Integrative cardiology: Where can Ayurveda contribute?

Dr M Vijayakumar, Clinical Professor, Adult Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala and Dr P Ram Manohar, Research Director, Amrita Centre for Advanced Research in Ayurveda, Amrita School of Ayurveda, Kollam, Kerala, share insights on blending traditional medicine and modern science to develop a holistic approach for cardiovascular healthcare

There is no question about the miraculous impact of advanced medical knowledge in saving millions of human lives. Specially so, when it comes to diseases that afflict a vital organ like the heart, which can create life and death situations demanding complex interventions. New pharmaceutical drugs, bypass surgery, angioplasty, heart transplantation, pacemakers and the list is endless when it comes to discussing about the path breaking developments that have revolutionised medical interventions in the field of cardiology.

Cardiology has become increasingly technology intensive and while these advances are life saving in many situations, there is growing concern that such interventions are sometimes being used out of context and become the cause of economic burden to the public.

Worldwide, there is growing dissatisfaction with conventional treatments as they can at times be not effective or cause side effects or be prohibitively expensive. People are searching for less invasive, cost effective and safer solutions where it is warranted. While the advancements in modern cardiology cannot be undermined in any way, complementing it with alternative approaches can perhaps reduce drug dependence, minimise surgical procedures and improve quality of life where it is reasonably possible to do so.

In many parts of the first world, Integrative Cardiology has emerged as a clinical discipline that attempts to integrate the best of both worlds in the bid to provide the best care for the patient.

Many cardiologists are beginning to consider alternatives to conventional treatment for management of a wide range of conditions including angina, arrhythmia and congestive heart failure. Apart from surgery and pharmaceutical drugs, Integrative Cardiologists are keen to prescribe diet and lifestyle modifications along with standard care.

Integrative Cardiology is developing around the world by incorporating many practices from complementary and clternative Medicine. However, the role that Ayurveda can play in Integrative Cardiology is yet to be widely recognised.

Ayurveda uses at least 1200 medicinal plants and about 25,000 herbal formulations. Many of these plants and formulations have been found to be potentially beneficial in the management of cardiovascular diseases in preclinical and clinical studies. However, sufficient translational work has not been done to integrate Ayurveda into mainstream clinical practice for management of cardiovascular diseases.

Terminalia arjuna, Desmodium gangeticum and Sida cordifolia are herbs that have shown promise in the management of chronic heart failure. T. arjuna may also have benefits in pulmonary hypertension. While Bacopa monnieri has been shown to increase rat coronary blood flow conferring protection against myocardial ischemic injury, Tinospora cordifolia has been found to have benevolent effects on physical and cardivascular performance induced by physical stress.

Commiphora mukul or Guggulu continues to be studied for lipid lowering activity. When it comes to hyperlipidemia herbs like Terminalia chebula and procedures like lekhana vasti and virecana have also been found to be beneficial. Many classical formulations remain unexplored for their potential benefits in management of dyslipidemia.

There are strong indications that Shirodhara, a specialised therapy in which medicated oils are dripped on the forehead in rhythmic back and forth movement can influence the autonomous nervous system and stabilise cardiovascular function.

Kalpamrita, Arogyavardhini Vati and Mustadi Ghanavati are formulations that have been studied for their efficacy in cardiovascular diseases.

Saussurea lappa, Inula racemosa, Terminalia chebula and even Withania somnifera have been studied for their benefits in ischemic heart disease.

There is preliminary evidence that a number of herbs, formulations and therapies from Ayurveda can be beneficial in management of heart diseases. Clinical experience suggests that Ayurveda could be considered as an option in Severe Peripheral Vascular Diseases, No option coronary disease as well left ventricular dysfunction.

There are reports from clinical practice in Ayurveda of successful reduction or weaning of antihypertensives and lipid lowering agents with adjuvant Ayurvedic therapy. However, lack of safety data and concerns about herb drug interactions come in the way of such combination therapies being accepted in mainstream clinical practice, especially by the physicians of modern medicine.

While adoption of modern methods of research can generate data to enhance its acceptability amongst practitioners of modern medicine, the introduction of Ayurvedic genomics and biology can also refine our understanding of diseases and open new avenues in drug discovery and therpeutics.

Modern research is also shedding new light on the significance of some of the traditional dietary practices in India.

A study conducted by cardiologists at Amrita Institue of Medical Sciences, Kochi with Dr M Vijayakumar showed that coconut oil, though rich in saturated fatty acids when used for cooking, in comparison to sunflower oil, did not change the lipid-related cardiovascular risk factors in those who received standard medical care.

Similarly, integration of Ayurvedic treatment along with conventional management of ischemic heart disease could potentially enhance quality of life and reduce mortality. Collaborative studies have to be conducted with the participation of Allopathic and Ayurvedic physicians to generate the kind of evidence that will enable development of treatment guidelines for Integrative Cardiology.

Integrative Cardiology is not merely the supplementation of some herbs, formulations or treatments from Alternative Medicine for better outcomes in some selected cardiovascular diseases. On the other hand, Integrative Cardiology means the active participation of practitioners of other medical systems in the assessment and decision making process potentially in all Cardiovascular diseases. In other words, we have to look at Integrative Cardiology as the collaboration of a multimodal team of clinicians who will deal with the patient in a wholesome manner integrating the body, mind and self. Intelligent synthesis of conventional medicine and Ayurveda medicine will definitely fill the gap in patient care.

India has a high incidence of heart disease and needs to develop approaches to prevent and manage heart diseases with deeper understanding of the causes that stem from socio cultural and other factors. In this context, blending of traditional wisdom and modern science has the potential to develop effective approach to holistic cardiovascular health.