Re: The Potential Value of Chinese Herbs for Cardiovascular Disease in Diabetics
Ceylan-Isik AF, Fliethman RM, Wold LE, Ren J. Herbal and traditional Chinese medicine for the treatment of cardiovascular complications in diabetes mellitus. Curr Diabetes Rev. 2008;4: 320-328.
Diabetes mellitus affects millions worldwide.
Chronic hyperglycemia severely damages kidneys, nerves, eyes, blood vessels,
and heart. Cardiovascular (CV) complications increase morbidity and mortality. Vascular
complications cause blindness, renal failure, neuropathy, and atherosclerosis.
Cardiac dystolic dysfunction is diabetics' most common primary heart defect.
Diabetic cardiomyopathy reduces heart wall compliance and rate of myocardial
relaxation. Other dysfunctional changes are also seen in diabetic hearts. Conventional
regimes for diabetes with CV complications include angiotensin-converting
enzyme inhibitors, digoxin, diuretics, β-blockers, Ca2+ antagonists,
and/or spironolactones. Insulin-sensitizing agents such as thiazolidinediones aid
insulin efficiency and exert beneficial effects on CV gene expression. However,
recent meta-analyses found greatly increased risk (~40%) of myocardial
infarction among patients taking one thiazolidinedione drug, compared with
other oral drugs or placebo, prompting renewed interest in the over 800 plants
listed with anti-diabetic potential.
The authors discuss four types of Traditional
Chinese Medicine (TCM) herbal remedies, giving several examples of each type with
potential benefit in CV complications of diabetes.
Energy-promoting
herbs affect central nervous
system (CNS), immune, endocrine, and CV systems. Asian ginseng (Panax ginseng), e.g., invigorates; restores
homeostasis; aids in CV disease, cancer, immune deficiency, and hepatotoxicity;
and may aid in aging, CNS disorders, and neurodegenerative diseases. Many energy-promoting
herbs have anti-inflammatory, anti-shock, and anti-tumor properties, and are immunopotentiating.
Ginseng and licorice (Glycyrrhiza
glabra) both stimulate endocrine
function. Ginseng's ginsenosides regulate adrenals. Dong quai (Angelica sinensis) and black cohosh (Actaea racemosa
syn. Cimicifuga racemosa) regulate menopausal symptoms. Most
energy-promoting herbs have hypoglycemic effects. Ginseng may protect β-islet
cells from toxicity, aiding insulin secretion. Energy-promoting herbs benefit
CV conditions such as angina pectoris, myocardial infarction, heart failure,
shock, and chronic respiratory disease. An injected combination of ginseng,
dong quai, and astragalus (Astragalus
membranaceus) inhibited platelet
aggregation.
Blood-promoting
herbs aid circulation,
nourish blood, increase its production, and are anti-thrombotic. Dong quai, Chinese
salvia (Salvia miltiorrhiza), Chinese peony (Paeonia lactiflora), and
safflower (Carthamus tinctorius) all support coronary blood flow and reduce
myocardial oxygen use, ischemia, and arrhythmia. Dong quai opposes induced
arrhythmia. Stephania (Stephania
tetrandra) lowers cardiac automatic
rhythm. Chinese salvia is vasodilating, improving microcirculation to the lungs
and kidneys. Ligusticum wallichii has
many potential CV benefits; with Chinese salvia and dong quai, it restored
microcirculation after adrenaline-induced contraction. A peony extract has
aspirin-like effects and may reduce platelet aggregation and thrombosis from
hyperlipidemia or hypercholesterolemia.
Yin- and
yang-promoting herbs restore balance and replenish cellular constituents. Yin
herbs lycium (Lycium chinense), schisandra (Schisandra
chinensis), glossy privet (Ligustrum lucidum), rehmannia (Rehmannia glutinosa), and others support
myocardial metabolism, improve hypoxia tolerance, lower oxygen consumption, and
increase coronary perfusion, adenosine triphosphate, and glucagon content. Yang herbs barrenwort (Epimedium grandiflorum), psoralea (Cullen corylifolium syn. Psoralea
corylifolia), and eucommia (Eucommia ulmoides) activate cellular
metabolism, especially catabolism, and dilate coronary arteries, easing blood
flow.
Other Asian herbalists use over 200
hypoglycemic plants in diabetes, including foods such as wheat (Triticum spp.), celery (Apium spp.), ginger (Zingiber officinale), and
pumpkin (Cucurbita pepo). Ginseng and ginkgo (Ginkgo biloba) are said to exert benefits in diabetes and its complications. Herbs frequently
used in diabetes include glucose regulators such as bitter gourd (Momordica charantia) and jambolan (Syzygium cumini syn. Eugenia
jambolana), the Ayurvedic fibrosis
improver ponkoranti (Salacia
oblonga), and lipid-lowering garlic (Allium
sativum).
Multifactorial therapies
offered by herbs are well-suited to treating diabetes, complementing necessary
mainstream medicines and relieving some complications. Plant products that act
on nucleic receptors may provide new therapies for impaired glucose and lipid
metabolism.