Cardiomyopathy

Cardiomyopathy refers to abnormalities in the structure or function of the heart muscle. There are three major types of cardiomyopathy: dilated congestive, hypertrophic, and restrictive. The most prevalent form is dilated congestive cardiomyopathy (DCM). In people with DCM, the heart muscle is damaged, most commonly by coronary artery disease (atherosclerosis).1 People with diabetes have been reported to be at increased risk of DCM.2 DCM can also be triggered by alcohol abuse, infections, exposure to certain drugs and toxins, nutritional deficiencies, connective tissue diseases, hereditary disorders, and pregnancy.

In DCM, the heart gradually loses its efficiency as a pump. Cardiomyopathy is a serious health condition and requires expert medical care rather than self-treatment. However, because of the associations between cardiomyopathy and diseases such as atherosclerosis, diabetes, hypertension, and congestive heart failure, lifestyle recommendations for the prevention of these conditions may also help prevent DCM.

Hypertrophic cardiomyopathy is usually a hereditary disorder, although incidence of this form of cardiomyopathy may also be higher in people with hypertension.3 Restrictive cardiomyopathy is usually due to a connective tissue disease, cancer, or an autoimmune condition. Both hypertrophic and restrictive cardiomyopathies are relatively uncommon.

Checklist for Cardiomyopathy

Rating Nutritional Supplements Herbs
2Stars Coenzyme Q10 Arjun
Hawthorn (if congestive heart failure is also present)
1Star L-carnitine (only for children with inherited cardiomyopathy)
Selenium (only for Keshan’s cardiomyopathy)
Taurine
Vitamin B1 (Thiamine) (only for wet beri beri)		 Coleus
Dan shen
Hawthorn (if congestive heart failure is not present)
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of cardiomyopathy? People with cardiomyopathy may have difficulty breathing during light exertion, and they may become fatigued easily. Other chronic symptoms are swelling around the ankles and an enlarged abdomen.

How is it treated? The conventional treatment includes specific therapy for any underlying cause and may also include ACE inhibitors (e.g., captopril, enalapril, lisinopril), beta-blockers, the combination of hydralazine and isosorbide dinitrate, digitalis, and diuretics. In some cases, heart transplantation surgery may be recommended.

Dietary changes that may be helpful: Protein-calorie malnutrition (PCM) may cause cardiomyopathy, though PCM is rare in U.S. society.

Lifestyle changes that may be helpful: Cardiomyopathy occurs with greater frequency in people who drink to excess.4 Alcoholics are at significantly greater risk of developing a deficiency of thiamine (vitamin B1).5 6 They also may develop a form of thiamine deficiency called wet beri beri or Shoshin beri beri, which frequently includes cardiomyopathy.7 8 See “Nutritional supplements that may be helpful,” below, for more information.

Among alcoholics, the risk of developing DCM is greater for women than for men.9 Many doctors suggest that people with cardiomyopathy abstain from alcohol consumption. People with alcohol-induced cardiomyopathy who avoid alcohol may regain their health.

Moderate to heavy physical activity can be life-threatening for people with cardiomyopathy;10 however, appropriate exercise often improves the condition.11 12 13 14 How much is “too much” varies from person to person. Any exercise program undertaken by someone with cardiomyopathy requires professional supervision.

The risk of being diagnosed with cardiomyopathy goes up with the number of cigarettes smoked per day.15 16 However, a few studies have reported a paradoxical decrease in the death rate among smokers with DCM compared with nonsmokers who have this disease.17 18 While the meaning of this association remains unclear, virtually all doctors recommend that smokers with DCM quit smoking for a wide variety of health-related reasons.

Nutritional supplements that may be helpful: People with DCM have been shown to be deficient in coenzyme Q10.19 Most studies using coenzyme Q10 in the treatment of cardiomyopathy have demonstrated positive results, including improved quality of life, heart function tests, and survival rates.20 21 22 Coenzyme Q10 also has been shown to improve cardiac function in people with hypertrophic cardiomyopathy—a less common form of cardiomyopathy.23 A few studies, however, have found no benefit from CoQ10 supplementation in treating people with cardiomyopathy.24 25 Despite a lack of consistency in the outcomes of published research, many doctors recommend that 100 to 150 mg be taken each day, with meals.

Deficiency of L-carnitine, an amino acid, is associated with the development of some forms of cardiomyopathy.26 Inherited forms of cardiomyopathy seen in children may be the most responsive to therapy with L-carnitine.27 28 Whether carnitine supplementation helps the average person with cardiomyopathy remains unknown. Nonetheless, some doctors recommend 1 to 3 grams of carnitine per day for adults of average weight.

Several veterinary studies have demonstrated benefits from supplementation with taurine, another amino acid, in animals with cardiomyopathy. Most of these studies showed taurine deficiency to be a cause of cardiomyopathy. Taurine supplementation in animals with DCM has resulted in improvement of symptoms and survival rates.29 30 However, clinical studies in humans are lacking; thus, despite a good safety record, the benefits of taurine supplementation in people with any form of cardiomyopathy remain speculative. When taurine supplements are used by doctors to treat people with other conditions, 2 grams taken three times per day for a total of 6 grams per day is often recommended.

Selenium deficiency has occasionally been reported as a cause of cardiomyopathy.31 32 Selenium deficiency is the probable cause of Keshan’s disease, a form of cardiomyopathy found in China33 34 but only rarely reported in the United States.35 Studies comparing populations in parts of the world other than mainland China have not supported a link between selenium deficiency and DCM,36 37 except in Taiwan.38 Moreover, no clinical trials outside of China have explored the effects of supplementation with selenium for people with DCM, nor is there reason to believe that selenium supplementation would help most people outside of China and Taiwan suffering from cardiomyopathy.

The small proportion of people with cardiomyopathy whose disease is due to severe vitamin B1 (thiamine) deficiency (known as wet beri beri) generally require intravenous vitamin B1, followed by oral supplementation. Vitamin B1 does not appear to be helpful for other types of cardiomyopathy. People requiring vitamin B1 for cardiomyopathy must first be diagnosed as having wet beri beri, and treatment must be supervised by a healthcare professional.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Many doctors expert in herbal medicine consider hawthorn to be an effective and low-risk therapy for congestive heart failure, the main complication of cardiomyopathy. Rigorous clinical trials have now confirmed the effectiveness of hawthorn for the signs and symptoms of early-stage congestive heart failure,39 40 41 though hawthorn studies with cardiomyopathy patients have yet to be conducted. The clinical trials with heart-failure patients have demonstrated efficacy using 80 to 300 mg of standardized extract of hawthorn leaves and flowers two to three times per day.

Two herbs used in the traditional medicine of India (Ayurveda) to treat people with cardiomyopathy and congestive heart failure have recently been supported by a small amount of clinical research. Arjun (Terminalia arjuna) has been shown to significantly improve the signs and symptoms of cardiomyopathy, as well as the objective measurements of heart function.42 In a clinical trial, people with DCM and severe heart failure took 500 mg of arjun extract three times daily. After two weeks, significant improvement in heart function was observed, an effect that continued over the course of approximately two years.43 The arjun used in this study was concentrated, but not standardized for any particular constituent. Commercial preparations are sometimes standardized to contain 1% arjunolic acid.

Another Ayurvedic herb, coleus, contains forskolin, a substance that may help dilate blood vessels and improve the forcefulness with which the heart pumps blood.44 Recent clinical studies indicate that forskolin improves heart function in people with cardiomyopathy and congestive heart failure.45 46 A preliminary trial found that forskolin reduced blood pressure and improved heart function in people with cardiomyopathy. These trials used intravenous injections of isolated forskolin. It is unknown whether oral coleus extracts would have the same effect. While many doctors and practitioners of herbal medicine would recommend 200 to 600 mg per day of a coleus extract containing 10% forskolin, these amounts are extrapolations and have yet to be confirmed by direct clinical research.

Dan shen (Salvia miltiorrhiza), a Chinese herb, has been traditionally used to treat angina and coronary artery disease. Some studies suggest that dan shen may improve the force of heart contractions and coronary circulation, and may prevent damage to the heart muscle that might lead to cardiomyopathy.47 48 49 However, no clinical trials of dan shen for DCM have been reported. Doctors expert in Chinese herbal medicine typically recommend 1 to 6 grams per day of dried root.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

References:

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