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53 Cards in this Set
- Front
- Back
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coenzyme Q10 (CoQ10) |
aka ubiquinone coenzyme in mitochondria |
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CoQ10 used for: |
heart failure myalgia w statins |
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CoQ10 MOA |
might act as an antioxidant or affect calcium-dependent ion channels in the heart |
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CoQ10 efficacy (HF) |
MA: improved EF by 3.7% (but no improvement in studies done after 1900s) recent study: can decrease risk of dying from HF class III or IV (50% decrease in mortality) -small study, conflicts with other research conclusion: insufficient evidence |
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CoQ10 safety |
generally well tolerated don't know long-term safety |
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CoQ10 DI |
antihypertensives (lower BP) warfarin (similar to vit K, decrease anticoagulation of warfarin) statins (decrease CoQ10 synthesis) |
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CoQ10 efficacy (myalgia) |
research shows that CoQ10 does not relieve muscle pain due to statins, no evidence it prevents it |
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Horse Chestnut used for |
chronic venous insufficiency hemorrhoids |
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horse chestnut MOA |
-active ingredient is "escin" -may increase venous tone, improve venous return, reduce vascular permeability |
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horse chestnut efficacy (venous insufficiency) |
many MA and reviews: subjective improvement! -decrease swelling |
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horse chestnut safety |
-GI irritation -bleeding? (should not be a problem if purified) -hypoglycemia |
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horse chestnut efficacy (hemorrhoids) |
no evidence |
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garlic used for: |
hypertension dyslipidemia Alliin --> allicin (odour -active ingredient?) |
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garlic efficacy (HTN) |
may modestly reduce BP -poor quality studies -became unblinded |
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garlic safety |
safe as food inhibition of platelet aggregation (many case reports of bleeding) odour GI irritation |
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fish peptides used for |
hypertension |
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fish peptides MOA |
some peptides have activity like ACE inhibitors |
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fish peptides efficacy |
insufficient evidence -only 1-2 very small studies: some decrease in BP |
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Hawthorn used for: |
hypertension heart failure |
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hawthorn efficacy (HTN) |
many studies found no decrease in BP (some even increased BP) |
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hawthorn efficacy (HF) |
one product increased progression of HF other RCTs found no benefit on exercise tolerance but + ADRs |
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Danshen used for: |
CV benefit (BP, angina) |
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danshen efficacy |
lack of evidence |
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danshen safety |
associated w a canadian case of methemioglobinemia, a rare but serious condition which may result in coma or death |
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danshen DI |
increased INR and bleeding when combined w warfarin induces cyp 3A4 (decrease effect of some statins) |
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flaxseed used for |
dyslipidemia |
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flaxseed MOA |
contains: 1. ALA (very concentrated source) 2. Lignans (phytoestrogens) 3. Dietary fibre (25% soluble fibre which lowers cholesterol) |
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flaxseed efficacy |
almost all research done on seeds incorporated into foods MA: whole flaxseeds or lignans or partially defatted: decreased LDL-C by 8-18% (0.1-0.3 mmol/L) CS? (proper diet can lower LDL by up to 16% and statins 55%) flaxseed oil: no benefit |
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flaxseed safety |
fibre: bulk laxative -take w fluids, space w po meds decrease platelet aggregation -caution if bleeding disorder or drug association of high ALA diets w prostate cancer lignans: -hypoglycemic effects? -anti-estrogenic effects? |
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flaxseed CI |
avoid in pts w prostate cancer caution in diabetes, pregnancy, estrogen sensitive cancer |
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omega-3 FA used for: |
dyslipidemia |
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omega-3 FA efficacy |
general popn: -decrease in all-cause mortality and nonfatal CV events w regular intake in pts w high TG: -decreased TG 20-50% depending on dose -increased LDL and HDL in pts w previous CV event: -decrease risk of CV death, all cause mortality in high risk pt -more recent MA: NS new data: no evidence, eat fish |
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omega 3-FA safety |
generally well tolerated -GI: belching (fish odour), heartburn, nausea, diarrhea -increase LDL -bleeding -suppress immune system? -decrease BP? |
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omega-3 FA CI |
caution: -seafood allergy -immunodeficiency may increase LDL |
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omega-3 FA DI |
anithypertensives (additive) anticoagulants |
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plant sterols (phytosterols) used for |
dyslipidemia |
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plant sterols source |
plant oils: nuts, seeds, soybeans, flaxseeds, avocados beta-sitosterol most common |
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plant sterols MOA |
similar structure to cholesterol may decrease cholesterol absorption in intestine (like ezitimibe) |
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plant sterols efficacy |
over 30 positive RCTs -lower LDL by 6-15% -no change in HDL may be added to statins = additional decrease in LDL by 7-11% |
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plant sterol safety |
likely safe -10% decrease in abs of beta carotene (eat fruits and vegetables) no evidence for too much plant sterol |
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plant sterol DI |
safe in conjunction w statins ezetimibe will decrease plant sterol absorption |
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plant sterol CI |
sitosterolemia --> premature CVD |
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red yeast rice used for |
dyslipidemia |
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red yeast rice MOA |
product when yeast grown on rice ~10 monacolins - HMGCoA reductase inhibitors the most common monacolin produced is monacolin K = lovastatin |
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red yeast rice safety |
may contain lovastatin: -myopathy, liver impairment toxic contaminant due to improper fermentation = citrinin (kidney damage) |
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red yeast rice efficacy |
if lovastatin present -yes (products have varied amounts of, perhaps none) not licensed in US or Canada if contains lovastatin |
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policosanol used for |
dyslipidemia |
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policosanol MOA |
mixture of carbon alcohols -may be derived from sugar cane, rice, other sources MOA: unknown |
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policosanol efficacy |
studies from manufacturer: lowered LDL by 23% -subsequent RCTs from different labs failed to reproduce this therefore: insufficient evidence |
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policosanol safety |
inhibits platelet aggregation |
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policosanol CI |
surgery bleeding tendency |
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policosanol DI |
anticoagulants |
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garlic efficacy: dyslipidemia |
older studies: poor quality recent studies: no sig effect -small benefit: lower LDL by ~0.2mmol/L |
