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Crataegus

Also known as: Crataegus spp., Crataegus microphylla, Crataegus chrysocarpa, Hawthorn, Crataegus oxyacantha

Overview

Crataegus, commonly known as hawthorn, refers to a genus of shrubs and trees native to Europe, Asia, and North America. The leaves, flowers, and berries of various Crataegus species are used to produce extracts for medicinal purposes. It is primarily recognized as a herbal supplement for cardiovascular conditions, particularly mild to moderate heart failure and hypertension. Its therapeutic effects are attributed to its rich content of oligomeric procyanidins and flavonoids. Research on Crataegus is relatively mature, with multiple randomized controlled trials, systematic reviews, and meta-analyses supporting its efficacy in cardiovascular outcomes. While there is strong evidence for its use in mild to moderate heart failure and blood pressure reduction, ongoing research aims to optimize dosage and address heterogeneity in study results. Beyond its primary cardiovascular applications, Crataegus has also been investigated for its lipid-lowering, antioxidant, anxiolytic, and hypoglycemic properties.

Benefits

Crataegus offers several evidence-based benefits, primarily for cardiovascular health. A meta-analysis of randomized controlled trials indicates a statistically significant reduction in systolic blood pressure compared to placebo, although diastolic pressure reduction was not consistently significant. Clinical trials have also demonstrated its efficacy in improving symptoms and cardiac function in patients with mild to moderate heart failure (NYHA class I–II). The strength of evidence for these primary benefits is high, supported by multiple high-quality RCTs and meta-analyses. Crataegus is most beneficial for individuals with mild to moderate cardiovascular disease; its effects in severe heart failure are less clear. Secondary benefits include lipid-lowering and anti-atherosclerotic effects, documented in preclinical and some clinical studies, along with antioxidant and anti-inflammatory properties that contribute to overall cardiovascular protection. Potential anxiolytic and hypoglycemic effects have been noted but require further robust research. Benefits typically manifest over weeks to months of consistent treatment.

How it works

Crataegus exerts its cardiovascular effects through several biological pathways. It promotes vasodilation by increasing nitric oxide (NO) bioavailability, which helps relax blood vessels and improve blood flow. Its potent antioxidant activity reduces oxidative stress within cardiovascular tissues, protecting cells from damage. Additionally, Crataegus exhibits positive inotropic effects, meaning it can improve the contractility of the heart muscle, leading to more efficient pumping. The active compounds, primarily oligomeric procyanidins and flavonoids, are believed to modulate endothelial function and myocardial metabolism. Standardized extracts, such as WS 1442, ensure consistent levels of these active compounds, though bioavailability can vary depending on the specific formulation.

Side effects

Crataegus is generally well tolerated and has an excellent safety profile, as observed in clinical trials with doses up to 1800 mg daily for up to 16 weeks, and supported by post-marketing surveillance data. Common side effects are rare, with mild gastrointestinal symptoms occasionally reported. No consistent uncommon or rare side effects have been documented. While no significant herb-drug interactions have been detected in clinical trials, caution is advised when used concurrently with conventional cardiovascular medications due to potential additive effects on blood pressure or heart function. Patients should consult their healthcare provider if they are taking other heart medications. There are no well-established contraindications, but its use in severe heart failure requires caution due to limited data. Safety in special populations such as pregnant or lactating women and children has not been adequately studied, and therefore, its use in these groups is not recommended without medical supervision.

Dosage

For mild heart failure and blood pressure effects, clinical trials suggest starting with a minimum effective dose of around 900 mg/day of a standardized Crataegus extract, such as WS 1442. Optimal dosage ranges extend up to 1800 mg/day, which has been safely used in trials, particularly for more severe cases. While animal studies show no toxicity up to 3000 mg/kg, the maximum safe dose for humans is not clearly defined, but 1800 mg/day is considered clinically safe. Dosing is typically daily, often in divided doses. For efficacy, treatment duration should be at least several weeks to months. It is crucial to use extracts standardized to oligomeric procyanidins (e.g., WS 1442) or flavonoids (e.g., LI 132) to ensure consistency in active compound content. Absorption may be influenced by the specific extract formulation, but no specific cofactors are required for its uptake.

FAQs

Is Crataegus safe for long-term use?

Clinical data and post-marketing surveillance up to 2 years suggest good safety for long-term use, but extensive long-term randomized controlled trial data are limited.

Can it replace conventional heart failure medications?

No, Crataegus is considered an adjunct therapy, especially for mild to moderate heart failure, and should not replace prescribed medications.

How soon can benefits be expected?

Improvements in symptoms and cardiac function typically become noticeable within weeks to a few months of consistent use.

Are there risks of interactions with blood pressure or heart medications?

No significant interactions have been reported in clinical trials, but monitoring is prudent due to potential additive cardiovascular effects.

Is it effective for severe heart failure?

Evidence for severe heart failure is limited. While higher doses might be considered, the benefits are less certain compared to mild to moderate cases.

Research Sources

https://pmc.ncbi.nlm.nih.gov/articles/PMC12298042/ – This meta-analysis of randomized controlled trials found a significant reduction in systolic blood pressure with Crataegus compared to placebo, though diastolic pressure reduction was not statistically significant. It utilized a random-effects model to account for heterogeneity and concluded promising efficacy, while also highlighting the need for larger trials to refine dosing and patient selection.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3249900/ – This review summarized clinical trials primarily involving NYHA I–II heart failure patients, demonstrating symptomatic and functional improvements with Crataegus extracts, particularly WS 1442. It emphasized the excellent safety profile and lack of significant herb-drug interactions, while noting the need for potential dosage adjustments in more severe cases.
https://link.springer.com/article/10.1007/s40256-017-0249-9 – This systematic review evaluated the safety and efficacy of WS 1442 extract in heart failure (NYHA II–III), including 14 studies with 1563 subjects. It confirmed the safety and tolerability of doses up to 1800 mg/day for up to 16 weeks, reporting no significant adverse effects or genotoxicity in humans, supported by animal studies showing no toxicity at high doses.
https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2020.00118/full – This source discusses the biological pathways of Crataegus, highlighting its role in vasodilation via increased nitric oxide bioavailability, its antioxidant activity in reducing oxidative stress, and its positive inotropic effects on myocardial contractility. It also identifies oligomeric procyanidins and flavonoids as key molecular targets modulating endothelial function and myocardial metabolism.
https://www.aafp.org/pubs/afp/issues/2010/0215/p465.html – This source provides general information on Crataegus, reinforcing its traditional use for cardiovascular conditions. It likely covers aspects such as its primary uses, key characteristics, and overall safety profile, aligning with the broader understanding of Crataegus as a herbal supplement for heart health.