A.Vogel Heart Care Heart tonic Sugar-, gluten- and lactose-free Composition Each 30 drop dose contains: Medicinal ingredient: Fresh Hawthorn berry (Crataegus monogyna) tincture (ratio 1:3.2) 0.7 mL equivalent to 233 mg of fresh berry. Non-medicinal ingredient: 1 mL of tincture contains 0.49 mL alcohol (ethanol). 1 mL = 33 drops. Dropper included. Dosage Adults: Take 30 drops with water, 3 times daily, 15 minutes before meals. Insalivate before swallowing. Historical overview Hawthorn is mentioned in ancient texts (Pline, Galinus, Dioscorides) but its cardiac virtues were only noted around the 16th Century (Quercetanus, 1544-1609). In the 19th Century, in the United States, Hawthorn was used by the eclectic physicians. Actions and Pharmacology Hawthorns active components are mostly flavonoids (luteolin, apigenin, vitexin, rutin, and quercetin as glycosides) and procyanidins. Hawthorn is also a source of tannins or polyphenols (oligomeric cathechins and epicathechins), carboxylic acids (caffeic acid), triterpenes and simple amines (choline, acetylcholine and tyramine). Researchers were unable to find one major active ingredient. It would seem that the therapeutic effect of Hawthorn, like that of many other herbs, rests on the synergy of all of its components.(1) The various in vivo and in vitro studies have identified many of Hawthorns therapeutic effects: Increase of cardiac contractility (positive inotropic effect). As a result, heart efficiency and ejection fraction are increased.(2) Peripheral resistance reduction (post-charge reduction). The lesser the resistance, the lesser the effort needed by the heart. The final effect is a reduction in oxygen consumption. (2) Coronary vasodilator (improves heart irrigation and oxygen supply). A well irrigated heart is better fit for exercise and stresses. (3) Increase of cardiac contraction efficiency. The contraction is quicker and more efficient, which allows for a longer rest period (refractory period). The heart has therefore a better endurance. (4) Slight reduction in hypertension. Incidentally, Hawthorn can also improve hypotension. Its final effect is a normalizing one on mild cases of either low or high blood pressure. (6) Cholesterol reduction. (7) The German Commission E acknowledges its benefits in cases of: decreasing cardiac output as described in functional Stage I and II (NYHA). See table 1. Table 1: Cardiac failure or cardiac insufficiency can be classified according to its symptoms and impact on the quality of life. The most used classification comes from the New York Heart Association. Stage I : No limitation in ordinary physical activity. No shortness of breath, undue fatigue or palpitation. Stage II : Slight limitation of physical activity. Patients are comfortable at rest. Ordinary physical activity results in fatigue, shortness of breath, palpitation or angina (chest pain). Stage III : Marked limitation of physical activity. Patients are comfortable at rest but slight activity leads to symptoms. Stage IV: Inability to carry on any physical activity without discomfort. Patients have congestive heart failure symptoms at rest and increased discomfort is experienced with any physical activity. Scientific studies Hawthorn has won acclaim in large-scale clinical studies on cardiac failure. In 1998, in a double blind placebo-controlled study, Dr NH Mashour and his collaborators showed that Hawthorn consumption leads to a sharp decrease in cardiac failure symptoms, stage II.(8) In a smaller study, 60 patients suffering from angina received 60 mg of Hawthorn 3 times daily. The researchers noted a significant improvement of coronary perfusion (quantity of blood flow) and a reduction of oxygen consumption, resulting in an increased effort capacity.(9) Precautions, contraindications and interactions Consult a healthcare practitioner prior to use if you are taking cardiovascular medications. For prolonged use, consult a healthcare practitioner. Not recommended during pregnancy or nursing. Avoid taking in case of known allergy to any of the ingredients in the product. Do not use if security cap is broken. Keep out of the reach of children. References 1-Upton R editor. Hawthorn Berry. American Herbal Pharmacopoeia June 1999. Santa Cruz CA USA. 2-Blesken R. Crataegus in der Kardiologie. Forstchr Med 1992; 110(15):290-2. 3-Roddweig C, Hensel H. Reaction of local myocardial blood flow in non-anesthetized dogs and anesthetized cats to oral and parentheral administration of a Crataegus fraction (oligomere procyanindines). Arznermittelforschung 1977;27:1407-10. 4-Schussler M, Hilzl J, Fricke U. Myocardial effects of flavonoids from Crataegus species. Arznermittelforschung 1995;45:842-5. 5-Abdul-Ghani AS. Hypotensive effect of Crataegus oxyacantha. Int J Crude Drug Res 1987;25:216-20. 6-Weiss RF. Lehrbuch der Phytotherapie 1990, p221-5. 7-Raqjerdan S, Deepalakshmi PD, Parasakthy K et al. Effect of tincture of Crataegus on the LDL receptors activity of plasma membranes of rats fed an atherogenic diet. Atherosclerosis 1996;123:235-41. 8-Mashour NH, Lin GI, Frishman WH. Herbal medicine for the treament of cardiovascular disease. Arch Intern Med 1998;158:2225-34. 9-Hanak T, Bruckel MH. Behhandlung con leichten stabilen fromen des Angina Pectoris mit Crataegutt novo. Therapiewoche 1983;33:4331-3. 10-Natural Medicines Comprehensive DataBase 2001. Pharmacist's Letter 3120 W. March Lane, PO Box 8190, Stockton, CA 95208. Tel: 1-209-472-2244 (Web site continually updated. www.naturaldatabase.com ) 11-Herbs: Everyday Reference Book for Health Professionals. Chandler F et al 2000. CPhA and CMA Ottawa, Ont, Can. 12-The Complete German Commission E Monographs, Therapeutic Guide to Herbal Medicines. Blumenthal M et al 1998. American Botanical Council, 6200 Manor Rd, Austin, Texas, 78723