|Year : 2019 | Volume
| Issue : 1 | Page : 98-101
Effect of Terminalia Arjuna on total platelet count and lipid profile in patients of coronary artery disease
Nidhi Priya1, KC Mathur2, A Sharma3, RP Agrawal3, V Agarwal3, Jitendra Acharya4
1 Department of Pathology, RUHS Medical College, Jaipur, Rajasthan, India
2 Department of Physiology, Sardar Patel Medical College, Bikaner, Rajasthan, India
3 Department of Medicine, Sardar Patel Medical College, Bikaner, Rajasthan, India
4 Department of Dentistry, Sardar Patel Medical College, Bikaner, Rajasthan, India
|Date of Web Publication||4-Jan-2019|
Sardar Patel Medical College, Bikaner, Rajasthan
Source of Support: None, Conflict of Interest: None
Objective: Our study was undertaken to observe the effect of Terminalia arjuna on total platelet count, lipid profile, clinical parameters in patients of coronary artery disease (CAD) and their usefulness in the same patient group. Materials and Methods: One hundred patients having CAD were selected and randomised to study group (to receive Arjuna Chhal Powder) and control group (not receiving any medication). After the therapy of 1 month with Arjuna Chhal Powder, patients of both study and control groups evaluated for body weight, blood pressure, pulse rate, total platelet count and lipid profile. Observations were analysed with use of appropriate statistical test. Results: We observed 0.22% decrease in body weight in study group although insignificant. The systolic blood pressure decreased by 10.28% and diastolic blood pressure by 4.8% in the study group which was statistically significant in comparison to control group. The pulse rate has shown a decrement of 4.85% of baseline and total platelet count decreased by 10.81% with statistically significant difference. Lipid profile improved with 10.2% reduction in total cholesterol level, 17.9% reduction in serum triglyceride level, 9.59% reduction in serum low-density lipoprotein (LDL) level, 16% reduction in serum very LDL level and 10.48% increase in serum high-density lipoprotein level, all being statistically significant. Conclusions: T. arjuna bark extract can significantly reduce blood pressure and favourably modify lipid profile. It might also have antioxidant properties and may be beneficial for cardiac as well as overall health.
Keywords: Alternative medicine, blood pressure, lipid profile, Terminalia arjuna
|How to cite this article:|
Priya N, Mathur K C, Sharma A, Agrawal R P, Agarwal V, Acharya J. Effect of Terminalia Arjuna on total platelet count and lipid profile in patients of coronary artery disease. Adv Hum Biol 2019;9:98-101
|How to cite this URL:|
Priya N, Mathur K C, Sharma A, Agrawal R P, Agarwal V, Acharya J. Effect of Terminalia Arjuna on total platelet count and lipid profile in patients of coronary artery disease. Adv Hum Biol [serial online] 2019 [cited 2020 Mar 28];9:98-101. Available from: http://www.aihbonline.com/text.asp?2019/9/1/98/249527
| Introduction|| |
Coronary artery disease (CAD; also known as atherosclerotic heart disease) is the most common type of heart disease and a frequent cause of cardiac events. An Indian shrub known as Arjuna has been used mainly in ayurvedic medicine to support cardiovascular health. Extract of this plant contains variety of flavonoids and polyphenols, which help to reduce inflammation that causes plaque formation in arteries. The extract also supports healthy lipid profile. Oligomeric proanthocyanidins and flavonoids present in Terminalia arjuna extract boost the natural antioxidant defence system of the heart and strengthen the vascular system of the body. It might prevent atherothrombosis by inhibiting platelet aggregation in CAD patients., It helps to treat angina, lower the blood pressure, to treat in congestive heart failure and improves lipid profile and prevents atherosclerosis. In a small clinical trial, it was found that frequency and severity of angina could be reduced and onset could be delayed with the use of Arjuna. In people with mild angina, changes in the heart muscles owing to ischaemia might be reversed by taking the herb., Arjuna bark powder taken along with vasodilator and diuretics improves the symptoms of heart failure. Findings in the animal studies show that therapy with Arjuna bark reduces total cholesterol, low-density lipoprotein (LDL) and triglycerides and increases high-density lipoprotein (HDL) or good cholesterol in blood. In a study, it was found that the rabbits receiving T. arjuna had a marked reduction in total cholesterol than control rabbits. Arjuna bark powder could protect the heart from adverse effect of chronic high blood pressure by lowering the systolic blood pressure levels. The herb might help to boost cardiovascular endurance. Keeping in mind all these medicinal use of T. arjuna, we decided to study the effect of herb on total platelet count, lipid profile and other clinical parameters in patients of CAD.
| Materials and Methods|| |
One hundred patients were selected from the patients attending Haldiram Moolchand Government Centre for cardiovascular research and Mohta Rasayanshala, Bikaner. The study was conducted at Department of Physiology, Sardar Patel Medical College, Bikaner. Approval from the institutional ethical committee was taken for the study. Selected patients were randomised to two groups of 50 patients no.ad/ec 18 as study and control group. Baseline parameters such as pulse rate, body weight, blood pressure, total platelet count and lipid profile were obtained from the patient of both groups after detailed history taking and general physical examination. Patients of the study group were asked to take 3 g of Arjuna Chhal Powder mixed in 250 ml of milk heated till it is boiling, twice daily for a period of 1 month. Both the groups were evaluated after 1 month for all the baseline parameters [Table 1].
Patient suffering from liver disease, arthritis, asthma, pulmonary tuberculosis, malabsorption and patient not giving consent.
Patients were examined for:
- Blood pressure: Average of two readings 5 min apart by mercury sphygmomanometer in sitting position
- Pulse rate: In right radial artery in sitting position
- Platelet count: By Rees–Ecker method
- Lipid profile: By complete automatic chemistry autoanalyser
- Arjuna Chhal Powder was collected from Mohta Rasayanshala, Bikaner.
For statistical comparison of data, appropriate model was applied and the results with P < 0.05 were considered significant. Since the study was conducted at one place, only geographical and climatic condition remained unchanged. The data are expressed as mean ± standard deviation.
| Results|| |
The body weight in study group decreased slightly from 79.40 ± 7.63 to 79.22 ± 8.04 though the change was statistically insignificant. Systolic and diastolic blood pressure decreased from 163.22 ± 19.91 and 93.74 ± 10.86 to 146.44 ± 18.64 and 89.02 ± 10.71 both of which were statistically significant. Pulse rate changed favourably from 82.46 ± 3.63 to 78.46 ± 3.97 (P = 0.0001). Total platelet count decreased from 4.429 ± 0.83 to 3.95 ± 0.71 (P = 0.002). Serum cholesterol decreased from 235.02 ± 47.58 to 210.82 ± 41.36 and serum triglyceride level decreased from 151.3 ± 49.92 to 124.08 ± 39.86. Serum HDL cholesterol (HDL-C) increased from 42.34 ± 9.27 to 46.78 ± 6.52 and serum LDL and serum very LDL cholesterol level decreased from 134.40 ± 25.16, 36.78 ± 11.93 to 121.5 ± 21.45, 30.86 ± 7.64. Change in all parameters of lipid profile was statistically significant [Table 2]. Baseline data of both the study and control groups were matched.
|Table 2: Effect of Terminalia arjuna on different parameters after 1 month of therapy|
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| Discussion|| |
Arjuna has been a part of Ayurveda since 2500 BC as a heart tonic. It is used to treat cardiovascular disease including angina pectoris, ischaemic heart disease, cardiomyopathy and congestive heart failure and act as cardioprotective agent in hypertension.
In the present study, it was found that use of T. arjuna is beneficial in patient of CAD. A report published in journal of research in education in Indian medicine (1988) has stated Arjuna to be possessing antihypertensive, cardiotonic and diuretic properties. It has been shown to increase the HDL-C levels. Indian Medical Gazette (1998) has stated that Arjuna bark extract in dose of 500 mg with other drug given for 3 months improves treadmill test and exercise tolerance considerably without any side effects in angina pectoris. It was observed that aortic prostaglandin E2 (PGE2)-like activity was enhanced after administration of T. arjuna. PGE2 is known to produce coronary vasodilation and increased coronary flow in patients of CAD. In a 1995 double-blind study in the international journal of cardiology, patients who had taken Arjuna for 2 weeks experienced a 19% lower heart rate than those who took a placebo. Symptoms such as fatigue, high blood pressure, heart rate and frequent contractions also improved.
In our study, we found that systolic and diastolic blood pressure decreased after 1 month of T. arjuna therapy. The extract of T. arjuna might contain active compound possessing adrenergic β2 receptor agonistic action and/or direct action on the heart. One month of treatment of 500 mg/kg Arjuna bark powder extract to normal and diabetic rats, reflex bradycardia was improved in diabetic rats. The alteration in reflex tachycardia was not improved by Arjuna over 30 days. Sandhu JS and Shah B stated that Arjuna bark powder could protect the heart from the adverse effect of chronic high blood pressure by lowering the systolic blood pressure levels and our results are in close conformity in their statement.
In the present study, whole lipid profile changed favourably after 1 month therapy of T. arjuna. Dwivedi reports that a study described in a thesis by S. Khalil in 2005 found that Arjuna bark powder along with statin for 3 months resulted in a 15% decrease in total cholesterol, 11% decrease in serum triglyceride level and 16% decrease in LDL cholesterol. There was a minimal decline in lipoprotein and nitrite levels. The result suggests that Arjuna may work synergistically with statin in hyperlipidaemia.
The cardioprotective effects of Arjuna are partly related to its antioxidant activities, and several studies have shown that Arjuna protects the heart against myocardial ischaemic reperfusion injury.,, Arjunolic acid has furthermore been shown to prevent the decrease in the levels of superoxide dismutase, catalase, glutathione peroxidase, ceruloplasmin, alpha-tocopherol, glutathione (GSH), ascorbic acid, lipid peroxide and myeloperoxidase in experimental myocardial necrosis in rats and to restore the electrocardiographic changes towards normalcy. More recently, arjuna has been shown to enhance the cardiac intracellular antioxidant activity. Histological studies also supported the protective role of arjuna. On the evaluation at the end of 3 months therapy with bark of T. arjuna, it was found that treadmill test grading of positivity was reduced significantly and exercise tolerance of patients increased.
| Conclusions|| |
It can be concluded that in patients of CAD, T. arjuna can significantly reduce blood pressure and favourably modify lipid profile. It might also have antioxidant properties and may be beneficial for cardiac as well as overall health.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Fowkes FG, Price JF, Rumley A, Lowe GD. Hemostatic Heart Attack/Coronary Artery Disease. New York: Mount Sinai Hospital; 1977.
Dwivedi S. Terminalia arjuna
Wight & Arn – A useful drug for cardiovascular disorders. J Ethnopharmacol 2007;114:114-29.
Seneviratine CK, Thabrew MI, Abeysekra AM. Antiradical and antiperoxidative effect of some plant extract used by Sri Lankan traditional medical practitioners for cardioprotection. Pyhtother Rev 2001;15:519-23.
Ram A, Lauria P, Gupta R, Kumar P, Sharma VN. Hypocholesterolaemic effects of Terminalia arjuna
tree bark. J Ethnopharmacol 1997;55:165-9.
. Altern Med Rev 1999;4:436-7.
Malik N, Dhawan V, Bahl A, Kaul D. Inhibitory effects of Terminalia arjuna
on platelet activation in vitro
in healthy subjects and patients with coronary artery disease. Platelets 2009;20:183-90.
Dwivedi S, Agarwal MP. Antianginal and cardioprotective effects of Terminalia arjuna
, an indigenous drug, in coronary artery disease. J Assoc Physicians India 1994;42:287-9.
Bharani A, Ganguli A, Mathur LK, Jamra Y, Raman PG. 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;54:170-5.
Bharani A, Ganguly A, Bhargava KD. Salutary effect of Terminalia arjuna
in patients with severe refractory heart failure. Int J Cardiol 1995;49:191-9.
Subramaniam S, Subramaniam R, Rajapandian S, Uthrapathi S, Gnanamanickam VR, Dubey GP, et al.
Anti-atherogenic activity of ethanolic fraction of Terminalia arjuna
bark on hypercholesterolemic rabbits. Evid Based Complement Alternat Med 2011;2011:487916.
Tiwari AK, Gode JD, Dubey GP. Effect of Terminalia arjuna
on lipid profiles of rabbit fed hypercholesterolemic diet. Int J Crude Drug Res 1990;28:43-7.
Bhatia J, Bhattacharya SK, Mahajan P, Dulivedi S. Effect of Terminalia arjuna
on coronary flow – An experimental study. Indian J Pharmacol 1998;30:118.
Verma SK, Bordia A, et al
. Efficacy of Terminalia arjuna
in chronic stable angina; a double blind placebo – Controlled, crossover study. J Res Edu Ind Med 1995;9:180-4.
Namm S, Guda Valli R, Babu BS, Lodagala DS. Possible mechanism of hypotension produced 70% alcoholic extract of Terminalia arjuna
in anaesthetized dogs. BMC Complement Altern Med. 1999;7:56-61.
Dall'Ago P, Fernandes TG, Machado UF, Belló AA, Irigoyen MC. Baroreflex and chemoreflex dysfunction in streptozotocin-diabetic rats. Braz J Med Biol Res 1997;30:119-24.
Khalil S. Effect of Statin Versus Terminalia arjuna
on Acute Myocardial Infarction. DNB Thesis (medicine). New Delhi, India: National Board of Examination; 2005.
Gauthaman K, Maulik M, Kumari R, Manchanda SC, Dinda AK, Maulik SK, et al.
Effect of chronic treatment with bark of Terminalia arjuna
: A study on the isolated ischemic-reperfused rat heart. J Ethnopharmacol 2001;75:197-201.
Karthikeyan K, Bai BR, Gauthaman K, Sathish KS, Devaraj SN. Cardioprotective effect of the alcoholic extract of Terminalia arjuna
bark in an in vivo
model of myocardial ischemic reperfusion injury. Life Sci 2003;73:2727-39.
Gauthaman K, Banerjee SK, Dinda AK, Ghosh CC, Maulik SK. Terminalia arjuna
(Roxb.) protects rabbit heart against ischemic-reperfusion injury: Role of antioxidant enzymes and heat shock protein. J Ethnopharmacol 2005;96:403-9.
Sumitra M, Manikandan P, Kumar DA, Arutselvan N, Balakrishna K, Manohar BM, et al.
Experimental myocardial necrosis in rats: Role of arjunolic acid on platelet aggregation, coagulation and antioxidant status. Mol Cell Biochem 2001;224:135-42.
Manna P, Sinha M, Sil PC. Phytomedicinal activity of Terminalia arjuna
against carbon tetrachloride induced cardiac oxidative stress. Pathophysiology 2007;14:71-8.
Jain V, Poonia A, Agrawal RP, Panwar RB, Kochar DK, Mishra SN. Effect of Terminalia arjuna
in patients of angina pectoris (A clinical trial). Indian Med Gaz 1992;2:56-9.
[Table 1], [Table 2]