Many of popular herbal supplements, including St. John's wort, gingko biloba, garlic and even grapefruit juice can pose serious risks to people who are taking medications for heart disease, according to a review article published in the Journal of the American College of Cardiology. The use of these products is especially concerning among elderly patients who typically have co-morbidities, take multiple medications and are already at greater risk of bleeding.

In addition to their direct effects on body function, these herbs can interact with medications used to treat heart disease, either reducing their effectiveness or increasing their potency, which may lead to bleeding or a greater risk for serious cardiac arrhythmias.

According to the report, a major concern is that patients do not readily disclose their use of herbal remedies, and healthcare providers may not routinely ask about such use. In addition, because these herbs are regarded as food products, they are not subject to the same scrutiny and regulation as traditional medications.

Two nationwide surveys conducted in 1990 and 1997 found that the number of visits to complementary and alternative providers increased from 427 million to 629 million, whereas the number of visits to primary care physicians remained basically unchanged.

Some examples of herbs and their adverse effect on heart disease management include:

• St. John's wort, which is typically used to treat depression, anxiety and sleep disorders among other problems, reduces the effectiveness of medications contributing to recurrences of arrhythmia, high blood pressure or increase in blood cholesterol levels and risk for future heart problems;

• Ginkgo biloba, which is supposedly used to improve circulation or sharpen the mind, increases bleeding risk in those taking Warfarin ( Coumadin ) or Acetylsalicylic acid ( Aspirin );

• Garlic, which supposedly helps boost the immune system and is commonly used for its cholesterol and blood pressure lowering properties, can also increase the risk of bleeding among those taking Warfarin.

Source: American College of Cardiology, 2010

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