Hawthorn
CLINICAL STUDIES ON THE FOLLOWING INGREDIENTS:
Hawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) Trial
Abstract
Aims: Hawthorn's efficacy when added to contemporary evidence-based heart failure therapy is unknown. We aimed to determine whether hawthorn increases submaximal exercise capacity when added to standard medical therapy.
Methods and results: We performed a randomized, double-blind, placebo-controlled trial in 120 ambulatory patients aged ≥18 years with New York Heart Association (NYHA) class II-III chronic heart failure. All patients received conventional medical therapy, as tolerated, and were randomized to either hawthorn 450 mg twice daily or placebo for 6 months. The primary outcome was change in 6 min walk distance at 6 months. Secondary outcomes included quality of life (QOL) measures, peak oxygen consumption, and anaerobic threshold during maximal treadmill exercise testing, NYHA classification, left ventricular ejection fraction (LVEF), neurohormones, and measures of oxidative stress and inflammation. There were no significant differences between groups in the change in 6 min walk distance (P = 0.61), or on measures of QOL, functional capacity, neurohormones, oxidative stress, or inflammation. A modest difference in LVEF favoured hawthorn (P = 0.04). There were significantly more adverse events reported in the hawthorn group (P = 0.02), although most were non-cardiac.
Conclusion: Hawthorn provides no symptomatic or functional benefit when given with standard medical therapy to patients with heart failure. This trial is registered in ClinicalTrials.gov ID: NCT00343902.
Keywords: Hawthorn, Crataegus, Heart failure, Systolic
Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC2754502/
Real world effectiveness of Hawthorn special extract WS 1442 in a retrospective cohort study from Germany
Abstract
Hawthorn special extract WS 1442 has beneficial effects on the cardiovascular system. Experimental studies have shown an antiarrhythmic effect of the substance. In the present study, we investigated antiarrhythmic effects of WS 1442 compared with magnesium/potassium in a large collective of outpatients. Using the IQVIA Disease Analyzer (DA) database, we included 4550 patients with a prescription of WS 1442 and 4550 matched patients with Tromcardin prescriptions (all registered products under the trademark Tromcardin that are magnesium and potassium supplementing foods for special medical purposes) who were followed for 5 years after the index date. The incidence of various cardiac arrhythmias (atrial fibrillation and flutter (AFF), tachycardia, and other cardiac arrhythmias) was recorded. Cox regression models were used to evaluate the potential association between both drugs and arrhythmias. The cumulative incidence of atrial fibrillation and flutter was significantly lower among patients with a prescription of WS 1442 compared to patients with magnesium/potassium prescriptions (10.8% vs. 16.4%, p < 0.001). WS 1442 prescription was significantly associated with a lower incidence of atrial fibrillation and flutter compared to magnesium/potassium (HR 0.71; 95% CI 0.64–0.80; p < 0.001). The cumulative incidence of tachycardia was significantly lower in the WS 1442 group compared to the magnesium/potassium group (8.3% vs. 9.4%, p < 0.001), similarly, the cumulative incidence of other cardiac arrhythmias was significantly lower among patients with WS 1442 compared to patients with magnesium/potassium (10.2% vs. 14.8%, p < 0.001). This study showed that in a large collective of outpatients, intake of hawthorn special extract WS 1442 was associated with a significantly lower incidence of atrial fibrillation, tachycardia, and other cardiac arrhythmias compared to magnesium/potassium, indicating its potential in treating and preventing such conditions.
Source: https://www.nature.com/articles/s41598-024-74325-4
Evidence of the effectiveness of hawthorn extract
The meta-analysis by Pittler et al (1) of eight randomized, controlled, double-blind studies of the effectiveness of hawthorn extract in chronic heart failure included appreciable clinical heterogeneity. That this was not detectable as statistically significant heterogeneity may well reflect the small number of studies included. Most patients received the 45% ethanolic extract WS 1442 standardized on 18.8% oligomeric procyanidins, but some received a 70% methanolic extract standardized on 2.2% flavonoids. The drug extract ratio of both extracts is 4 to 7:1; however, the content of oligomeric procyanidins in extract WS 1442 (≥169 mg in the confirmatory study) was consistent with the upper daily dose range recommended by the German Commission E monograph (30 to 169 mg), whereas the content of flavonoids in the LI 132 extract (6.6 mg in the exploratory study) was at the lower daily dose range (3.5 to 20 mg) (2). Oligomeric procyanidins as well as flavonoids are coactive constituents of “the active principle” of hawthorn extract (3), which is the sum of the effects of and interactions between several coactive constituents. So the overall effects of these extracts are not the same, and differences in clinical effects need to be evaluated.
The monograph dose recommendation was chosen empirically, without systematic evaluation of dose responses. Two of the more transparent clinical studies provide some information on the dosing of hawthorn extract WS 1442. One showed that 240 mg extract per day for 12 weeks was not a sufficiently high dose to show a substantial benefit over placebo in terms of increased exercise tolerance in New York Heart Association (NYHA) class II patients (4). The other showed that, in NYHA class III patients, 1800 mg extract per day for 24 weeks significantly improved the primary outcome measure (a formally tested workload) over placebo, whereas the effect of half that dose did not, although there were some effects on subsidiary measures (5). It is tempting to speculate that the 900-mg dose might have produced detectable improvement in less severely sick NYHA class II patients. The virtual absence of appreciable side effects with the 1800-mg dose is also noteworthy.
The protocol for an ongoing study has been published (6) in which 900 mg per day of WS 1442 is being tested against placebo in 2600 NYHA class II and III patients in addition to standard therapy for heart failure (i.e., diuretics, glycosides, angiotensin-converting enzyme inhibitors). The primary outcome variable was defined as a combined endpoint of cardiac death, nonlethal myocardial infarction, and hospitalization because of progression of heart failure. The secondary outcome variables included total mortality, exercise duration, echocardiographic parameters, quality of life, and aspects of cost-effectiveness. If this study shows promise, it will open the way for studies of whether additional benefit can be achieved without unacceptable side effects by using higher doses; whether the optimum dose depends on the state of the patient as described, for example, by the NYHA classification; or whether the optimum dose needs to be determined empirically for individual patients irrespective of NYHA class, by graded increases until a ceiling effect or an unacceptable side effect is reached.
Source: https://www.amjmed.com/article/S0002-9343(03)00480-7/fulltext
Hawthorn (Crataegus spp.) in the treatment of cardiovascular disease
Abstract
The medicinal properties of hawthorn (Crataegus spp., a genus comprising approximately 300 species) have been utilized by many cultures for a variety of therapeutic purposes for many centuries. In the Western world cardiovascular disease (CVD) has become one of the single most significant causes of premature death. Echoing this situation, more recent research into the therapeutic benefits of hawthorn preparations has focused primarily upon its cardiovascular effects. This review covers research into the various mechanisms of action proposed for Crataegus preparations, clinical trials involving Crataegus preparations, and the herb's safety profile.
Clinical trials reviewed have been inconsistent in terms of criteria used (sample size, preparation, dosage, etc) but have been largely consistent with regard to positive outcomes. An investigation into data available to date regarding hawthorn preparations and herb/drug interactions reveals that theoretical adverse interactions have not been experienced in practice. Further, adverse reactions relating to the use of hawthorn preparations are infrequent and mild, even at higher dosage ranges. A recent retrospective study by Zick et al. has suggested a negative outcome for the long-term use of hawthorn in the prognosis of heart failure. These findings are examined in this paper.
Although further research is needed in certain areas, current research to date suggests that hawthorn may potentially represent a safe, effective, nontoxic agent in the treatment of CVD and ischemic heart disease (IHD).
Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC3249900/
The effect of hawthorn (Crataegus spp.) on blood pressure: A systematic review
Abstract
Background: Hawthorn (Crataegus spp.) is a herbal medicine used for the treatment of cardiovascular disease, particularly congestive heart failure. Hawthorn is also indicated for the management of hypertension.
Objectives: To evaluate the clinical efficacy, dosage forms, and side effects of hawthorn mono-preparations versus placebo for their effects on blood pressure (BP).
Methods: Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review to identify randomised controlled trials (RCTs) that assessed the effect of hawthorn mono-preparations on BP. The databases AMED (Ebsco), CINAHL, EMBASE (Ovid), and PubMed, and The Cochrane Central Register of Controlled Trials, and grey literature were searched to September 2016. There was no restriction regarding language or date of publication. Data on patients, interventions, methods, outcome measures, results and adverse events were extracted and assessed. The risk of bias (RoB) was assessed using the Cochrane RoB tool. Any queries in study evaluation were resolved through discussion between the authors.
Results: The search identified 370 citations. Four trials (254 participants) met the inclusion criteria. Studies administered hawthorn as tablets or liquid drops and reported a reduced BP in patients with pre-hypertension or stage 1 hypertension. No serious adverse side effects were reported. Pooled analysis of the results was not possible because of the heterogeneity of study design, participants and interventions. Significantly reduced BP was shown in three trials of 12- and 16-week duration (P < 0.05).
Conclusion: This systematic review found that hawthorn can significantly lower BP in people with mild hypertension if applied for at least 12 weeks. Further trials are suggested to confirm the longer-term, hypotensive effects of hawthorn preparations.
Source: https://www.sciencedirect.com/science/article/abs/pii/S2212958817301106
Effect of hawthorn standardized extract on flow mediated dilation in prehypertensive and mildly hypertensive adults: a randomized, controlled cross-over trial
Abstract
Background: Hawthorn extract has been used for cardiovascular diseases for centuries. Recent trials have demonstrated its efficacy for the treatment of heart failure, and the results of several small trials suggest it may lower blood pressure. However, there is little published evidence to guide its dosing. The blood pressure lowering effect of hawthorn has been linked to nitric oxide-mediated vasodilation. The aim of this study was to investigate the relationship between hawthorn extract dose and brachial artery flow mediated dilation (FMD), an indirect measure of nitric oxide release.
Methods: We used a four-period cross-over design to evaluate brachial artery FMD in response to placebo or hawthorn extract (standardized to 50 mg oligomeric procyanidin per 250 mg extract). Randomly sequenced doses of hawthorn extract (1000 mg, 1500 mg, and 2500 mg) and placebo were assigned to each participant. Doses were taken twice daily for 3 1/2 days followed by FMD and a 4-day washout before proceeding to the next dosing period.
Results: Twenty-one prehypertensive or mildly hypertensive adults completed the study. There was no evidence of a dose-response effect for our main outcome (FMD percent) or any of our secondary outcomes (absolute change in brachial artery diameter and blood pressure). Most participants indicated that if given evidence that hawthorn could lower their blood pressure, they would be likely to use it either in conjunction with or instead of lifestyle modification or anti-hypertensive medications.
Conclusion: We found no evidence of a dose-response effect of hawthorn extract on FMD. If hawthorn has a blood pressure lowering effect, it is likely to be mediated via an NO-independent mechanism.
Source: https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/1472-6882-12-26
Roles and Mechanisms of Hawthorn and Its Extracts on Atherosclerosis: A Review
Cardiovascular disease (CVD), especially atherosclerosis, is a leading cause of morbidity and mortality globally; it causes a considerable burden on families and caregivers and results in significant financial costs being incurred. Hawthorn has an extensive history of medical use in many countries. In China, the use of hawthorn for the treatment of CVD dates to 659 AD. In addition, according to the theory of traditional Chinese medicine, it acts on tonifying the spleen to promote digestion and activate blood circulation to dissipate blood stasis. This review revealed that the hawthorn extracts possess serum lipid-lowering, anti-oxidative, and cardiovascular protective properties, thus gaining popularity, especially for its anti-atherosclerotic effects. We summarize the four principal mechanisms, including blood lipid-lowering, anti-oxidative, anti-inflammatory, and vascular endothelial protection, thus providing a theoretical basis for further utilization of hawthorn.
Introduction: Cardiovascular disease (CVD), especially atherosclerosis, is a leading cause of morbidity and mortality worldwide. CVD imposes a considerable burden on families and primary caregivers, along with a high financial cost to society. During past decades in China, ischemic heart disease and stroke are the top two causes of death (Yang et al., 2013). With a rapidly aging population, the absolute number of deaths due to CVD increased by 46% in China, a figure four and three times higher than those in the United States and Western Europe, respectively (Du et al., 2019). Beyond conventional medical treatment, herbal plants have several natural compounds for the prevention and treatment of various diseases. Herbal medicine, such as adjuvants, has also been popular worldwide. It is estimated by the World Health Organization that in the developing countries, nearly four billion people consume herbal medications as a primary source of healthcare (Bodeker and Ong, 2005). Therefore, the use of herbal remedies in complementary and alternative medicines has been widely embraced in many countries (Ekor, 2014).
Crataegus sp., commonly known as hawthorn, or hawberry, is a large genus of thorny shrubs and trees belonging to the family Rosaceae, comprising approximately 280 species, native to zones with a mild climate in Europe, East Asia, and North America (Hobbs and Foster, 1994). Hawthorn has been used for centuries worldwide as both food and folk medicine. Hawthorn is one of the recognized medicinal plants in European medicine, as Dioscorides primarily described its cardiovascular actions in the first century (Petrovska, 2012). Currently, countries such as China, Germany, and France have officially recorded some species in their pharmacopeias (Chang et al., 2002).
In China, the bright red berries of hawthorn, also called Shanzha (Figure 1), have been extensively used to treat various ailments given their medicinal properties. It was mentioned first for “treating dysentery” in Tang Materia Medica (Tang Ben Cao) dating back to 659 AD, the first known official pharmacopeia in the world. As described in the Compendium of Materia Medica (Bencao Gangmu), which is regarded as the most complete and comprehensive herbal monograph, the dried berry of Crataegus pinnatifida was described with healing efficacy for thoracalgia, hernia, indigestion, blood stagnation, and hematochezia (Liu et al., 2011). Currently, considerable efforts are underway to identify bioactive components from different parts of the plants and to unveil potential mechanisms of their pharmaceutical actions.
Source: https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2020.00118/
Biological properties and potential application of hawthorn and its major functional components: A review
Highlights
- Hawthorn is a good source of health food and medicine.
- Functional characteristics of hawthorn are summarized.
- Phenols and flavonoids are major bioactive substances in hawthorn.
- Hawthorn pectin oligosaccharides are helpful to improve lipid metabolism.
- Polysaccharides of hawthorn can act as prebiotics.
Abstract
Hawthorn (Crataegus) widely distribute in the world, and is known as an excellent fruit resource commonly planted in China. It has been used for food and medicine for thousands of years in China. This paper surmised the up-to-date literatures on the functional properties of flavonoids, phenols, terpenoids and polysaccharides of hawthorn. Meanwhile, the application prospects of hawthorn in functional foods are also prospected. These will be helpful for the developments of functional foods or deep-processing technologies of hawthorn.
Source: https://www.sciencedirect.com/science/article/pii/S1756464622000585
Food Applications and Potential Health Benefits of Hawthorn
Abstract and Figures
Hawthorn (Crataegus) is a plant of the Rosaceae family and is widely grown throughout the world as one of the medicinal and edible plants, known as the “nutritious fruit” due to its richness in bioactive substances. Preparations derived from it are used in the formulation of dietary supplements, functional foods, and pharmaceutical products. Rich in amino acids, minerals, pectin, vitamin C, chlorogenic acid, epicatechol, and choline, hawthorn has a high therapeutic and health value. Many studies have shown that hawthorn has antioxidant, anti-inflammatory, anticancer, anti-cardiovascular disease, and digestive enhancing properties. This is related to its bioactive components such as polyphenols (chlorogenic acid, proanthocyanidin B2, epicatechin), flavonoids (proanthocyanidins, mucoxanthin, quercetin, rutin), and pentacyclic triterpenoids (ursolic acid, hawthornic acid, oleanolic acid), which are also its main chemical constituents. This paper briefly reviews the chemical composition, nutritional value, food applications, and the important biological and pharmacological activities of hawthorn. This will contribute to the development of functional foods or nutraceuticals from hawthorn.
Phytochemical composition and bioactivities of hawthorn (Crataegus spp.): review of recent research advances
Abstract
Hawthorn (Crataegus spp.) is one of the most famous plants which has been used as natural medicine and nutraceutical. Its phytochemical composition, bioactive compounds and health benefits have been intensively studied and hawthorn preparations may be recognized as classical natural products for cardiovascular health. Polyphenolic compounds of different hawthorn anatomical parts as well as their extracts have been the focus of a majority of these studies, although various other classes of natural health promoting constituents have also been isolated, identified and characterized. Regardless, numerous published reports have particularly focused on the activity mechanisms which are very important for supporting various health benefits. This review summarizes the most recent studies on hawthorn, mainly published since 2015. Search of different databases indicates that approximately 200 publications, which are relevant to phytochemistry and health benefits of Crataegus spp., have appeared since then, most of them have not been included in the existing reviews.
Source: https://www.sciopen.com/article/10.31665/JFB.2018.4163
References:
- https://pmc.ncbi.nlm.nih.gov/articles/PMC2754502/
- https://www.nature.com/articles/s41598-024-74325-4
- https://www.amjmed.com/article/S0002-9343(03)00480-7/fulltext
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3249900/
- https://www.sciencedirect.com/science/article/abs/pii/S2212958817301106
- https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/1472-6882-12-26
- https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2020.00118/
- https://www.sciencedirect.com/science/article/pii/S1756464622000585
- https://www.researchgate.net/publication/363589728_Food_Applications_and_Potential_Health_Benefits_of_Hawthorn
- https://www.sciopen.com/article/10.31665/JFB.2018.4163