Herbal-based medications have been used as therapeutic agents for thousands of
years, particularly in Asian cultures. It is now well established that these
herbal medications contain potent bioactive phytochemicals which exert a plethora
of beneficial effects such as those seen on the cardiovascular system. Among the
most widely studied of these herbal agents is ginseng, a member of the genus
Panax
, which has been shown to produce beneficial effects in terms of
reducing cardiac pathology, at least in experimental studies. The beneficial
effects of ginseng observed in such studies are likely attributable to their
constituent ginsenosides, which are steroid-like saponins of which there are at
least 100 and which vary according to ginseng species. Many ginseng species such
as
Panax ginseng
(also known as Asian ginseng) and
P
quinquefolius
(North American ginseng) as well as specific ginsenosides have
been shown to attenuate hypertrophy as well as other indices of myocardial
remodeling in a wide variety of experimental models.
Ginkgo biloba
on
the other hand has been much less studied although the leaf extract of the
ancient ginkgo tree has similarly consistently been shown to produce
anti-remodeling effects. Ginkgo’s primary bioactive constituents are thought to
be terpene trilactones called ginkgolides, of which there are currently seven
known types. Ginkgo and ginkgolides have also been shown to produce
anti-remodeling effects as have been shown for ginseng in a variety of
experimental models, in some cases via similar mechanisms. Although a
common single mechanism for the salutary effects of these compounds is unlikely,
there are a number of examples of shared effects including antioxidant and
antiapoptotic effects as well as inhibition of pro-hypertrophic intracellular
signaling such as that involving the calcineurin pathway which results in the
upregulation of pro-hypertrophic genes. Robust clinical evidence represented by
large scale phase 3 trials is lacking although there is limited supporting
evidence from small trials at least with respect to ginseng. Taken together, both
ginseng and ginkgo as well as their bioactive components offer potential as
adjuvant therapy for the treatment of myocardial remodeling and heart failure.