines in healthy subjects.Eur J Pharmacol. 1990; 183: 525-526
- Efficacy of the hawthorn extract LI132 (600 mg/d) during eight weeks treatment. Placebo controlled double blind trial with 78 NYHA stage II heart failure patients.Münch Med Wschr. 1994; 136: S13-S19
- Survival and Prognosis.Eur J Heart Fail. 2000; 2: 431-437
- Efficacy of hawthorn (crataegus) preparation LI132 in 78 patients with chronic congestive heart failure defined as NYHA functional class II.Phytomedicine. 1994; 1: 17-24
- Crataegus bei mäßige reduzierter linksventrikulärer Auswurffraktion.Münch Med Wschr. 1994; 136: S21-S26
- Klinische Wirkung von Crataegutt® bei Herzerkrankungen ischämischer und/oder hypertensiver Genese. Eine multizentrische Doppelblindstudie.Planta Med. 1981; 42: 1-16
- Die Beschwerden-Liste als Test.Therapiewoche. 1971; 21: 1908-1920
- Report of the American College of Cardiology. Guidelines for the evaluation and management of heart failure.Circulation. 1995; 92: 2764-2784
- Guidelines for the diagnosis and treatment of chronic heart failure.Eur Heart J. 2001; 22: 1527-1560
- ABC of heart failure. Acute and chronic management strategies.BMJ. 2000; 320: 559-562
- Diagnosis and management of heart failure.BMJ. 1994; 308: 321-328
- Beta-blockers for congestive heart failure.Drugs Aging. 2000; 16: 1-7
- Effects of beta-blocker therapy on mortality in patients with heart failure.Eur Heart J. 1997; 18: 560-565
- Drug treatment in heart failure.BMJ. 2000; 320: 1188-1192
- Clinical benefit of angiotensin-converting enzyme inhibitors in chronic heart failure.J Cardiovasc Pharmacol. 1996; 27: S19-S24
- What is the ideal study design for evaluation of treatment of heart failure?.Eur Heart J. 1996; 17: 120-134
- Exercise testing in heart failure.Drugs. 1994; 47: S14-S24
- Pharmacologic action profile of crataegus extract in comparison to epinephrine, amrinone, milrinone and digoxin in the isolated perfused guinea-pig heart.Arzneimittelforschung. 1995; 45: 1261-1265
- Crataegus extract blocks potassium currents in guinea pig ventricular cardiac myocytes.Planta Med. 1999; 65: 335-339
- Crataegus special extract WS 1442 increases the force of contraction in human myocardium cAMP-independently.J Cardiovasc Pharmacol. 2000; 35: 700-707
- Incidence of hospitalization for digitalis toxicity among elderly Americans.Am J Med. 1994; 96: 426-431
- High-dose crataegus (hawthorn) extract WS®1442 in the treatment of NYHA stage II heart failure.Herz. 1999; 24: 465-474
- High dosed therapy with crataegus extract in patients suffering from heart failure NYHA stage I and II.Z Phytother. 1998; 19: 22-30
- Trends in alternative medicine use in the United States 1990–1997.JAMA. 1998; 280: 1569-1575
- Different standards of reporting of ADRs to herbal remedies and conventional OTC medicines.Br J Clin Pharmacol. 1998; 45: 496-500
- Possible interactions between synthetic and herbal medicinal products part 1.Perfusion. 2000; 13: 4-15
- Herb-Drug Interaction Handbook. Church Street Books, Nassau, New York2002
Tankanow R, Tamer HR, Streetman DS, et al. Examination of potential interactions between hawthorn and digoxin in healthy normals. Poster presented at: International Scientific Conference on Complementary, Alternative and Integrative Medicine Research; April 2002; Boston, Massachusetts
- The existence of publication bias and risk factors for its occurrence.JAMA. 1990; 263: 1385-1389
- Publication bias in clinical research.Lancet. 1991; 337: 867-872
- Bias in location and selection of studies.BMJ. 1998; 316: 61-66
- Alternative therapy bias.Nature. 1997; 385: 480
- Bias in alternative medicine is still rife but is diminishing.BMJ. 2001; 323: 1071
- Location bias in con-trolled clinical trials of complementary/alternative therapies.J Clin Epidemiol. 2000; 53: 485-489
- Language bias in randomised controlled trials published in English and German.Lancet. 1997; 350: 326-329
- Bias against European journals in medical publication databases.Lancet. 1999; 353: 1592
Article Info
Publication History
Accepted:
January 23,
2003
Received:
August 5,
2002
Identification
Copyright
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
