Angina

Angina is a type of atherosclerosis that occurs when atherosclerotic plaque accumulates in the arteries leading to heart muscle.  This plaque progressively narrows and ultimately blocks the blood vessels (coronary arteries) that supply the heart, leading to a significant reduction in the amount of blood and oxygen that reach the heart.  The main symptom of angina is pain in the chest that radiates to the back of the neck, the left shoulder blade, left arm or jaw.  The pain associated with angina typically lasts for one to twenty minutes.

Other cardiovascular diseases can be the underlying cause of angina.  For example, atherosclerosis prevents adequate supplies of oxygen from reaching the heart.  Angina can also occur as one of the manifestations of congestive heart failure.

The following are suggested therapies that may treat angina:

Arginine:

Rationale:

Arginine has been found to improve blood circulation and vasodilatation (the opening/widening of blood vessels) in angina patients.  In a clinical study involving patients with stable angina, subjects receiving supplemental arginine were found to experience an increase in their ability to undertake exercise without experiencing heart muscle strain (heart pain) by almost three minutes.  They also experienced a reduction in ECG abnormalities.

Dosage:

2,000 - 4,000 mg per day.

Carnitine:

Rationale:

Carnitine alleviates the symptoms of angina and allows angina patients to become more physically active.  In one study, stable angina patients experienced an average 22% improvement in their ability to engage in exercise after carnitine therapy.

Dosage:

1,500 - 3,000 mg per day.

Bromelain:

Rationale:

Bromelain (a group of enzymes derived from pineapple) is a highly effective therapy for angina patients because of its ability to break down a damaging protein named fibrinogen.  Elevated fibrinogen levels are a significant causative factor in angina.  In one study, bromelain therapy resulted in the disappearance of all symptoms of angina within 4 to 90 days of commencement of daily bromelain treatment (the number of days taken until the symptoms of angina disappeared depended on the severity of the occlusions in the angina patients).

Dosage:

1,200 mg per day.

Magnesium:

Rationale:

Many angina patients have been found to be deficient in magnesium.  Supplemental magnesium reduces the symptoms of angina (by exerting antispasmodic effects on blood vessels).  Some hospitals use intravenous magnesium preparations for patients with severe angina.

Dosage:

200 - 500 mg per day.

Coenzyme Q10:

Rationale:

Coenzyme Q10 has been found to reduce the requirement for medication in angina patients.  It facilitates the heart's ability to produce oxygen in response to the hypoxia (lack of oxygen) associated with angina.  Angina patients who use supplemental coenzyme Q10 experience an increase in their ability to exercise without pain.

Dosage:

150 - 300 mg per day.

Vitamin C:

Rationale:

Vitamin C has been found to help to prevent and treat angina.  People whose intake of vitamin C is low have a higher incidence of angina.

Dosage:

1,000 - 3,000 mg per day.

Lysine:

Rationale:

Dr. Linus Pauling found that the combination of high-dose lysine with vitamin C reduced the symptoms of angina by lowering lipoprotein (a) levels.  Elevated lipoprotein (a) is implicated as a cause of angina.

Dosage:

5,000 mg per day (used in combination with high-dose vitamin C).

Vitamin E:

Rationale:

Vitamin E helps to prevent angina and may alleviate the symptoms of angina in existing angina patients.

Dosage:

800 IU or more per day.

Hawthorn:

Rationale:

Hawthorn alleviates the symptoms of angina, improves the ability of angina patients to exercise and reduces the frequency of angina attacks by improving blood circulation to the heart.

Dosage:

3 - 6 ml per day (using hawthorn 1:1 fluid extract or tincture).

12 - 15 ml per day (using hawthorn 1:5 fluid extract or tincture).

160 - 900 mg per day (using capsules or tablets containing hawthorn leaves or flowers standardized to contain 20% and 1.8% vitexin).

4,000 - 6,000 mg per day (using capsules containing freeze-dried hawthorn berries).

Tribulus terrestris:

Rationale:

Tribulus terrestris causes significant improvement (in terms of remissions and ECG indicators) in angina patients.  It dilates coronary arteries and improves blood circulation to the heart in angina patients.

Dosage:

750 - 1,500 mg per day.

Fish Oils:

Rationale:

Fish oils contains high levels of the omega-3 fatty acids named docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).  Clinical studies have found that fish oils reduce the frequency of angina attacks, reduce the chest pain associated with angina and help to prevent angina.  Many patients using fish oils are able to reduce their dose of nitroglycerin (a pharmaceutical treatment for angina).

Dosage:

9,000 mg or more per day.

Garlic:

Rationale:

Garlic is helpful for the prevention of angina attacks and improves the quality of life in angina patients.

1,000 - 3,500 mg per day (using garlic capsules/tablets).

Folic Acid:

Rationale:

Homocysteine is a toxic amino acid that, in higher than normal concentrations, is closely associated with angina.  Folic acid has been proven to help to lower elevated homocysteine levels.

Dosage:

800 - 2,000 mcg (0.8 - 2 mg) per day.

Vitamin B6:

Rationale:

Homocysteine is a toxic amino acid that, in higher than normal concentrations, is closely associated with angina.  Vitamin B6 has been proven to help to lower elevated homocysteine levels.

Dosage:

25 - 250 mg per day.

Selenium:

Rationale:

Selenium reduces the chest pain that occurs in angina patients.

Dosage:

200 - 400 mcg per day.

Korean Ginseng:

Rationale:

Korean ginseng reduces the pain associated with angina.

Dosage:

The short-term (up to three months) dosage for non standardized Korean ginseng is 1,000 - 2,000 mg per day or 300 - 400 mg per day for Korean ginseng products that have been standardized in terms of their ginsenosides content.

If Korean ginseng is used for periods of more than three months continuously the daily dosage (for non standardized Korean ginseng) is reduced to approximately 500 - 1,000 mg per day or 100 - 200 mg per day if using standardized Korean ginseng.

DHEA:

Rationale:

DHEA may reduce the tautness, heaviness and chest pains experienced by angina patients.

Dosage:

25 – 50 mg per day.

The optimal timing for DHEA supplements is first thing in the morning (either before breakfast or with breakfast).

Glutamine:

Rationale:

A clinical study found that oral glutamine administration to chronic stable angina patients increased their capacity for exercise.

Dosage:

2,000 - 6,000 mg per day.

Higher doses (up to 15,000 mg per day) are used in some circumstances.

Inula:

Rationale:

Indian scientists recently compared the effects of inula with nitroglycerin (a standard pharmaceutical treatment for angina) and found inula to be more effective for reducing chest pain in angina patients than nitroglycerin.

Dosage:

3,000 mg per day.

Arjun:

Rationale:

A clinical study found that treatment with arjun improved the condition of 66% of stable angina patients and 20% of unstable angina patients after three months of treatment.  Arjun treatment resulted in a 50% reduction in the number of angina episodes, reduced systolic blood pressure, improved left ventricular ejection function and increased exercise tolerance in these patients.

Another study in men  with angina found that seven days treatment with arjun reduced the frequency of angina attacks and improved treadmill exercise performance in stable angina patients.

Dosage:

500 – 1,500 mg per day.

Astragalus:

Rationale:

Astragalus has been shown to improve some aspects of angina.  One study found two weeks of astragalus treatment improved cardio output by almost 20%.  Another study found that angina patients noticed improvement in their subjective condition with astragalus treatment.

Dosage:

750 – 1,500 mg per day.

Lifestyle Changes to Assist the Prevention/Treatment of Angina

Saturated Fats:

Excessive consumption of saturated fatty acids (such as those found in animal products) can cause angina.

Trans-Fatty Acids:

Trans-fatty acids are synthetically altered fats that are present in high amounts in margarine, processed vegetable oils and fried foods.  They have been implicated in angina.

Lose Weight:

Obese people have a higher risk of angina compared to people who are at their ideal weight.

Exercise:

Regular exercise helps to prevent angina and also treats pre-existing angina.

Tobacco Smoking:

Tobacco smoking is a major underlying cause of angina.

Mercury:

Excessive accumulation of mercury has been implicated as an underlying cause of angina.

References

Arginine

· Ceremuzynski, L., et al.  Effect of supplemental oral L-arginine on exercise capacity in patients with stable angina pectoris.  Am J Cardiol.  80:331-333, 1997.

Arjun

· Bharani, A., et al.  Efficacy of Terminalia Arjuna in chronic stable angina: a double blind, placebo-controlled, crossover study comparing Terminalia Arjuna with isosorbide mononitrate.  Indian Heart Journal.  54(2):170-175, 2002.

Astragalus

· Lei, Z. Y., et al.  Action of Astragalus membranaceus on left ventricular function of angina pectoris.  Chung Kuo Chung His I Chief Ho Tsa Chih.  14(4):199-202, 1994.

Bromelain

· Nieper, H.  Effect of bromelain on coronary heart disease and angina pectoris.  Acta Medica Empirica.  5:274-278, 1978.

Carnitine

· Cacciatore, L., et al.  The therapeutic effect of L-carnitine in patients with exercise-induced stable angina: A controlled study.  Drugs Exp Clin Res.  17(4):225–235, 1991.

Coenzyme Q10

· Kamikawa T. et al.  Effects of coenzyme Q10 on exercise tolerance in chronic stable angina pectoris.  American Journal of Cardiology.  56(4):247, 1985.

DHEA

· DHEA report [letter].  Smart Life News.  6(5):8, 1998.

Fish Oils

· Salachas, A., et al.  Effects of a low-dose fish oil concentrate on angina, exercise tolerance time, serum triglycerides and platelet function.  Angiology.  45(12):1023-1031, 1994.

Folic Acid

· Brouwer, I. A., et al.  Low-dose folic acid supplementation decreases plasma homocysteine concentrations:  a randomized trial.  American Journal of Clinical Nutrition.  69(1):99-104, 1999.

Garlic

· Li, H., et al.  [Effects of garlicin tablet on plasma endothelin and nitric oxide in patients with coronary heart disease and angina pectoris].  Zhongguo Zhong Xi Yi Jie He Za Zhi.  19(11):670-671, 1999.

Glutamine

· Khogali, S. E., et al.  Is glutamine beneficial in ischemic heart disease?  Nutrition.  18(2):123-126, 2002.

Hawthorn

· Hanack, T., et al.  [The treatment of mild stable forms of angina pectoris using Crataegutt® novo.]  Therapiewoche. 33:4331-4333, 1983.

Inula

· Tripathi, S. N., et al.  Beneficial effect of Inula racemosa (Pushkarmoola) in angina pectoris: a preliminary report.  Ind J Physiol Pharmac.  28:73-75, 1984.

Korean Ginseng

· Hu, J. X., et al.  [Clinical and experimental study of shenshao tongguan pian in treating angina pectoris of coronary heart disease].  Chung Hsi I Chieh Ho Tsa Chih.  10(10):596-599, 1990.

Lysine

· Pauling, L.  Case report: Lysine/ascorbate-related amelioration of angina pectoris.  Journal of Orthomolecular Medicine.  6:144-146, 1991.

Magnesium

· Guo, H., et al.  Relationship between the degree of intracellular magnesium deficiency and the frequency of chest pain in women with variant angina.  Herz.  29(3):299-303, 2004.

Selenium

· Ogilvie, R. A.  Beat angina.  Nature & Health.  22(2):72-74, 2001.

Tribulus terrestris

· Wang, B., et al.  [406 cases of angina pectoris in coronary heart disease treated with saponin of Tribulus terrestris.]  Chung Hsi I Chieh Ho Tsa Chih.  10(2):85-87, 1990.

Vitamin B6

· McKinley, M., et al.  Low-dose vitamin B-6 effectively lowers fasting plasma homocysteine in healthy elderly persons who are folate and riboflavin replete.  American Journal of Clinical Nutrition.  73(4):759-764, 2001.

Vitamin C

· Kugiyama, K., et al.  Vitamin C attenuates abnormal vasomotor reactivity in spasm coronary arteries in patients with coronary spastic angina.  Journal of the American College of Cardiology.  32(1):103-109, 1998.

Vitamin E

· Miwa, K., et al.  Vitamin E deficiency in variant angina.  Circulation.  94(1):14-18, 1996.

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