One in Three Cardiac Patients Use Complementary Health, Often Unbeknownst to Their Doctors

More than one-third of US patients diagnosed with cardiovascular disease report using complementary health approaches like nonvitamin/nonmineral supplements, herbal products, chiropractic manipulation, and massage, yet one-third of them do not tell their doctors, according to new research.

This isn’t the first study to look at the prevalence of these kinds of adjunct therapies among Americans: a report published last year found that one in five adults overall had used an herbal supplement at some point and that a full 70% did not disclose it to their physicians. Still, lead author Fuschia Sirois, PhD, BSc (University of Sheffield, England), told TCTMD she was surprised to see the “concerning” rate of nondisclosure among a population of cardiac patients.

“I didn't think it would come up in this population given the nature of the condition and the risks involved in terms of interactions with some of the drugs used to manage hypertension and blood pressure,” she said.

For the analysis, published online March 29, 2018, ahead of print in the American Journal of Cardiology, Sirois, along with Linghui Jiang, MSPH, and Dawn Upchurch, PhD, LAc (University of California, Los Angeles), looked at data from the 2012 National Health Interview Survey on 12,364 individuals who reported being diagnosed with cardiovascular disease. Overall, 34.75% of them had used at least one of 20 specific kinds of complementary health approaches over the previous year. Choices included acupuncture, massage, yoga, meditation, and “natural products.”

People who used one of these adjunct therapies tended to be women, younger, Asian, white, US born, and/or of higher socioeconomic status. Also, adults who used one approach tended to use several.

More than half of individuals who said they used a complementary health approach reported taking multivitamin/mineral tablets (55.78%), and 19.92% used nonvitamin/nonmineral or herbal supplements. Chiropractic or osteopathic manipulation (9.20%) and massage (8.19%) were the next most commonly used approaches.

About one-third of users reported that they did not disclose their behavior to their doctors—45.51% said it was because they weren’t asked and 9.44% said they didn’t think their physician needed to know.

Start the Conversation Early

The issue of nondisclosure is “really important because there are a lot of people using these alternative health practices, and sometimes they may be using them appropriately, and sometimes it may be less appropriate,” Sirois said. Also, there are “certain health conditions where people are clearly using other medications and have other medical regimens that might not necessarily be compatible with some of these alternative health practices.”

For example, she noted, St. John's Wort can decrease serum digoxin concentrations and hawthorn can increase the effects of digoxin. The Chinese herb ma huang, also known as ephedra, can “have some very dangerous effects” on heart rate and blood pressure.

There are a lot of people using these alternative health practices, and sometimes they may be using them appropriately, and sometimes it may be less appropriate. Fuschia Sirois

“Not all of these complementary health approaches are potentially dangerous,” Sirois observed, but those that are seem to be the most commonly used. Because of that, “there needs to be more of a proactive approach from physicians.”

Cardiologists specifically should initiate these conversations early and have a greater awareness of their patients’ use of complementary health approaches as well as the wide range of potentially helpful and dangerous options available to them, she said. “It's up to the physician to educate their patients a little bit about this. This is something we need to talk about.”