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Various herbal medicines have been used around the world for more than 5,000 years. Herbal medicines, or herbal supplements, are defined as any products originating from plants and used to preserve or recover health. In the United States, the popularity of herbal supplements has increased in the last several decades. Many physicians do not ask patients about herbal supplement use, and one-third of patients do not inform their physician about supplement use. However, physicians should ask, because although many supplements are considered low risk and safe, some have significant risks of adverse effects. For example, St John’s wort (Hypericum perforatum) can have significant drug interactions with prescription or over-the-counter drugs. The effectiveness of herbal supplements in the management of specific conditions varies. For some conditions, there is robust clinical data supporting the use of specific herbal supplements, but for other conditions there is poor or insufficient data. The content and safety of herbal supplements are the purview of the Food and Drug Administration (FDA). However, the FDA primarily responds to after-the-fact reports of postmarketing safety concerns. When an herbal supplement-related adverse effect is suspected, patients or physicians should report it to the FDA via the MedWatch reporting system.

Case 3. Antonio is a 50-year-old man who had a myocardial infarction (MI) last year. The cardiology subspecialist placed two drug-eluting stents and prescribed a beta blocker, dual antiplatelet therapy, and a statin. Currently, Antonio is angina-free and has resumed his job as an attorney without any limitations.

Today he tells you that he discontinued taking the statin a few months ago because he read on the internet that statins cause cancer. He saw an advertisement for an herbal supplement for cholesterol management and wants to know if he can take it instead of the statin.

Various herbal medicines have been used around the world for more than 5,000 years.83 Herbal medicines, or herbal supplements, as broadly defined by the National Institutes of Health (NIH), are any products originating from plants and used to preserve or recover health. In the United States, the popularity of herbal supplements has increased in the last several decades.84 In 2018, total US retail sales of herbal supplements increased by 9.4% compared with 2017, and US consumers spent an estimated more than $8.8 billion on herbal supplements.

A 2015 national survey that collected data from more than 26,000 respondents found that 35% of US adults use at least one herbal supplement, with an average of 2.6 supplements per user.83 The survey also found that supplement use was more common among individuals with an education level higher than high school, who already take prescription or over-the-counter (OTC) drugs, and who are older than 70 years. The conditions most strongly associated with use were stroke, cancer, and arthritis.

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