Heart patients, do you tell your doctor you're using alternative medicines?

Doctors, do you ask your patients if they're using alternative medicines?

According to the Medical Dictionary Online, alternative therapies are practices which are not currently considered an integral part of conventional medical practice and are used instead of conventional treatment.

As the use of alternative medicines increases, physicians must be more active in determining what their heart patients should take and educating them on the risks, according to new research reported at the American Heart Association's Scientific Sessions 2005. "Depending on the alternative medication, there can be life-threatening interactions with prescribed cardiac medications," said Beth Abramson, M.D., F.R.C.P., F.A.C.C., lead author of the study and director of the Cardiac Prevention Center at St. Michael's Hospital in Toronto.

"What is striking is the number of heart patients taking these types of medications and not talking to their doctors about it," she said. "Some of these patients are on multiple prescribed heart medications."

Abramson, an assistant professor of medicine at the University of Toronto, advises heart patients to give their doctors a list of the complementary or alternative medicines they are taking.

According to researchers the use of complementary and alternative medicines continues to grow in North America and they find it surprising that reasonably educated populations, who are on multiple heart medications, also are taking alternative medications without talking to their doctor. "There are specific interactions with cardiac drugs that could make alternative medicines dangerous," Abramson said. "Patients are hearing about these alternative therapies from the lay press and friends. No doubt, in the time of instantaneous information on the Internet, patients must be cautious where they gather their information."

For example, certain herbal preparations interfere with cardiac drugs.

• Hawthorne berries may be dangerous to heart patients on prescribed drugs.
• Medications containing licorice affect high blood pressure.
• St. John's wart interferes with levels of heart drugs such as digoxin and warfarin.

In a study of 308 heart patients, using standardized interviews, the Toronto researchers found that 45 percent of patients used complementary or alternative medicines (CAM). The majority of the therapies was herbal medications, vitamins and minerals. Yet, only 56 percent of CAM users' heart specialists and 75 percent of family doctors were aware of the use. Researchers found that only about eight percent of specialists and 13 percent of family doctors inquired about what alternative medicines patients were taking. Only 39 percent of CAM users believed it was important for their physicians to know about such usage. Fifty percent of CAM users in the study claimed they were aware of the risks of using alternative medicines. More than half of patients using CAMs received information on the use of these medications through the news media or friends. Only 21 percent received information prompting usage from their physicians.

"In the era of evidenced-based medicine, we have more patients who are quite comfortable with alternative medicine rather than drugs proven to work," Abramson said. "Unfortunately many patients believe that if something is natural, then it's safe. But many of these alternative medicines are not regulated, aren't necessarily safe and many have not been proven effective."