Correction

Jul 1, 2001 Issue

Corrections

Am Fam Physician. 2001 Jul 1;64(1):36-38.

The article “Alternative Therapies: Part II. Congestive Heart Failure and Hypercholesterolemia” (September 15, 2000, page 1325) contained an error in the second sentence of the first full paragraph in the right-hand column on page 1328. The correct sentence reads as follows: “This ‘red rice yeast product’ has been used for centuries in China and contains starch, protein, fiber and at least eight statin compounds, which function as 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors.” The abbreviation was also incorrectly expanded in Table 1. The corrected table is reprinted above.

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TABLE 1

Summary of Natural Products Used in the Management of Cardiac Disorders

Product	Other names	Efficacy	Mechanism of action	Formulation	Dosage/interval	Side effects	Drug interactions
Congestive heart failure (CHF)
Q₁₀	Ubiquinone	Modest, at best	Antioxidant; positive ionotrope	Liquid, capsules	100 to 200 mg per day	None recorded	None recorded
Hawthorn	Crataegus species, haw, may, whitethorn	Incomplete, but highly promising data; approved for use in Germany and Asia for mild cases of CHF	Vasodilatory effects; increased coronary flow; decreased peripheral resistance; ACE–inhibitor-like effect	Dry extracts or liquid	Average daily dosage: 5 g or 160 to 900 mg extract for a minimum a minimum of 6 weeks	None recorded	May interfere with digoxin or digoxin monitoring
Hypercholesterolemia
Garlic	Allium sativum, poor man's treacle	Not efficacious	None	Fresh, oil, aqueous, fermented or dried		Large quantities can cause stomach stomach complaints	None recorded
Soy	Glycine soja	Proved efficacy; will decrease total cholesterol 5 to 9%, LDL 13%	Estrogen-like properties; alters hepatic cholesterol metabolism	Extract	Average daily dosage: 25 g soy protein	Possible occasional stomach pain loose stool and diarrhea	None recorded
Cholestin	Went yeast, Monascus purpureus, fermented on rice	As efficacious as commercial Statins	HMG CoA reductase inhibitor	Capsules	1,200 mg twice daily	Possible liver enzyme elevation and myositis; none, however, recorded	Same as commercially available statins
Gugulipid/guggal gum	Commiphora molmol, Arabian myrrh, Somalian myrrh	Preliminary data promising; needs larger controlled studies; widely used in India	Increased hepatic LDL binding sites*	Extract powdered resin; concentrated tablets	75 mg per day	None recorded†	None recorded

ACE = angiotensin-converting enzyme; LDL = low-density lipoprotein; HMG CoA = 3-hydroxy-3-methylglutaryl coenzyme A.

^*—Information from Singh V, Kaul S, Chander R, Kapoor NK. Stimulation of low-density lipoprotein receptor activity in liver membrane of guggulsterone-treated rats. Pharmacol Res 1990;22:37–44.

†—Information from Lawrence Review of Natural Products. Guggul. St. Louis, Mo.: Facts and Comparisons, 1995.

TABLE 1

Summary of Natural Products Used in the Management of Cardiac Disorders

Product	Other names	Efficacy	Mechanism of action	Formulation	Dosage/interval	Side effects	Drug interactions
Congestive heart failure (CHF)
Q₁₀	Ubiquinone	Modest, at best	Antioxidant; positive ionotrope	Liquid, capsules	100 to 200 mg per day	None recorded	None recorded
Hawthorn	Crataegus species, haw, may, whitethorn	Incomplete, but highly promising data; approved for use in Germany and Asia for mild cases of CHF	Vasodilatory effects; increased coronary flow; decreased peripheral resistance; ACE–inhibitor-like effect	Dry extracts or liquid	Average daily dosage: 5 g or 160 to 900 mg extract for a minimum a minimum of 6 weeks	None recorded	May interfere with digoxin or digoxin monitoring
Hypercholesterolemia
Garlic	Allium sativum, poor man's treacle	Not efficacious	None	Fresh, oil, aqueous, fermented or dried		Large quantities can cause stomach stomach complaints	None recorded
Soy	Glycine soja	Proved efficacy; will decrease total cholesterol 5 to 9%, LDL 13%	Estrogen-like properties; alters hepatic cholesterol metabolism	Extract	Average daily dosage: 25 g soy protein	Possible occasional stomach pain loose stool and diarrhea	None recorded
Cholestin	Went yeast, Monascus purpureus, fermented on rice	As efficacious as commercial Statins	HMG CoA reductase inhibitor	Capsules	1,200 mg twice daily	Possible liver enzyme elevation and myositis; none, however, recorded	Same as commercially available statins
Gugulipid/guggal gum	Commiphora molmol, Arabian myrrh, Somalian myrrh	Preliminary data promising; needs larger controlled studies; widely used in India	Increased hepatic LDL binding sites*	Extract powdered resin; concentrated tablets	75 mg per day	None recorded†	None recorded

ACE = angiotensin-converting enzyme; LDL = low-density lipoprotein; HMG CoA = 3-hydroxy-3-methylglutaryl coenzyme A.

^*—Information from Singh V, Kaul S, Chander R, Kapoor NK. Stimulation of low-density lipoprotein receptor activity in liver membrane of guggulsterone-treated rats. Pharmacol Res 1990;22:37–44.

†—Information from Lawrence Review of Natural Products. Guggul. St. Louis, Mo.: Facts and Comparisons, 1995.

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