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A COMPREHEnSiVE
liTERATuRE REViEw finDS
THAT PHYSiCiAnS knOw
SuRPRiSinGlY liTTlE AbOuT
THEiR CARDiAC PATiEnTS’
DiETARY SuPPlEMEnT uSE
– A SiTuATiOn THAT COulD
COMPROMiSE THE EffECTiVE
TREATMEnT Of SERiOuS
HEART COnDiTiOnS.
over 500 articles were retrieved and
20 studies met the criteria for the review.
Their meta-analysis revealed that while the
use of dietary supplements is common –
with up to 64 per cent of cardiac patients
taking supplements – most treating
physicians (40 to 95 per cent) are not aware
of their patients’ supplement use.
The research found that when patients were
asked why they did not disclose
supplement use to their doctors, they
placed the responsibility with their doctors,
saying that they thought their doctors
would ask if the issue was of significance.
“This has profound implications,” said
Professor Kiat. “For more than half of all
doctors never to ask about medications
other than prescription medications is
potentially troubling.”
Professor Kiat’s concern lies in the fact that
supplements could potentially interfere
with the effectiveness of prescription
medications or produce clinically important
drug interactions.
“A typical example is blood thinners, which
are widely used in cardiology,” said Professor
Kiat. “Warfarin, aspirin and clopidogrel, for
example, are potent drugs in themselves.
“Many patients, however, take additional
supplements that have blood thinning
properties – such as ginkgo, fish oil, vitamin
e, ginger, garlic and glucosamine.
Alternatively, some patients take vitamin K
or St John’s wort, which could reduce the
blood thinning effect of warfarin. either way,
these supplements and possibly others may
result in deleterious effects for a patient.
“We have not yet had robust clinical studies
evaluating the impact of supplements on
prescription medications, so this situation is
further complicated.
“even if patients did disclose their
supplement use – and many patients might
be taking three to five different types of
supplements – then it is still difficult for a
doctor to control or adjust the prescription
medication accordingly.”
Because of the potential for negative effects,
Professor Kiat says change is needed.
“It is very important that doctors ask
specifically what complementary medicines
their patients are taking, in addition to their
questions about prescription medication,”
explained Professor Kiat.
“The key is that doctors must actually ask
this question in order to give patients a
window of opportunity to disclose
pertinent information.”
But this alone is not enough. In addition to
more research on the interaction between
alternative and prescription medicines,
pharmacology training around this is
important.
“even if the research exists, if a doctor
doesn’t know what fish oil does, then that is
an impediment to his or her practice,”
explained Professor Kiat. “education in at
least the most commonly used supplements,
the top ten – such as ginkgo, ginseng, folic
acid, vitamin e, evening primrose oil and fish
oil – would make a difference.”
Ideally, this education would form part of
pharmacology training in medical schools,
but it could also be available as continuing
education for doctors already practicing.
There are also cultural differences that doctors
need to be aware of. The Chinese community
might make extensive use of ginseng, but a
patient from the Arab community may
never have heard of this supplement.
Doctors must be able to address different
communities’ habits. education and
awareness training could target doctors
working in specific communities to make
sure they have culturally relevant knowledge.
Professor Kiat says that some advanced and
informal training is already happening. For
example, the complementary medicine and
education group (CompleMeD) at the
University of Western Sydney, to which he
belongs, is comprised of scientists and
doctors undertaking robust research into
complementary medicine and promoting
awareness and education to GPs and
specialists.
“Whether we like it or not, our patients are
taking complementary medicines,” noted
Professor Kiat. “We may agree or disagree,
but it’s happening and it’s our duty as
physicians to know what a patient is taking
and how to respond effectively.”
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