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Angina

Essentially, angina is a muscle cramp in the heart—the one muscle that cannot take a rest. It develops when the heart muscle does not receive enough oxygen for its needs from the arteries that supply it: the coronary arteries. Angina is, therefore, a symptom of coronary artery disease. Atherosclerosis is the most common cause of coronary artery disease; it causes thickened arterial walls and impaired blood flow.

People usually experience angina as a squeezing chest pain, as if a heavy weight rested on the chest or a tight band wrapped around it. This is often accompanied by sweating, shortness of breath, and possibly pain radiating into the left arm or neck. Usually, angina is brought on by exercise—the more rapidly the heart pumps, the more oxygen it needs. Atherosclerosis (hardening of the arteries) is the most common cause of angina.

People with angina are at high risk for a heart attack , and treatment must take that into account. Drugs that expand (dilate) the heart's arteries, such as nitroglycerin, can give immediate relief. Other drugs help over the long-term by making the heart's work easier. It is also important to slow or reverse the progression of atherosclerosis by treating high blood pressure and high cholesterol and by reducing other risk factors. Surgical treatments (such as angioplasty and coronary artery bypass grafting) physically widen the blood vessels that feed the heart.

Principal Proposed Natural Treatments

Angina is a serious disease that absolutely requires conventional medical evaluation and supervision. No one should self-treat for angina. However, alternative treatments may provide a useful adjunct to standard medical care when monitored by an appropriate healthcare professional. We intentionally do not give dosages in this section as they should be individualized by your doctor; however, you can find general guidelines in the separate articles on each substance.

Note: Because angina is usually caused by atherosclerosis, other relevant information may be found in the Atherosclerosis article.

L-Carnitine

The vitamin-like substance L-carnitine might be a good addition to standard therapy for angina. Carnitine plays a role in the cellular production of energy. Although carnitine does not address the cause of angina, it appears to help the heart produce energy more efficiently, thereby enabling it to get by with less oxygen.

In one controlled study, 200 individuals with angina (the exercise-induced variety) received either a daily dose of L-carnitine or were left untreated. 1  All the study participants continued to take their usual medication for angina. Those taking carnitine showed improvement in several measures of heart function, including a significantly greater ability to exercise without chest pain. They were also able to reduce the dosage of some of their heart medications (under medical supervision) as their symptoms decreased.

Unfortunately, the results of this study can't be fully trusted because it didn't use a double-blind, placebo-controlled  design. (For information on why double studies are so important, see Why Does This Database Rely on Double-blind Studies? ) A smaller trial that did use a double-blind, placebo-controlled format evaluated 52 people with angina. 2 The results showed that daily use of L-carnitine significantly improved symptoms as compared to placebo.

Other studies (both single- and double-blind) used a special form of L-carnitine called L-propionyl-carnitine, and researchers found evidence of benefit. 3-6 Consult with your physician regarding dosage and specific safety issues.

For more information, including dosage and safety issues, see the full L-carnitine article.

Magnesium

Magnesium has actions in the body that resemble those of drugs in the calcium channel blocker family , although much weaker. Since these drugs are useful for angina, magnesium has been tried as well.

In a 6-month, double-blind, placebo-controlled study, 187 individuals with angina were given either daily oral magnesium or placebo. 17 The results showed that use of magnesium significantly improved exercise capacity, lessened exercise-induced chest pain, and improved general quality of life.

Similarly, two double-blind, placebo-controlled studies, enrolling a total of about 100 people with coronary artery disease found that supplementation with magnesium significantly improved exercise tolerance. 18,24

For more information, including dosage and safety issues, see the full Magnesium article.

Other Proposed Treatments for Angina

A one-week, double-blind, placebo-controlled crossover trial of 58 people evaluated the effectiveness of the herb Terminalia arjuna for angina by comparing it against placebo, and the standard drug isosorbide mononitrate. 16 The results indicated that the herb reduced anginal episodes and increased exercise capacity. It was more effective than placebo and approximately as effective as the medication. A subsequent 3-month study compared the effectiveness of Terminal arjuna against placebo in 40 people with a recent heart attack . 22 All participants in this study suffered from a particular complication of a heart attack, called ischaemic mitral regurgitation. The results showed that use of the herb improved heart function and reduced angina symptoms. Another study found benefits with an Ayurvedic herbal combination containing Terminalia arjuna . 19

Preliminary evidence suggests that the amino acids arginine7,14 and glutamine 15 might improve exercise tolerance in angina. Coenzyme Q 10 (CoQ 10 ) is best known as a treatment for congestive heart failure, but it may offer benefits in angina as well. 8

N-acetyl cysteine may be helpful when taken along with the drug nitroglycerin, but severe headaches may develop. 10-12

Results are conflicting on whether the omega-3 fatty acids found in fish oil are helpful for people with angina. 23

The herbs hawthorn , khella, and Coleus forskohlii are often recommended for angina by herbalists, but as yet there is no meaningful evidence that they work. Vitamin E has been found only slightly effective at best for angina, and beta-carotene may actually increase angina. 13

Chelation therapy is widely promoted for the treatment of angina, but there is no meaningful evidence that it is effective, and some evidence that it is not. 9,20,21

In a randomized trial of 66 adults with angina, 4 weeks of daily Chinese herbal Shenshao tablets (containing ginsenosides and white peony) were found to reduce angina frequency and improve quality of life scores. 26

The addition of safflower oil injections to conventional medications was associated with more than 50% decrease in the number of angina attacks in a review of 7 randomized trials involving 1,134 people with unstable (irregular) angina. Unfortunately, the trials were of low quality, which can affect the overall results. 27

Herbs and Supplements to Use Only With Caution

Various herbs and supplements may interact adversely with drugs used to treat angina. For more information on this potential risk, see the individual drug article in the Drug Interactions section of this database.

Revision Information

  • 1

    Cacciatore L, Cerio R, Ciarimboli M, et al. The therapeutic effect of L-carnitine in patients with exercise-induced stable angina: a controlled study. Drugs Exp Clin Res . 1991;17:225-235.

  • 2

    Cherchi A, Lai C, Angelino F, et al. Effects of L-carnitine on exercise tolerance in chronic stable angina: a multicenter, double-blind, randomized, placebo controlled crossover study. Int J Clin Pharmacol Ther Toxicol . 1985;23:569-572.

  • 3

    Bartels GL, Remme WJ, Pillay M, et al. Effects of L-propionylcarnitine on ischemia-induced myocardial dysfunction in men with angina pectoris. Am J Cardiol . 1994;74:125-130.

  • 4

    Bartels GL, Remme WJ, den Hartog FR, et al. Additional anti-ischemic effects of long-term L-propionylcarnitine in anginal patients treated with conventional antianginal therapy. Cardiovasc Drugs Ther. 1995;9:749-753.

  • 5

    Lagioia R, Scrutinio D, Mangini SG, et al. Propionyl-L-carnitine: a new compound in the metabolic approach to the treatment of effort angina. Int J Cardiol . 1992;34:167-172.

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    Bartels GL, Remme WJ, Holwerda KJ, et al. Anti-ischaemic efficacy of L-propionylcarnitine—a promising novel metabolic approach to ischaemia? Eur Heart J. 1996;17:414-420.

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    Bednarz B, Wolk R, Chamiec T, et al. Effects of oral L-arginine supplementation on exercise-induced QT dispersion and exercise tolerance in stable angina pectoris. Int J Cardiol . 2000;75:205-210.

  • 8

    Kamikawa T, Kobayashi A, Yamashita T, et al. Effects of coenzyme Q 10 on exercise tolerance in chronic stable angina pectoris. Am J Cardiol. 1985;56:247-251.

  • 9

    Ernst E. Chelation therapy for coronary heart disease: An overview of all clinical investigations. Am Heart J . 2000;140:4-5.

  • 10

    Pizzulli L, Hagendorff A, Zirbes M, et al. N-acetylcysteine attenuates nitroglycerin tolerance in patients with angina pectoris and normal left ventricular function. Am J Cardiol . 1997;79:28-33.

  • 11

    Ardissino D, Merlini PA, Savonitto S, et al. Effect of transdermal nitroglycerin or N-acetylcysteine, or both, in the long-term treatment of unstable angina pectoris. J Am Coll Cardiol. 1997;29:941-947.

  • 12

    Iversen H. N-acetylcysteine enhances nitroglycerin-induced headache and cranial arterial responses. Clin Pharmacol Ther. 1992;52:125-33.

  • 13

    Rapola JM, Virtamo J, Haukka JK, et al. Effect of vitamin E and beta-carotene on the incidence of angina pectoris. JAMA. 1996;275:693-698.

  • 14

    Maxwell AJ, Zapien MP, Pearce GL, et al. Randomized trial of a medical food for the dietary management of chronic, stable angina. J Am Coll Cardiol . 2002;39:37-45.

  • 15

    Khogali SE, Pringle SD, Weryk BV, et al. Is glutamine beneficial in ischemic heart disease? Nutrition. 2002;18:123-126.

  • 16

    Bharani A, Ganguli A, Mathur LK, et al. Efficacy of Terminalia arjuna in chronic stable angina: a double-blind, placebo-controlled, crossover study comparing Terminalia arjuna with isosorbide mononitrate. Indian Heart J. 2002;54:170-175.

  • 17

    Shechter M, Bairey Merz CN, Stuehlinger HG, et al. Effects of oral magnesium therapy on exercise tolerance, exercise-induced chest pain, and quality of life in patients with coronary artery disease. Am J Cardiol . 2003;91:517-521.

  • 18

    Shechter M, Sharir M, Labrador MJ, et al. Oral magnesium therapy improves endothelial function in patients with coronary artery disease. Circulation . 2000;102:2353-2358.

  • 19

    Antani J, Kulkarni R, Antani N. Effect of Abana on ventricular function in ischaemic heart disease. Japanese Heart Journal . 1990;31:829-835.

  • 20

    Anderson TJ, Hubacek J, Wyse DG, et al. Effect of chelation therapy on endothelial function in patients with coronary artery disease: PATCH substudy. J Am Coll Cardiol . 2003;41:420-425.

  • 21

    Knudtson ML, Wyse DG, Galbraith PD, et al. Chelation therapy for ischemic heart disease: a randomized controlled trial. JAMA . 2002;287:481-486.

  • 22

    Dwivedi S, Aggarwal A, Agarwal MP, et al. Role of Terminalia arjuna in ischaemic mitral regurgitation. Int J Cardiol. 2005;100:507-508.

  • 23

    Burr ML, Dunstan FD, George CH, et al. Is fish oil good or bad for heart disease? Two trials with apparently conflicting results. J Membr Biol. 2006;206:155-163.

  • 24

    Pokan R, Hofmann P, von Duvillard SP, et al. Oral magnesium therapy, exercise heart rate, exercise tolerance, and myocardial function in coronary artery disease patients. Br J Sports Med. 2006 Jul 6. [Epub ahead of print]

  • 25

    Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet . 2007;369:1090-1098.

  • 26

    Wang J, He QY, Zhang YL. Effect of shenshao tablet on the quality of life for coronary heart disease patients with stable angina pectoris. Chin J Integr Med. 2009;15:328.

  • 27

    Kong D, Xia W, et al. Safflower yellow injection combined with conventional therapy in treating unstable angina pectoris: a meta-analysis. J Tradit Chin Med. 2013;33(5):553-561.