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Cardiovascular toxicity associated with supplement use.

Justin Corcoran1,2

  • 1Department of Emergency Medicine, Division of Medical Toxicology, Medical College of Wisconsin, Milwaukee, WI, USA.

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Summary

Dietary supplements can cause serious heart problems through various mechanisms, including stimulant effects, ion channel poisoning, and endocrine disruption. Awareness is crucial as these can lead to life-threatening cardiovascular toxicity.

Keywords:
Cardioactive steroidscardiovascular toxicityendocrine modulatorsion channel poisonsstimulantssupplements

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Area of Science:

  • Cardiology
  • Toxicology
  • Pharmacology

Background:

  • Dietary supplement use is increasing, with limited FDA regulation primarily relying on post-marketing surveillance.
  • Supplements pose cardiovascular safety risks due to adulteration, substitution, or inherent toxicity.
  • Mechanisms of supplement-induced cardiovascular toxicity include stimulant effects, ion channel poisoning, cardioactive steroids, and endocrine modulation.

Purpose of the Study:

  • To review the mechanisms and clinical significance of cardiovascular toxicity associated with dietary supplement use.
  • To inform clinicians about potential life-threatening cardiovascular events linked to supplements.

Main Methods:

  • Literature review of reported cases and mechanisms of supplement-induced cardiovascular toxicity.
  • Categorization of toxic effects based on the active supplement components and their physiological targets.

Main Results:

  • Central nervous system stimulants (e.g., ephedra, synephrine) can cause tachycardia, hypertension, myocardial infarction, and cardiac arrest.
  • Cardiac ion channel poisoning (e.g., aconitine, grayanotoxins, berberine) can lead to arrhythmias like wide complex dysrhythmias and torsade de pointes.
  • Cardioactive steroids and endocrine modulators (e.g., black licorice) can result in severe toxicity, including hypokalemia and fatal arrhythmias.

Conclusions:

  • Cardiovascular toxicity from supplements, though rare, can be severe and life-threatening.
  • Multiple mechanisms contribute to supplement-induced heart damage.
  • Clinicians must be vigilant regarding potential cardiovascular poisoning from dietary supplements.