Plants considered useful for hypoglycemic, antihypertensive or hypolipidemic treatments by patients with peripheral vascular diseases
Plantas consideradas útiles como hipoglicemiantes, antihipertensivas o hipolipemiantes por pacientes con enfermedades vasculares periféricas
MSc. Gertrudis García-Lazo,I MSc. Ela Lauzant-Diaz,I DrC. Arquímedes Díaz Batista,I DraC. Milagros Garcia-MesaII
I National Institute of Angiology and Vascular Surgery. Cerro, La Habana, Cuba.
II Central Laboratory of Pharmacology. Cerro, La Habana, Cuba.
ABSTRACT
Introduction: knowing patients ‘believes about the medicinal utility of plants may provide a basis for educating them for a rational use of herb preparations.
Objective: to characterize the plants that are considered useful for antidiabetic, antihypertensive or hypolipidemic treatment among patients with peripheral vascular diseases.
Methods: a survey was performed among patients of the National Institute of Angiology and Vascular Surgery from February through April 2007. The characteristics of the use of plants as medicinal remedies and the names of species considered useful for the treatment of diabetes, arterial hypertension and dyslipidemia were recorded.
Results: two hundred and forty five both sex adult volunteers (142 female/103 male), aged 44 to 72 years) were included in the study. More than 80 % of them used medicinal plants at least occasionally and confided on their efficacy to treat different illnesses Fifteen species, mainly Allium sativum L., Citrus aurantifolia Ch., Justicia pectoralis Jacq.., Morinda citrifolia L., Ocinum sanctum L and Salvia officinalis L, from 11 botanical families, were mentioned by participants. Most patients’ claims about plants´ properties have been scientifically supported in some extent, nevertheless, the majority of the pharmacological evidence relays on pre-clinical studies and results of clinical trials are not conclusive. The lack of standardized plant preparations with identified active principles and demonstrated clinical effectiveness are limitations for recommending their therapeutic use.
Conclusion: this study has provided the first characterization of the use of plant products by patients with peripheral vascular diseases for medicinal purposes and confirmed that physicians should be aware about the possibility of herb-drug interactions that should be diagnosed. This information would aid the scientifically supported integration of Phytotherapy to the clinical practice.
Key words: medicinal plant, herb medicine, Diabetes mellitus, arterial hypertension, dyslipidemia, glucose, cholesterol, atherosclerosis, atherothrombosis.
RESUMEN
]]> Introducción: el conocimiento tradicional de los pacientes sobre la utilidad de las plantas medicinales puede servir de base para su educación en el uso racional de las preparaciones herbarias.Palabras clave: planta medicinal, medicina herbaria, Diabetes mellitus, hipertensión arterial, dislipidemia, glucosa, colesterol, aterosclerosis, aterotrombosis.
INTRODUCTION
Atherosclerosis is a silent and chronic inflammatory process at the artery wall that reduces the arterial lumen, the blood flow inside it and the oxygen supply to the affected organs. Secondary to atherosclerotic plaque disruption a procoagulant state may arise leading to the occurrence of acute arterial thrombosis (atherothrombosis). The clinical consequences of these events (myocardial infarction, stroke or lower limb occlusive disease) are responsible for high number of deaths and disabilities worldwide. The progression of the atherosclerotic plaque and occurrence of its clinical manifestations are directly related to the oxidation of lipids in low dense lipoproteins (LDLs) that become trapped in the extracellular matrix of the subendotelial space.1
]]> Diabetes mellitus, arterial hypertension and dyslipidemia are risk factors for atherothrombosis and different drugs are used for their pharmacological control,2-4 However, the need for effective, safe and low-cost therapeutic options that contribute to the quality of life of the growing number of subjects who suffer from these diseases is still a problem and people has empirically looked for herb remedies to relieve their clinical symptoms.4-7 However, it has been suggested that physicians should be alert about the possibility of adverse effects due to concomitant intake of conventional drugs and herb remedies and ask their patients about the use of these products.8Since patients with peripheral vascular diseases, mainly those with arterial diseases9 are likely to suffer from Diabetes mellitus, arterial hypertension and dyslipidemia, knowing their believes about the medicinal utility of plants may provide a basis for educating them for a rational use of herb preparations. In consequence, this work was aimed to characterize the plants that are considered useful for antidiabetic, antihypertensive or hypolipidemic treatment among this group of patients.
METHODS
Adult patients with peripheral vascular diseases admitted to the medical care units of the National Institute of Angiology and Vascular Surgery were included in a survey aimed to determine the medicinal plants that they considered useful for the treatment of diabetes, arterial hypertension and hypercholesterolemia.
Sample size calculation
Ten percent of the average number of patients who attended each single unit in a three-month period was considered an appropriate sample of institutional attendees for the stated purpose. These figures were: 100; 65 and 80 for Diabetic Angiopathy, Arteriology and Phlebo-Lymphology units, respectively. Thus, 245 was the whole number of patients to be included in the study.
Patient inclusion strategy
Ethics
This study was done according to a research protocol previously approved by the Ethics Committee and the Scientific Council of the National Institute of Angiology and Vascular Surgery.
The objective and the characteristics of the investigation were explained to the patients and their informed consent obtained before their inclusion in the study.
Quality assurance of the study
A group of nurses of the three medical care units were trained to perform the survey and informed on topics regarding medicinal plants nomination. Protocol adherence and the quality of the information recorded in a data base were systematically double-checked by two researchers.
]]> Statistical analysis
The data are expressed as absolutes values and percentages.
RESULTS
Included patients demographic characteristics
The research protocol was accomplished according to the plan. Two hundred and forty five both sex adult volunteers, were included in the study. The majority of them had a secondary or higher level of education and was socially active persons that lived in Havana or in the two nearest provinces to it (table 1).
Use of medicinal plants by patients with peripheral vascular diseases
More than 80 % of participants used medicinal plants at least occasionally and confide on their efficacy to treat different illnesses either as domestic remedies or pharmaceutical herb preparations (table 2).
]]>
Plants considered useful for the treatment of Diabetes mellitus (DM), arterial hypertension (HT) or high blood lipids (DL) by patients with peripheral vascular diseases
The number of reports recorded regarding plants considered useful to treat diabetes, hypertension and hypercholesterolemia were 120; 155 and 215 respectively. Fifteen plant species from 11 botanical families were mentioned by the participants in the study. Ocimum tenuiflorum L., Morinda citrifolia L. and Allium sativum L. were the most reported plants among those with attributed hypoglycemic effect. Allium sativum L., Justicia pectoralis Jacq. and Citrus aurantifolia Ch., were the most mentioned within the group of plants considered good for blood pressure lowering, while Morinda citrifolia L., Salvia officinalis L. and Allium sativum L . had the highest number of reports among plants appreciated as blood cholesterol reducers (table 3).
DISCUSSION
This work has provided the first characterization of the use of plant products by patients with peripheral vascular diseases for medicinal purposes and has demonstrated the usefulness of this kind of studies.
Most patients claims about the beneficial properties of plants have been scientifically supported. Nevertheless, the majority of the pharmacological evidence available relays on pre-clinical studies and the results of the clinical trials performed are not conclusive.10-12 In addition, some information gaps and contradictory facts, like those described below, are limitations to assure that some of them would be clinically effective in humans.
For instance, it has been reported the use of Solanum melongena L. fruit aqueous macerates as natural remedies for hypercholesterolemia in Cuba,13 however, as far as we know, there is no scientific evidence that support this practice. Besides, the results of the evaluation of other types of preparations from this species are variable. Thus, oral administration of fresh, ripe fruits to rabbits under atherogenic diet significantly reduced serum concentrations of total cholesterol, triglyceride, LDL-cholesterol, increased HDL-C and HDL/LDL- C ratio and decreased hepatic lesions.14 However, ad libitum intake of S. melongena fruit aqueous extract provoked serum cholesterol increase and hepatic cholesterol decrease in rats under hypercholesterolemic diet without influence on circulating and tissue triglyceride levels.15 Furthermore, serum total cholesterol and atherogenic lipoproteins, as well as aortic lesion area were unaffected, while oxidative stress markers were elevated in LDLR (-/-) mice fed atherogenic diet treated with a fruit extract.16 Moreover, a double-blind placebo-controlled study with hypercholesterolemic human volunteers demonstrated significant reduction of blood levels of total and LDL-cholesterol and of apolipoprotein B after daily intake of a dried powder fruit infusion, however these changes were similar to those achieved when patients accomplished dietary changes and exercise activities.17 Besides, oral intake of dried powdered fruits failed to decrease serum total cholesterol, LDL- cholesterol and LDL/HDL during another double-blind placebo-controlled study with hyperlipidemic volunteers.18 Therefore, the possible hypolipidemic effects of S. melongena fruit aqueous macerates should be assessed.
Plantago major L. is another example, since a single oral dose of P. major leaf crude aqueous extract was unable to prevent hyperglycemia in rats during the glucose tolerance test 19. However, lower blood cholesterol levels and atherosclerotic lesions in aorta were demonstrated in rabbits treated with a leaf extract given concomitantly with a hypercholesterolemic diet.20 Thus, suggesting a hypolipidemic but not a hypoglycemic potential of products derived from this species.
]]> Finally, patients´ believes with respect to the utility of Citrus aurantifolia Ch. and Justicia pectoralis Jacq. for hypertension control agrees with Ethnomedical reports21,22 but scientific evidence is missing.This study has led to the identification of botanical species that could be candidates for the development of plant preparations useful as complementary therapies for Diabetes mellitus, arterial hypertension and dyslipidemia. Pharmaceutical products from three of these species (Allium sativum L., Justicia pectoralis Jacq. and Orthosiphon aristatus Blume) are included in Cuban Ministry of Health’s Formulary of Phyto pharmaceutical products from23-25 and their hypoglycemic, anti-hypertensive and/or hypolipidemic efficacy should be demonstrated during clinical studies with patients who would benefit from these treatments.
Similar preparations should be developed from the other species mentioned by the interviewees that have been accepted for their medicinal use in Cuba26 (Citrus aurantifolia Ch., Cymbopogon citratus (DC.) Stapf, Morinda citrifolia L., Ocimum enuiflorum L., Plantago major L. and Salvia officinalis L.) and pharmacologically assessed in pre/clinical and clinical conditions. Nevertheless,Allophylus comini (L.) Sw., Artocarpus altilis (Parkinson) Forberg, Citrus paradisi L. Persea americana Mill. andSolanum melongena L., should not be excluded from a research plan, since, they are used in Cuba as medicinal and /or edible plants.13,22,27,26,29
The scientific evidence available suggests that some herb remedies that patients with peripheral vascular diseases consider therapeutically useful could, in fact, be pharmacologically active. Thus, pharmacological interactions between these products and conventional drugs may be expected. Therefore, physicians should be aware about this possibility that should be diagnosed. This information would aid the scientifically supported integration of Phytotherapy to the clinical practice.
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Recibido: 16 de junio de 2014.
Aprobado: 16 de enero de 2015.
]]> DraC. Milagros Garcia-Mesa. Central Laboratory of Pharmacology, 156 Carvajal ST, Postal code 12000. Cerro, Habana, Cuba.
