Herbal Medicine: Back to the Future

Cardiovascular diseases (CVD) represent one of the most important causes of death all over the world. Consequently, many efforts are invested in their treatment and in the development of drugs that can be useful against these ailments. Plants and plant-derived drugs and functional foods are very important in this respect. On the one hand, molecules obtained from different species of the genus Digitalis (particularly D. lanata and D. purpurea), such as digitalin, digoxin and digoxigenin, are among the most relevant cardiotonic drugs and still come from their natural sources, since their synthesis would be complicated and expensive. On the other hand, many plants are used to cure, palliate or prevent heart, blood vessel and related illnesses at a popular level. As in many other fields of health, folk knowledge has led to both drug development in pharmaceutical industry and herbalist preparation production. Additionally, the direct plant management and use continues to be active at the popular level for this as well as for many other wellness-related purposes. Ethnobotanical research, which inventories the folk plant use in all domains, has been important since old times and has increased its focus on industrialised areas in the recent decades, where it continues to be practised currently. In this chapter we review the state-of-art of herbal medicines that are claimed to be useful for CVD in the Iberian Peninsula and the Balearic Islands. This territory (comprising three states, Andorra, Portugal and Spain, and a small area belonging to the United Kingdom) comprises one of the areas of highest plant biodiversity in Europe and an important linguistic and cultural diversity (Basque, Catalan, Galician, Portuguese, Spanish, and English in Gibraltar), this pointing to a very rich ethnobotanical knowledge. These territories being located in an industrial and economically developed area, certain ailments such as hypertension and hypercholesterolemia are frequent. In addition, functional foods play an important role in the Mediterranean diet, the one typical of the area, and, consequently, in the primary prevention of CVD. We record a total amount of 5,249 use reports of 784 taxa used against CVD. We analyse the existing ethnobotanical data linked to the cardiovascular system in the area considered, from our own results and from other relevant and representative sources. This review depicts a panorama of the folk use of herbal products to address the quoted ailments, and provides a basis for further (phytochemical, pharmacological and other) research, which could help in the development of medicinal products.

Hypertension is one of the most common diseases in the current health scenario as per the report of World Health Organization. It is a chronic medical condition in which the blood pressure remains elevated and thus leads to a plethora of pathological conditions including renal, pulmonary and cardiovascular disorders. The root cause of this disease lies in the changing lifestyle that includes food habits and stress. A number of conventional drugs are available for hypertension and its comorbidities viz. thiazide-diuretics, angiotensin converting enzyme inhibitors and calcium channel blockers. Use of these drugs is limited by side effects like hypokalaemia, precipitation of diabetes, hyperuricaemia, diarrhoea, rash, abdominal pain, chest pain, dizziness, impotence, bleeding, etc. In last few decades, researchers have focused on drug discovery from herbal medicines. Moreover, we have a long history of usage of herbal drugs for the clinical management of hypertension. The pharmacological activity of these drugs is mainly attributed to phytoconstituents such as flavonoids, phenols and alkaloids, which synergistically act against hypertensive disease and significantly diminish the co-morbidities of this disease. In this chapter, we discuss about the anti-hypertensive activity of plants selected among the most reported in literature, with a focus on their possible mode of action.

Obesity causes serious chronic diseases and affects quality of life of all age groups. It is associated with vascular and metabolic alterations and chronic inflammation leading to the development of the metabolic syndrome. Adipose tissue expansion occurs mainly through hypertrophy (increasing the volume of preexisting adipocytes) and/or hyperplasia (generating new small adipocytes). Adipocytes produce adipocytokines or adipokine, which modulate adipocyte growth and metabolism through a combined action of endocrine, paracrine, and autocrine mediators. These mediators are increasingly secreted during the progression of obesity and are closely associated with the development of obesity-related diseases.

Weight loss and increased physical activity were reported by numerous scientific papers to prevent/treat obesity and related chronic heart disease. Herbs, diet and their extracts/constituents exert their weight reducing effects through six principal pathways: Inhibiting pancreatic lipase activity, controlling appetite, preventing adipogenesis, and stimulating lipolysis, thermogenesis and lipid metabolism. The cardiovascular beneficial effects of the traditional Mediterranean diet are well documented in numerous animal as well as in clinical studies. This dietary pattern distinguished by relatively high amounts olive oil, vegetables, nuts, fruits, grains, a moderate intake of fish, and a low intake of red meat or processed meats. This diet prevents the development/progression of heart disease, hypertension, diabetes, obesity, breast cancer, colorectal cancer, and erectile dysfunction. This chapter will highlight the role of diets and medicinal plants in prevention and treatment of obesity and its related cardiovascular diseases.

Cardiovascular disorders (CVD) like ischemic heart disease, hypertension, dysrhythmia and cerebrovascular complications account for maximum mortality in developed and developing world. According to World Bank health review, estimated deaths in all age groups due to CVD may mount up to 33% by 2015. In addition, ever increasing healthcare costs to the society are also becoming a huge social liability. Especially, ischemic heart diseases (IHD) are leading cause of mortalities and morbidities encountered by almost all CVD patients around the world. Till now there are a few approved therapeutic agents, one of them is tissue plasminogen activator (tPA), for the treatment of ischemic disorders. Moreover, use of thrombolytic agents and surgical interventions involve high interventional costs both economically and physiologically. Prevention of IHD can significantly add on to the quality of life of the vulnerable section of population than its therapeutic management. It has been established that injury and ensuing necrosis to cardiomyocytes can result from sudden reperfusion of the ischemic core which is pathognomonic of myocardial ischemic reperfusion injury. The underlying mechanisms viz. exacerbated generation of reactive oxygen species (ROS), inflammatory reactivity and uncontrollable necrosis are responsible for massive cellular injury during IHD. An ideal treatment should address most of these mechanisms without disturbing other vital physiological systems. Traditional herbal therapy has been shown to provide almost all of these benefits. The clinical evaluation of active constituents of many ayurvedic medicines like Terminalia arjuna greatly reinforces these centuries’ old beliefs. However, the increasing concomitant use of herbal therapeutic agents with modern medicines by patients with CVD poses a grave clinical challenge to physicians. In addition to this, less than 50% of the patients inform the use of alternative medicines to their physicians. Even if patients report it, many times physicians himself is unaware of the knowledge about the activity and the toxicity potentials of active constituents. Hence, a physician sometimes finds himself grossly unequipped to handle possible alterations in the actions of modern medicines used for the treatment of CVDs.

To highlight the advances in traditional herbal medicines, their potential therapeutic effects, possible drug-herb interactions and precautions to be taken are discussed in this chapter. Patients commonly use These scientifically validated herbs as an alternative therapy for the prevention and management of cardiovascular disorders.