Artichoke leaf extract for treating hypercholesterolaemia

Cochrane Database of Systematic Reviews

Volumn , Issue 4, 2009, Pages

  Wider, Barbara ^a   Pittler, Max H ^b   Thompson Coon, Joanna ^c   Ernst, Edzard ^a  

^a PENINSULA MEDICAL SCHOOL   (United Kingdom)

^b INSTITUTE FOR QUALITY AND EFFICIENCY IN HEALTH CARE IQWIG   (Germany)

^c Peninsula Technology Assessment Group (PenTAG)   (United Kingdom)

Author keywords

Humans; Hypercholesterolemia *drug therapy ; Phytotherapy; Plant extracts therapeutic use ; Plant leaves chemistry ; Randomized controlled trials as topic; Vegetables *chemistry

Indexed keywords

CHOLESTEROL; CYNARA SCOLYMUS EXTRACT; HIGH DENSITY LIPOPROTEIN CHOLESTEROL; LOW DENSITY LIPOPROTEIN CHOLESTEROL; PLACEBO; TRIACYLGLYCEROL;

ARTICHOKE; CHOLESTEROL BLOOD LEVEL; CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; CONTROLLED STUDY; DRUG EFFICACY; DRUG SAFETY; FAT INTAKE; HUMAN; HYPERCHOLESTEROLEMIA; PLANT LEAF; QUALITY OF LIFE; RANDOMIZED CONTROLLED TRIAL; REVIEW; SHORT COURSE THERAPY; STATISTICAL ANALYSIS; TRIACYLGLYCEROL BLOOD LEVEL; WELLBEING;

EID: 76049111897     PISSN: 1469493X     EISSN: None     Source Type: Journal    
DOI: 10.1002/14651858.CD003335.pub2     Document Type: Review

References (85)

1. Bundy 2008 {published data only} Bundy R, Walker AF, Middleton RW, Wallis C, Simpson HC. Artichoke leaf extract (Cynara scolymus) reduces plasma cholesterol in otherwise healthy hypercholesterolemic adults: A randomized, double blind placebo controlled trial. Phytomedicine 2008;15:668-75.
2. Englisch 2000 {published data only} Englisch W, Beckers C, Unkauf M, Ruepp M, Zinserling V. Efficacy of artichoke dry extract in patients with hyperlipoproteinemia. Arzneimittel-Forschung 2000;50:260-5.
3. Petrowicz 1997 {published data only} Petrowicz O, Gebhardt R, Donner M, Schwandt M, Kraft K. Effects of artichoke leaf extract (ALE) on lipoprotein metabolism in vitro and in vivo. Atherosclerosis 1997;129:147.
4. Anon 2007 {published data only} Anon. High-dose extract from the leaves of artichoke increases choleresis and lowers the cholesterol level [Hochdosierter artischockenblatterextrakt steigert cholerese und senkt cholesterinspiegel]. Schweizerische Zeitschrift fur GanzheitsMedizin 2007;19:295-8.
5. Anon 2008 {published data only} Anon. Artichoke leaf extract in the treatment of hyperlipoproteinemia [Artischockenblatterextrakt bei hyperlipoproteinamie]. Schweizerische Zeitschrift fuer GanzheitsMedizin 2008;20:73-4.
6. Dog 2003 {published data only} Dog TL, Riley D. Management of hyperlipidemia. Alternative Therapies in Health & Medicine 2003;9:28-40.
7. Dorn 1995 {published data only} Dorn M. Improvement in raised lipid levels with artichoke juice (Cynara scolymus L). British Journal of Phytotherapy 1995/1996;4:21-6.
8. Goetz 2007 {published data only} Goetz P, Le Jeune R. Artichoke, Cynara scolymus. Phytotherapie 2007;5:219-22.
9. Hausler 2003 {published data only} Hausler M, Ganzera M, Stuppner H, Abel G, Popp M. Artichoke preparations [Artischocken-praparate]. Deutsche Apotheker Zeitung 2003;143:64-73.
10. Joy 2007 {published data only} Joy JF, Haber SL. Clinical uses of artichoke leaf extract. American Journal of Health-System Pharmacy 2007;64:1904-9.
11. Kirchoff 1994 {published data only} Kirchhoff R, Beckers CH, Kirchhoff GM, Trinczek-Gaertner H, Petrowicz O, Reimann H-J. Increase in choleresis by means of artichoke extract. Phytomedicine 1994;1:107-15.
12. Kraft 2002 {published data only} Kraft K. Artichoke leaf extract and pectin may lower serum cholesterol. Focus on Alternative and Complementary Therapies 2002;7:350-1.
13. Kupke 1991 {published data only} Kupke D, Sanden von H, Trinczek-Gaertner, Lewin J, Bluemel, Reimann H-J. An evaluation of the choleretic activity of a plant-based cholagogue [Pruefung der choleretischen Aktivitaet eines pfanzlichen Cholagogums]. Zeitschrift fur Allgemeinmedizin 1991;67:1046-58.
14. Lupattelli 2004 {published data only} Lupattelli G, Marchesi S, Lombardini R, Roscini AR, Trinca F, Gemelli F, Vaudo G, et al.Artichoke juice improves endothelial function in hyperlipemia. Life Sciences 2004;76:775-82.
15. Meletis 2003 {published data only} Meletis CD. Cardiovascular disease: Phytochemical and nutritional prevention and treatment. Alternative and Complementary Therapies 2003;9:158-62.
16. Montini 1975 {published data only} Montini M, Levoni P, Ongaro A, Pagani G. Controlled application of cynarin in the treatment of hyperlipemic syndrome. Observations in 60 cases [Kontrollierte Anwendung von Cynarin in der Behandlung hyperlipaemischer Syndrome]. Arzneimittel- Forschung 1975;25:1311-4.
17. Nazni 2006 {published data only} Nazni P, Poongodi VT, Alagianambi P, Amirthaveni M. Hypoglycemic and hypolipidemic effect of Cynara scolymus among selected type 2 diabetic individuals. Pakistan Journal of Nutrition 2006;5:147-51.
18. Pittler 2001 {published data only} Pittler MH. Encouraging findings for artichoke extract in the treatment of hyperlipoproteinaemia. Focus on Alternative and Complementary Therapies 2001;6:13-4.
19. Schmiedel 2002 {published data only} Schmiedel V. Cholesterol-lowering effects of artichoke and dietary fibre [Senkung des Cholesterinspiegels durch Artischocke und Ballaststoffe]. Erfahrungsheilkunde 2002;51:405-14.
20. Springer 2003 {published data only} Springer D. High-dose artichoke improves choleresis and lowers blood lipids [Hochdosierter Artischockenextrakt steigert Cholerese und senkt die Blutfette]. Gesundes Leben 2003;80:22-5.
21. Thompson 2003 {published data only} Thompson Coon JS, Ernst E. Herbs for serum cholesterol reduction: a systematic view. Journal of Family Practice 2003;52:468-72.
22. Wolf 1996 {published data only} Wolf E. Artichoke for lowering cholesterol level. Pharmazeutische Zeitung 1996;141:35-6.
23. Adam 1979 Adam G, Kluthe R. Cholesterol-lowering effects of cynarin [Cholesterinsenkender Effekt von Cynarin]. Therapiewoche 1979;29:5673-40.
24. Alder 2003 Alder R, Lookinland S, Berry JA, et al.A systematic review of the effectiveness of garlic as an anti-hyperlipidemic agent. Journal of the American Academy of Nurse Practitioners 2003;15:120-9.
25. Allender 2007 Allender S, Peto V, Scarborough P, Boxer A, Rayner M. Coronary heart disease statistics. London: British Heart Foundation, 2007.
26. Artner-Dworzak 2000 Artner-Dworzak E, Mayr O, Mueller B, Maly K, Grunicke H. Influence of the artichoke extract on lipid metabolism. Phytomedicine 2000;Supplement II:46 SL-91.
27. Baigent 2005 Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, et al.Efficacy and safety of cholesterol-lowering treatment: Prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005;366:1267-78.
28. BHF 2009 British Heart Foundation. Health care and economic costs of CVD and CHD. available at www.heartstats.org [accessed 24 March 2009] 2009.
29. Brown 1998 Brown JE, Rice-Evans CA. Luteolin-rich artichoke extract protects low density lipoprotein from oxidation in vitro. Free Radical Research 1998;29:247-55.
30. Buckley 2007 Buckley D, Muensch J, Hamilton A, Pejic RN. Clinical inquiries. How effective are dietary interventions in lowering lipids for adults with dyslipidemia?. Journal of Family Practice 2007;56:46-8.
31. Capasso 2003 Capasso F, Gaginella TS, Grandolini G, Izzo AA. Phytotherapy: A Quick Reference to Herbal Medicine. Berlin: Springer, 2003.
32. Cima 1959 Cima G, Bonora R. Artichoke. Minerva Medica 1959;50:2288-91.
33. Egger 1997 Egger M, Zellweger-Zahner T, Schneider M, Junker C, Lengeler C, Antes G. Language bias in randomised controlled trials published in English and German. Lancet 1997;350:326-9.
34. Ernst 1998 Ernst E, de Smet PAGM, Shaw D, Murray V. Traditional remedies and the test of time. Eur J Clin Pharmacol 1998;54:99- 100.
35. Ernst 2006 Ernst E, Pittler MH, Wider B, Boddy K. The Desktop Guide to Complementary and Alternative Medicine. Edinburgh: Elsevier/Mosby, 2006.
36. Fintelmann 1996a Fintelmann V. Therapeutic profile and mechanism of action of artichoke leaf extract: hypolpemic, antioxidant, hepatoprotective and choleretic properties. Phytomedicine 1996;Supplement 1:50.
37. Fintelmann 1996b Fintelmann V. Anti-dyspeptic and lipid-lowering effects of artichoke extract [Antidyspeptische und lipidsenkende Wirkung von Artischockenextrakt]. Zeitschrift fur Allgemeinmedizin 1996;72:48-57.
38. Fintelmann 1997 Fintelmann V, Wegener T. Long-term application of artichoke leaf extract (Hepar SL forte) for dyspepsia symptoms [Langzeitanwendung von Artischockenblaetterextrakt (Hepar SL forte) bei dyspeptischem Symptomkomplex]. Phytotherapiekongress Wuerzburg 27-28 November 1997.
39. Fintelmann 1999 Fintelmann V. Artichoke leaf extract for dyspepsia symptoms. Methods and results of an observational study [Artischockenextrakt bei dyspeptischem Symptomenkomplex. Methodik und Ergebnisse einer Anwendungsbeobachtung]. Zeitschrift fuer Phytotherapie 1999;20:93-5.
40. Friis 2006 Friis S, Olsen JH. Statin use and cancer risk: an epidemiologic review. Cancer Investigation 2006;24:413-24.
41. Gebhardt 1995 Gebhardt, R. Artichoke extract - in vitro investigation of cholesterin biosynthesis inhibition [Artischockenextrakt - in vitro Nachweis einer Hemmwirkung auf die Cholesterinbiosynthese]. Med Welt 1995;46:348-50.
42. Gebhardt 1996a Gebhardt R. New findings on the effects of artichoke leaf extract [Neue Erkenntnisse zur Wirkung von Artischockenblaetterextrakt]. Z Allg Med 1996;72:20-3.
43. Gebhardt 1996b Gebhardt R. Hepatocellular actions of artichoke extracts: stimulation of biliary secretion, inhibition of cholesterol biosynthesis and antioxidant properties. Phytomedicine 1996;Supplement 1:51.
44. Gebhardt 1997 Gebhardt R. Inhibition of hepatic cholesterol biosynthesis by artichoke leaf extracts is mainly due to luteolin. Cell Bio Toxicol 1997;13:58.
45. Gebhardt 1998 Gebhardt RJ. Inhibition of cholesterol biosynthesis in primary cultured rat hepatocytes by artichoke (Cynara scolymus L.) extracts. Pharmacol Exp Ther 1998;286:1122-8.
46. Gould 2007 Gould AL, Davies GM, Alemao E, Yin DD, Cook JR. Cholesterol reduction yields clinical benefits: meta-analysis including recent trials. Clin Ther 2007;29:778-94.
47. Grundy 2004 Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, et al.Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004;110:227-39.
48. Hammerl 1959 Hammerl H, Pichler O. Über den Einfluß eines Artischockenextraktes auf die Serumlipide im Hinblick auf die Arterioskleroseprophylaxe. Wiener Klinische Wochenschrift 1959;44:853-5.
49. Held 1992 Held C. From the German-Hungarian Phytopharmaceuticals Conference. Budapest 20 November 1991 [Von der deutsch-ungarischen Phytopharmakakonferenz. Budapest 20. November 1991]. Z Klin Med 1992;47:92.
50. Herbert 1997 Herbert PR, Gaziano JM, Chan KS, Hennekens CH. Cholesterol lowering with statin drugs, risk of stroke and total mortality. JAMA 1997;278:313-21.
51. Higgins 2003 Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-60.
52. Holtmann 2003 Holtmann G, Adam B, Haag S, Collet W, Grünewald E, Windeck T. Efficacy of artichoke leaf extract in the treatment of patients with functional dyspepsia: a six-week placebo-controlled, double-blind, multicentre trial. Aliment Pharmacol Ther 2003;18:1099-105.
53. Laker 2006 Laker MF, Joint British Societies. Cardiovascular disease prevention: the new Joint British Societies' guidelines. Ann Clin Biochem 2006;43(Pt 5):335-9.
54. Law 2006 Law M, Rudnicka AK. Statin safety: A systematic review. Am J Cardiol 2006;97(8A):52C-60C.
55. Lietti 1977 Lietti A. Choleretic and cholesterol lowering properties of two artichoke extracts. Fitoterapia 1977;48:153-8.
56. Lupattelli 2004 Lupattelli G, Marchesi S, Lombardini R, Roscini AR, Trinca F, Gemelli F, Vaudo G, Mannarino E. Artichoke juice improves endothelial function in hyperlipemia. Life Sci 2004;76:775-82.
57. Mancini 1960 Mancini M, Oriente P, D'Andrea L. Artichoke. Minerva Med 1960;51:2460-3.
58. Marakis 2002 Marakis G, Walker AF, Middleton RW, Booth JC, Wright J, Pike DJ. Artichoke leaf extract reduces mild dyspepsia in an open study. Phytomedicine 2002;9:694-9.
59. Moher 1998 Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M, et al.Does quality of reports of randomised trials affect estimated of intervention efficacy reported in meta-analyses?. Lancet 1998;352:609-13.
60. Moher 1999 Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup D for the QUOROM group. Improving the quality of reporting of meta-analysis of randomised controlled trials: the QUOROM statement. Lancet 1999;354:1896-1900.
61. NCEP 2002 National Cholesterol Education Program. Third report of the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Available at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf [accessed 23 July 2008]. Bethesda, MD: National Heart, Lung, and Blood Institute, National Institute of Health, 2002. [: NIH Pub. No. 02-5215]
62. Pittler 2003 Pittler MH, White AR, Stevinson C, Ernst E. Effectiveness of artichoke extract in preventing alcohol-induced hangovers: a randomized controlled trial. CMAJ 2003;169:1269-73.
63. Poobalan 2004 Poobalan A, Aucott L, Smith WC, Avenell A, Jung R, Broom J, Grant AM. Effects of weight loss in overweight/obese individuals and long-term lipid outcomes: a systematic review. Obesity Review 2004;5:43-50.
64. Ross 1999 Ross SD, Allen IE, Connelly JE, Korenblat BM, Smith ME, Bishop D, Luo D. Clinical outcomes in statin treatment trials. Archives of Internal Medicine 1999;159:1793-1802.
65. Samochowiec 1959 Samochowiec L. Investigations on experimental atherosclerosis. Part XV. The effect of Cynara scolymus L. and Cynara cardunculus L. on the development of experimental atherosclerosis in white rats. Dissertationes Pharmaceutica 1959;11:99-113.
66. Samochowiec 1962a Samochowiec L. The action of herbs and roots of artichokes (Cynara scolymus) and cardoons (Cynara cardunculus) on the development of experimental atherosclerosis in white rats. Dissertationes Pharmaceutica 1962;14:15-122.
67. Samochowiec 1962b Samochowiec L. The effect of artichoke (Cynara scolymus) and cardoons (Cynara cardunculus) on developed atherosclerotic changes in white rats. Folia Biologica 1962;10:75-83.
68. Shimoda 2003 Shimoda H, Ninomiya K, Nishida N, Yoshino T, Morikawa T, Matsuda H, Yoshikawa M. Anti-hyperlipidemic sesquiterpenes and new sesquiterpene glycosides from the leaves of artichoke (Cynara scolymus L.): structure requirement and mode of action. Bioorganic & Medicinal Chemistry Letters 2003;13:223-8.
69. Siedek 1963 Siedek H, Hammerl H Pichler O. Choleresis and cholesterol metabolism [Cholerese und Cholesterinstoffwechsel]. Wiener Klinische Wochenschrift 1963;23:460-3.
70. Silva 2006 Silva MA, Swanson AC, Gandhi PJ, Tataronis GR. Statin-related adverse events: a meta-analysis. Clinical Therapeutics 2006;28:26-35.
71. Sterne 2001 Sterne JAC, Egger M, Davey Smith G. Investigating and dealing with publication and other biases. In: Egger M, Davey Smith G, Altman G editor(s). Systematic reviews in healthcare Meta-analysis in context. 2nd Edition. London: BMJ publishing group, 2001:189-208.
72. Stevinson 2000 Stevinson C, Pittler MH, Ernst E. Garlic for treating hypercholesterolemia. Annals of Internal Medicine 2000;133:420-9.
73. Thompson 2001 Thompson SG. Why and how sources of heterogeneity should be investigated. In: Egger M, Davey Smith G, Altman G editor(s). Systematic reviews in healthcare Meta-analysis in context. 2nd Edition. London: BMJ publishing group, 2001:157-75.
74. Verschuren 1995 Verschuren WM, Jacobs DR, Bloemberg BP, Kromhout D, Menotti A, Aravanis C, et al.Serum total cholesterol and longterm coronary heart disease mortality in different cultures: twenty five year follow up of the seven countries study. JAMA 1995;274:131-6.
75. von Weiland 1973 von Weiland HH, Kindler K, Kranzl CH. The influence of cynarin on hyperlipidaemia in general and on type II in particular (hypercholesterolaemia) [Uber den Einfluss von Cynarin auf Hyperlipidamien unter besonderer Berucksichtigung des Typs II (Hypercholesterinamie)]. Wiener Medizinische Wochenschrift 1973;41:601-5.
76. Vorberg 1980 Vorberg G. Cynarix. Therapeutic experiences with Cynarix in disorders of fat metabolism in general practice [Cynarix. Therapeutische Erfahrungen bei Fettstoffwechselstorungen mit Cynarix in der Allgemeinpraxis]. Zeitschrift fur Allgemeinmedizin 1980;56:1598- 1602.
77. Walker 2001 Walker AF, Middleton RW, Petrowicz O. Artichoke leaf extract reduces symptoms of irritable bowel syndrome in a post-marketing surveillance study. Phytotherapy Research 2001;15:58-61.
78. Wegener 1995 Wegener T. About the therapeutic activity of the artichoke [Zur therapeutischen Wirksamkeit von Artischockenextrakt]. Zeitschrift fuer Phytotherapy 1995;16:81.
79. WHO 2002 World Health Organization. The world health report 2002 - Reducing Risks, Promoting Healthy Life. Available at http://www.who.int/ whr/2002/en/ [accessed 23 July 2008]. Geneva: World Health Organization, 2002.
80. Wojcicki 1975 Wojcicki J, Winter S. Effect of preparation cynarex on the blood serum lipids level of the workers exposed to the chronic action of carbon disulphide. Medycyna Pracy 1975;26:213-7.
81. Wojcicki 1976 Wojcicki J. Effect of 1,5-dicaffeoylquinic acid on ethanol- induced hypertriglyceridemia. Arzneim-Forsch/Drug Res 1976;26:2047.
82. Wojcicki 1978 Wojcicki J. Effects of 1,5-dicaffeoylquinic acid (cynarin) on cholesterol levels in serum and liver of acute ethanol-treated rats. Drug Alcohol Dep 1978;3:143.
83. Wojcicki 1981 Wojcicki J, Samochowiec L, Kosmider K. Influence of an extract from artichoke (Cynara scolymus L.) on the level of lipids in serum of aged men. Herba Polonica 1981;27:265-8.
84. Pittler 1998 Pittler MH, Ernst E. Artichoke leaf extract for serum cholesterol reduction. Perfusion 1998;11:338-340.
85. Pittler 2002 Pittler MH, Thompson Coon J, Ernst E. Artichoke leaf extract for treating hypercholesterolaemia. Cochrane Database of Systematic Reviews 2002, Issue 3. [DOI: 10.1002/14651858.CD003335]