Herbs have been used as medical treatments since the beginning of civilization and some derivatives (eg, aspirin, reserpine, and digitalis) have become mainstays of human pharmacotherapy. For cardiovascular diseases, herbal treatments have been used in patients with congestive heart failure, systolic hypertension, angina pectoris, atherosclerosis, cerebral insufficiency, venous insufficiency, and arrhythmia. However, many herbal remedies used today have not undergone careful scientific assessment, and some have the potential to cause serious toxic effects and major drug-to-drug interactions. With the high prevalence of herbal use in the United States today, clinicians must inquire about such health practices for cardiac disease and be informed about the potential for benefit and harm. Continuing research is necessary to elucidate the pharmacological activities of the many herbal remedies now being used to treat cardiovascular diseases.
Since the beginning of human civilization, herbs have been an integral part of society, valued for both their culinary and medicinal properties. Herbal medicine has made many contributions to commercial drug preparations manufactured today including ephedrine from Ephedra sinica (ma-huang), digitoxin from Digitalis purpurea (foxglove), salicin (the source of aspirin) from Salix alba (willow bark), and reserpine from Rauwolfia serpentina (snakeroot), to name just a few. A naturally occurring β-adrenergic blocking agent with partial agonism has been identified in an herbal remedy.1 The recent discovery of the antineoplastic drug paclitaxel from Taxus brevifolia (pacific yew tree) stresses the role of plants as a continuing resource for modern medicine.
However, with the development of patent medicines in the early part of the 20th century, herbal medicine has been losing ground to new synthetic medicines touted by scientists and physicians to be more effective and reliable. Nevertheless, about 3% of English-speaking adults in the United States still report having used herbal remedies in the preceding year.2 This figure is probably much higher for non–English-speaking Americans. Despite this heavy use of herbal medicines in the United States, health practitioners often fail to ask about their use when taking clinical histories. It is imperative that physicians become more aware of the wide array of herbal medicines available, as well as learning more about their beneficial and adverse effects.3
Part of the problem for both consumers and physicians has been the paucity of scientific data on herbal medicines used in the United States.4 As a result, those who wish to obtain factual information regarding the therapeutic use or potential harm of herbal remedies would have to obtain it from books and pamphlets, most of which base their information on traditional reputation rather than relying on existing scientific research. One may wonder why the herbal industry never chose to simply prove its products safe and effective. The answer is primarily economical. With the slim chance of patent protection for the many herbs that have been in use for centuries, pharmaceutical companies have not provided financial support for research on the merits of herbal medicine.5 At the same time, the National Institutes of Health have only been able to offer limited funding for this purpose.
