Mechanism of Action
cAMP-independent Positive inotropic / Negative chronotropic, dromotropic effects
Increased coronary blood flow / Increased cardiac output / Reduced O2 consumption
Blockade of Angiotensin Converting Enzyme (ACE)
Vasodilatory (peripheral and coronary) effect
Potassium Channel Activation
Inhibition of Thromboxane Synthesis
Positive suggested effect on total cholesterol, triglycerides, LDL, VLDL lipid fractions as well as upregulation of LDL receptors in the liver.
Usually protects against ischemia-induced ventricular arrhythmias
suspect through multiple pathways, rationale for Peri-cycle/PCT use potential.
Procyanidins have been found unmetabolized in renal and intestinal elimination pathways (for other similar cpds), suggesting limited metabolic degradation. The procyanidins of hawthorn are reported to have a higher degree of polymerization, yet a lower concentration of flavanoids and procyanidins...this area is still being considered though. Stay tuned...
Typical Therapeutic Uses
Approved Uses: Commission E approves hawthorn leaf and flowers in the treatment of heart failure (NYHA, Stage II). This herb is as well studied as any for cardiovascular disease and is commonly used in combination with cardiac glycosides (i.e. – digoxin) to potentiate their effects and thereby lessen the dose of cardiac glycoside drugs. Clinical trials support its use for mild to moderate congestive heart failure. It has been the subject of a number of major long-term multi-center clinical trials on the survival and prognosis of congestive heart failure as well.
Unproven Uses: More research is needed to determine hawthorn’s value in treating hypertension, atherosclerosis, hyperlipidemia, asthma, arrthythmia in the elderly, and orthostatic hypertension. Due to its high flavanoid content, it may be used to decrease capillary fragility, lessen inflammation, and prevent collagen destruction of joints. This herb has been used as a coffee substitute and to flavor cigarettes.
Literature Review – 15 studies to date:
(1) Congestive Heart Failure (CHF):
- 11 randomized clinical trials to date showing statistically significant results, most recently 1 in 2003
- 1 systematic review
- 1 meta-analysis (2003)
- 1 equivlence trial
- 1 non-randomized, cohort, non-inferiority study (2003)
(2) Coronary Artery Disease:
- 1 randomized clinical trial to date showing statistically significant results, unfortunately most recent
(3) Functional Cardiovascular Disorders
- 2 randomized clinical trials to date showing statistically significant results, most recently 1 in 2000; 1 of the trials hawthorn was in combo with camphor, 1 of the trials hawthorn was in combo with garlic (so, somewhat hard to draw true conclusions)
Post-Cycle Therapy (PCT)
There has been a recent resurgence of Hawthorn use amongst the bodybuilding community – namely with the advent of more highly animated adjunct schedules for PCT regimes. I have explored this agent and its potential use in light of its potential to lower blood pressure and lipid (cholesterol) values as discussed in this article and PCT: A Clinician’s View article series.
A few things worth noting here is that there are NO clinical trials or the like to support the use of such agents with concurrent administration of PH/PS/AAS and any resultant blood pressure and/or hyperlipidemic effects. However, with the current plethora of quoted anti-estrogenic agents and aromatase-inhibiting agents being marketed, yet not even 1/1000th of the same amount of money being driven toward health benefits of supplements regarded generally safe, with relatively few, if any noted side effects that are substantiated (see toxicology section of this very article) – the employment of such an agent as a “safety-net” may be in better taste than the purported UN-tested agents described above.
Well dinoiii, with all this talk of treatment for congestive heart failure and seemingly lack of support to surround the theory of lowering blood pressure, why would you suggest employment of this agent as an adjunct for PCT? Great question!
Rationale 1. In a study conducted by Schmidt of Cologne, Germany on 40 patients (avg. age 60 years old) with high blood pressure and “stable coronary insufficiency” who took hawthorn dosed at 200mg, three times per day, for eight weeks – saw statistically significant drops in blood pressure spanning that time frame. Before taking the hawthorn, they tired easily and had diminished physical ability, but after eight weeks on hawthorn, these symptoms occurred 42% fewer times. Maybe that’s not all too exciting, however, blood pressure dropped an from an average of 171/115 --> 164/110 and the patient’s ability to tolerate the heart stress of physical work increased.
Rationale 2. In a related study by German physicians (again, Eastern bloc trumps the West!) Bodigheimer and Chase studied 36 patients (average age of 61) who had angina, a history of heart attacks and arrhythmia, and who were 20% overweight, taking 300mg daily of hawthorn extract for 28 days. Cardiovascular health improved and significant blood pressure declinations (average 10 points systolic, 5 points diastolic) were seen after about a two week treatment span.
This being said, due to the indication of some of the antihypertensive effects to take a few weeks to kick in and adequate dosing may entail addition of such an agent two to three weeks prior to cycle. There is good clinical suggestion that starting it at a point when blood pressure is already above baseline may be unwarranted.
Typical Forms & Dosage
- Suggested Daily Dose: 3.5-19.8mg flavanoids, calculated as hyperoside (DAB 10), or 160-900mg extract (3:1 - 7:1 with ethanol 45% v/v or methanol 70% v/v), corresponding to 30-168.7mg oligomeric procyanidins, calculated as epicatechol. Hawthorn leaf/flower can be used for unlimited time periods.
- How this translates if not concentrated (See short topic series IV for more on concentration): 0.75mg – 6 grams per day of dried flower, leaf, or by infusion; 3 – 6 mL per day of a 1:2 liquid extract of hawthorn leaf or equivalent in tablet/capsule form; 3.5 – 17.5 mL per day of a 1:5 tincture of hawthorn leaf.
- Doses for leaf and flower extracts tested in clinical trials ranged from 160-1800mg/day, while the berry extracts were tested from 300-1000mg three times per day.
- Products containing standardized extract WS 1442: (18.75% OPCs): statistically significant trials have used doses of 60mg three times per day or 80mg twice daily. The U.S. brand HeartCare (Nature's Way) is standardized in this fahsion.
- Products containing standardized extract LI 132: (2.2% flavanoids): statistically significant trials have used doses of 100mg three time daily, 200mg twice daily, and up to 300mg three times per day.