Efficacy of Chamomile-Lemon Balm Syrup in Patients With Conventional Drug-Resistant Cardiac Syndrome X: A Single-Arm Clinical Trial

Objectives: Treatment of cardiac syndrome X (CSX) remains a major challenge for conventional medicine. In this regard, developing new natural treatments could be an alternative choice. This study was planned to appraise the efficacy of chamomile-lemon balm syrup on chest pain and quality of life in patients with conventional drug-resistant CSX. Materials and Methods: 29 participants with conventional drug-resistant were enrolled in a single-arm clinical trial, and 14 participants completed the study protocol. Chamomile (Matricaria chamomilla L.)-lemon balm (Melissa officinalis L.) syrup was provided for the treatment for the 90-day study period. All conventional treatments of CSX remained unchanged. Efficacy assessment included Seattle Angina Questionnaires (SAQ), 36-item short form survey, and the Hospital Anxiety and Depression Scale (HADS). Results: An improvement was observed in the total score of all questionnaires with statistically significant changes over time of the study (P<0.001). Conclusions: Chamomile-lemon balm syrup showed promising results in improving effect on angina symptoms, quality of life, and anxiety and depression in the patients with drug-resistant CSX. However, a placebo-controlled trial should be performed to verify these data.

[1]  A. Kazemnejad,et al.  Effects of Melissa officinalis on anxiety and sleep quality in patients undergoing coronary artery bypass surgery: A double-blind randomized placebo controlled trial , 2019, European Journal of Integrative Medicine.

[2]  Yara M Zain,et al.  Experimental and clinical antihypertensive activity of Matricaria chamomilla extracts and their angiotensin‐converting enzyme inhibitory activity , 2018, Phytotherapy research : PTR.

[3]  F. Crea,et al.  Microvascular angina: prevalence, pathophysiology and therapy. , 2018, Journal of cardiovascular medicine.

[4]  M. Zarshenas,et al.  Convenient, Traditional and Alternative Therapies for Cardiovascular Disorders. , 2017, Current pharmaceutical design.

[5]  Shanshan Wang,et al.  Apigenin and naringenin ameliorate PKCβII-associated endothelial dysfunction via regulating ROS/caspase-3 and NO pathway in endothelial cells exposed to high glucose. , 2016, Vascular pharmacology.

[6]  A. Sahebkar,et al.  Melissa officinalis L. - A review of its traditional uses, phytochemistry and pharmacology. , 2016, Journal of ethnopharmacology.

[7]  S. Joukar,et al.  The effects of Melissa officinalis (lemon balm) pretreatment on the resistance of the heart to myocardial injury , 2016, Pharmaceutical biology.

[8]  A. Noorbala,et al.  Heart palpitation relief with Melissa officinalis leaf extract: double blind, randomized, placebo controlled trial of efficacy and safety. , 2015, Journal of ethnopharmacology.

[9]  Christopher M Kramer,et al.  Coronary microvascular dysfunction, microvascular angina, and treatment strategies. , 2015, JACC. Cardiovascular imaging.

[10]  G. Ulrich-Merzenich Combination screening of synthetic drugs and plant derived natural products—Potential and challenges for drug development , 2014 .

[11]  S. Joukar,et al.  Efficacy of Melissa officinalis in Suppressing Ventricular Arrhythmias following Ischemia-Reperfusion of the Heart: A Comparison with Amiodarone , 2014, Medical Principles and Practice.

[12]  H. Ebrahim,et al.  Quality of life in angina pectoris patients: Assessing with the Seattle Angina Questionnaire (SAQ) , 2014 .

[13]  Wei Zhou,et al.  Systems pharmacology strategies for drug discovery and combination with applications to cardiovascular diseases. , 2014, Journal of ethnopharmacology.

[14]  Stephen P. H. Alexander,et al.  Distinct mechanisms of relaxation to bioactive components from chamomile species in porcine isolated blood vessels. , 2013, Toxicology and applied pharmacology.

[15]  H. Shang,et al.  Potential effectiveness of traditional Chinese medicine for cardiac syndrome X (CSX): a systematic review and meta-analysis , 2013, BMC Complementary and Alternative Medicine.

[16]  S. Ganapaty,et al.  Anti-ischemic Effect of German Chamomile (Matricaria recutita L.) Against Ischemia/reperfusion Induced Myocardial Damage in Isolated Rat Heart , 2012 .

[17]  E. Jones,et al.  Cardiac syndrome X and microvascular coronary dysfunction. , 2012, Trends in cardiovascular medicine.

[18]  G. Teule,et al.  Long-term prognosis of patients with cardiac syndrome X: a review , 2012, Netherlands Heart Journal.

[19]  C. Pepine,et al.  Syndrome X and Microvascular Coronary Dysfunction , 2011, Circulation.

[20]  Sarabjeet Singh,et al.  Cardiac syndrome X: current concepts. , 2010, International journal of cardiology.

[21]  F. Crea,et al.  Primary Coronary Microvascular Dysfunction: Clinical Presentation, Pathophysiology, and Management , 2010, Circulation.

[22]  T. Jalili,et al.  Quercetin: A Treatment for Hypertension?—A Review of Efficacy and Mechanisms , 2010, Pharmaceuticals.

[23]  C. Lang,et al.  Therapeutic development in cardiac syndrome X: a need to target the underlying pathophysiology. , 2009, Cardiovascular therapeutics.

[24]  G. Teule,et al.  Association between anxiety disorder and the extent of ischemia observed in cardiac syndrome X , 2009, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[25]  I. Orhan,et al.  Endothelium-dependent induction of vasorelaxation by Melissa officinalis L. ssp. officinalis in rat isolated thoracic aorta. , 2008, Phytomedicine : international journal of phytotherapy and phytopharmacology.

[26]  R. Carrillo,et al.  Mental stress-induced myocardial ischemia in women with angina and normal coronary angiograms , 2006, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[27]  G. Lanza,et al.  Cardiac syndrome X: a critical overview and future perspectives , 2005, Heart.

[28]  V. P. Pakhomov,et al.  Improved Method of Flavonoid Extraction from Bird Cherry Fruits , 2005, Pharmaceutical Chemistry Journal.

[29]  B. Gandek,et al.  The Short Form Health Survey (SF-36): Translation and validation study of the Iranian version , 2005, Quality of Life Research.

[30]  F. Crea,et al.  Assessment of systemic inflammation and infective pathogen burden in patients with cardiac syndrome X. , 2004, The American journal of cardiology.

[31]  Filippo Crea,et al.  Angina pectoris and normal coronary arteries: cardiac syndrome X , 2004, Heart.

[32]  M. Kayıkçıoğlu,et al.  Benefits of statin treatment in cardiac syndrome-X1. , 2003, European heart journal.

[33]  N. Farnsworth,et al.  The value of plants used in traditional medicine for drug discovery. , 2001, Environmental health perspectives.

[34]  W H Rogers,et al.  Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. , 1995, Medical care.

[35]  R A Deyo,et al.  Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease. , 1995, Journal of the American College of Cardiology.

[36]  A. Yeung,et al.  The effect of atherosclerosis on the vasomotor response of coronary arteries to mental stress. , 1991, The New England journal of medicine.

[37]  A. Stewart,et al.  The MOS short-form general health survey. Reliability and validity in a patient population. , 1988, Medical care.

[38]  Vahid Aliannezhadi,et al.  A Review of Aromatherapy for Cardiovascular Disorders: From Persian Medicine to Current Evidence , 2021 .

[39]  P. Dehghan,et al.  The effects of Melissa officinalis (lemon balm) in chronic stable angina on serum biomarkers of oxidative stress, inflammation and lipid profile. , 2018, Asia Pacific journal of clinical nutrition.

[40]  Zahra Memariani,et al.  Medicinal plants with antithrombotic property in Persian medicine: a mechanistic review , 2017, Journal of Thrombosis and Thrombolysis.

[41]  C. N. Bairey Merz,et al.  Cardiac Syndrome X: Update. , 2016, Heart failure clinics.

[42]  D. Kaushik,et al.  PHARMACOLOGICAL POTENTIAL OF MATRICARIA RECUTITA-A REVIEW , 2010 .

[43]  H. Kaviani,et al.  Reliability and validity of anxiety and depression hospital scales (HADS): Iranian patients with anxiety and depression disorders. , 2009 .

[44]  J. Kaski,et al.  Role of inflammation and endothelial dysfunction in the pathogenesis of cardiac syndrome X. , 2006, Future cardiology.