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  • Cardioprotective Potential of Polyherbal Formulations: A Critical Review

  • RJS College of Pharmacy Kokamthan, Kopargaon

Abstract

Cardiovascular disease are the most common cause of death worldwide, , especially in developed and developing countries, it plays a major role in increasing mortality rates [1]. Hypertension, myocardial infarction, cardiomyopathy and heart failure continue to emerge as major public health problems that warrant the development of safer and more effective therapeutic strategies. While synthetic cardioprotective medicines including beta-blockers, calcium channel blockers, ACE inhibitors, and statins are commonly employed, the nonlinear administration of these medications is frequently accompanied by defects and toxicity. [1,2] Traditional medicinal systems rely on herbal drugs, especially polyherbal formulations for the management of cardiac disorders. Polyherbal therapy is based on the idea of synergism, where different herbs work together to improve effectiveness and reduce toxicity.The present systematically reviews commonly used medicinal plants in cardiac polyherbal formulations, their phytoconstituents, mechanisms of action, and experimental evaluation methods. Furthermore, issues related to standardization, quality control, and marketed formulations are discussed.Evidence suggests that polyherbal formulations exert cardioprotective effects through antioxidant, anti-inflammatory, antihyperlipidemic, and membrane-stabilizing mechanisms. However, the lack of large-scale clinical validation remains a major limitation. Future research should focus on molecular mechanism studies, clinical trials, and advanced drug delivery systems for improved therapeutic outcomes.

Keywords

Polyherbal formulation; Cardioprotective activity; Herbal medicine; Synergism; Cardiac evaluation; Phytoconstituents

Introduction

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Cardiovascular diseases are a significant global health issue, and they're also a leading cause of death around the world. The World Health Organization reports that almost 17.9 million people die annually from these diseases, which represents about 32% of all deaths globally. A substantial number of these fatalities stem from heart attacks and strokes. The rising incidence of cardiovascular diseases is closely linked to lifestyle choices, including a lack of exercise, poor eating habits, smoking, obesity, and psychological stress. [3,4] Developing countries are grappling with a significant increase in non-communicable diseases, especially cardiovascular ones, in recent years. Recent epidemiological studies revealed that cardiovascular diseases are responsible for approximately one-fourth of total deaths in India. Urbanization, shifts in lifestyle, and the rising incidence of heart conditions among young adults have emerged as significant factors contributing to an increase in cardiovascular disease–associated morbidity and mortality. [3] Oxidative stress, inflammation, endothelial dysfunction, and dyslipidemia are among the various pathological factors involved in the initiation and progression of cardiovascular diseases. Various cardiovascular disorders like hypertension, atherosclerosis, myocardial infarction, heart failure interfere with the normal functioning of the heart. [31–34] Currently, traditional therapies such as statins, ACE inhibitors, β-blockers, and diuretics are utilized for the management and prevention of cardiovascular disorders. Despite reducing mortality rates and curing patients, several adverse effects associated with prolonged use are observed, including hepatotoxicity, renal dysfunction, and disturbances in electrolyte balance. In addition, drug interactions may occur when multiple medications are prescribed. Therefore, researchers are now focusing on alternative treatment options that are effective with fewer side effects. [30] Herbal medicines have been practiced since ancient times for the prevention and treatment of several diseases, including cardiovascular diseases, in traditional systems of medicine such as Ayurveda. Several herbs for the management of Hridroga (cardiac diseases) have been described in ancient Ayurvedic texts such as Charaka Samhita. Herbal drugs are composed of various phytoconstituents such as flavonoids, alkaloids, tannins, phenolic compounds, and glycosides that exhibit antioxidant, anti-inflammatory, antihyperlipidemic, and cardioprotective effects [24,25]  Hence, this review will emphasize a critical evaluation of the cardioprotective activity of polyherbal formulations, highlighting phytochemical constituents, mode of action, experimental systems used for assessment, and future perspectives in the management of cardiovascular diseases

2. Concept of polyherbal formulation

Poly herbal formulation is the admixture of more than one medicinal plants in one dosage form. The rationale behind polyherbal therapy lies in the concept of synergism, where the combined effect of herbs is greater than the sum of their individual effects.

2.1. Ayurvedic Perspective

Ayurveda emphasizes “Yogavahi” and “Samskara” principles, where herbs enhance each other’s potency and reduce toxicity.

2.2. Modern Scientific Perspective

Scientific studies demonstrate that multiple phytoconstituents target different pathways involved in cardiac pathology, such as oxidative stress, inflammation, lipid metabolism, and calcium regulation. [31–34]

Advantages

  1. Multi-target mechanism
  2. Reduced side effects
  3. Lower dose requirement
  4. Improved patient compliance

3. Medicinal Plants Used in Cardiac Polyherbal Formulations

Several medicinal plants have demonstrated cardioprotective activity.

Table 1. Cardioprotective Commonly Used Medicinal Plant and Their Properties

Sr.No.

Scientific Name of Medicine

Common Name

Part Used

Major Phytoconstituent

Pharmacological Activity

1

Terminalia arjuna

Arjuna

Bark

Arjunolic acid, tannins

Anti-ischemic, antioxidant

2

Withania somnifera

Ashwagandh

Root

Withanolides

Anti-inflammatory

3

Allium sativum

Garlic

Bulb

Allicin

Hypolipidemic

4

Ocimum sanctum

Tulsi

Leaves

Eugenol

Antioxidant

5

Boerhavia diffusa

Punarnava

Root

Alkaloids

cardioprotective

6

Camelia Sinesis

Green tea

Leaves

Catechins, Caffeine, Epicatechin, Flavonoids

Antioxodent, Antihypertensive, Antiplatelet

7

Emblica Officinalis

Amla

Fruit

Vitamin C, Gallic acid, Ellagic Acid

Antiatherosclerotic, Hypolipidemic

8

Ginkgo Biloba

Ginkgo

Leaves

Ginkgolides, Flavonoids

Improves Circulation, Catdioprotective

9

Curcumin Longa

Turmeric

Rhizo-me

Curcumin

Anti-inflammatory, Antioxidant

10

Panax ginseng

Ginseng

Root

Ginsenosides

Cardioprotective,

Anti-Stress

11

Rauvolfia serpentina

Sarpagandha

Root

Reserpine, Alkaloids, Glycosides

Antihypertensive, Cardioprotective

12

Tinospora terrestris

Guduchi

Stem

Tinosporin, Alkaloids, Glycosides

Antioxident

13

Nigella Sativa

Black seed

Seed

Thymoquinone

Hypolipidemic

14

Tribulus terrestris

Gokshura

Fruit

Saponins, Flavonoids

Hypolipidemic

15

Hibiscus rosa-sinensis

Hibiscus

Flower

Anthocyanins, Flavonoids

Anti-hypertensive, Antioxident

4. Phytochemicals in Phytotherapy with Effects on the Heart

1) Flavonoids - represent an important class of potent antioxidants that lower oxidative stress and lipid peroxidation.

2) Alkaloids - have hypotensive and vasodiolation properties.

3) Cardiac glycosides – increase myocardial contractility and regulates heart rate.

4) Saponins & Phenolic Compounds - positively influence lipid profile and stabilize cell membrane.

5. The Proposed Mechanisms for Cardioprotective Activity

1) Anti-oxidative Mechanism - reduction of myocardial damage occurs from scavenging reactive oxygen species.

2) Antihyperlipidemic Mechanism - lowering of low-density lipoproteins and triglycerides decreases risk of atherosclerosis.

3) Anti-inflammatory Mechanism - inhibiting cytokines such as tumor necrosis factor and interleukins decreases cardiac inflammation.

4) Calcium Channel Modulation - regulates intracellular calcium overload during ischaemia. 5) Stabilising Myocardial Membranes - decreases leakage of cardiac biomarkers.

CONCLUSION

Polyherbal formulations have significant cardioprotective activity with antioxidant, anti-inflammatory, antihyperlipidaemic, and stabilising characteristics. The combined use of multiple herbs increases effectiveness and reduces toxicity. However, due to inadequate clinical validation of the findings from the above studies, polyherbal formulations lack global acceptance. The future of this area of research should focus on standardisation, mechanistic studies, and well-designed clinical studies to confirm the safety and efficacy of polyherbal cardioprotective formulations.

REFERENCE

  1. World Health Organization. Cardiovascular diseases (CVDs). Geneva: WHO; 2023.
  2. Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases. J Am Coll Cardiol. 2020;76(25):2982–3021.
  3. Gupta R, Mohan I, Narula J. Trends in coronary heart disease epidemiology in India. Ann Glob Health. 2016;82(2):307–315.
  4. Yusuf S, Hawken S, Ounpuu S, et al. Effect of modifiable risk factors. Lancet. 2004;364(9438):937–952.
  5. Dwivedi S. Terminalia arjuna in cardiovascular disease. J Ethnopharmacol. 2007;114(2):114–129.
  6. Bharani A, Ganguli A, Mathur LK. Efficacy of Terminalia arjuna in chronic stable angina. Indian Heart J. 2002;54(2):170–175.
  7. Singh N, Bhalla M, Jager PD, Gilca M. Withania somnifera—An overview. Altern Med Rev. 2011;16(1):46–66.
  8. Banerjee SK, Maulik SK. Effect of Withania somnifera on oxidative stress. Phytother Res. 2003;17(6):647–652.
  9. Rahman K. Effects of Allium sativum on cardiovascular disorders. J Nutr. 2001;131(3):977S–979S.
  10. Amagase H. Clarifying the real bioactive constituents of Allium sativum. J Nutr. 2006;136(3):716S–725S.
  11. Cohen MM. Ocimum sanctum: a review. J Ayurveda Integr Med. 2014;5(4):251–259.
  12. Chatterjee TK. Boerhavia diffusa cardioprotective effect. Indian Drugs. 1994;31(10):450–452.
  13. Satoskar RS, Bhandarkar SD, Ainapure SS. Pharmacology and Pharmacotherapeutics. 24th ed. Mumbai: Popular Prakashan; 2015.
  14. Harborne JB. Phytochemical Methods. 3rd ed. London: Chapman & Hall; 1998.
  15. Kokate CK. Practical Pharmacognosy. 5th ed. Pune: Nirali Prakashan; 2010.
  16. WHO. Quality control methods for medicinal plant materials. Geneva; 2011.
  17. Benzie IF, Strain JJ. FRAP assay. Anal Biochem. 1996;239(1):70–76.
  18. Blois MS. DPPH assay. Nature. 1958; 181:1199–1200.
  19. Re R, Pellegrini N, Proteggente A. ABTS assay. Free Radic Biol Med. 1999;26(9–10):1231–1237.
  20. Wexler BC. Isoproterenol-induced myocardial infarction model. Circ Res. 1978;42(1):55–63.
  21. Octavia Y, Tocchetti CG. Doxorubicin-induced cardiomyopathy. J Mol Cell Cardiol. 2012;52(6):1213–1225.
  22. Upaganlawar A, Gandhi C, Balaraman R. Cardioprotective effect of plant extracts. Pharmacol Rep. 2011;63(2):345–352.
  23. Ojha S, Nandave M, Kumari S. Cardioprotective activity of herbal extracts. Exp Toxicol Pathol. 2008;60(4–5):255–261.
  24. Ekor M. Safety of herbal medicines. Front Pharmacol. 2014; 4:177.
  25. Parasuraman S, Thing GS, Dhanaraj SA. Polyherbal formulation concept. J Young Pharm. 2014;6(3):1–6.
  26. Williamson EM. Synergy in herbal medicines. Phytomedicine. 2001;8(5):401–409.
  27. Wagner H. Synergy research in phytomedicine. Fitoterapia. 2011;82(1):34–37.
  28. Chopra RN, Nayar SL, Chopra IC. Glossary of Indian Medicinal Plants. CSIR; 2006.
  29. Trease GE, Evans WC. Pharmacognosy. 16th ed. Saunders; 2009.
  30. Rang HP, Dale MM, Ritter JM. Pharmacology. 8th ed. Elsevier; 2016.
  31. Hansson GK. Inflammation and atherosclerosis. N Engl J Med. 2005;352(16):1685–1695.
  32. Madamanchi NR, Vendrov A, Runge MS. Oxidative stress and vascular disease. Arterioscler Thromb Vasc Biol. 2005;25(1):29–38.
  33. Siti HN, Kamisah Y, Kamsiah J. The role of oxidative stress in cardiovascular diseases. Vasc Pharmacol. 2015; 71:40–56.
  34. Goyal BR, Agrawal BB, Goyal RK, Mehta AA. Phyto-pharmacology of Terminalia arjuna. Phytother Res. 2007;21(8):727–736.
  35. Maulik SK, Kumar S. Oxidative stress and cardiac hypertrophy. Indian J Exp Biol. 2012;50(2):83–91.
  36. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors. Lancet. 2004;364(9438):937–952.
  37. Kannel WB. Risk factors in coronary heart disease. Am Heart J. 1987;114(4):918–925.
  38. Tiwari AK. Antioxidants: new-generation therapeutics. Curr Sci. 2001;80(9):1179–1187.
  39. Anand P, Kunnumakkara AB, Sundaram C, et al. Cancer is a preventable disease. Pharm Res. 2008;25(9):2097–2116.
  40. Patel SS, Acharya A, Ray RS, et al. Cardioprotective potential of medicinal plants. J Tradit Complement Med. 2021;11(5):432–445.
  41. Salehi B, Ata A, Anil Kumar NV, et al. Antioxidants from natural sources. Antioxidants. 2018;7(12):180.
  42. Newman DJ, Cragg GM. Natural products as sources of new drugs. J Nat Prod. 2020;83(3):770–803.
  43. Atanasov AG, Waltenberger B, Pferschy-Wenzig EM, et al. Discovery of plant-derived compounds. Biotechnol Adv. 2015;33(8):1582–1614.
  44. Kumar S, Pandey AK. Chemistry and biological activities of flavonoids. Sci World J. 2013; 2013:162750.
  45. Gupta SK, et al. Herbal medicines in cardiovascular disorders. Curr Pharm Des. 2018;24(30):3571–3582.
  46. Rangarajan P, Karthikeyan A. Herbal cardioprotective agents review. J Pharm Sci Res. 2019;11(3):823–829.
  47. Sharma A, Gupta R. Polyherbal formulations in cardioprotection. Pharmacogn Rev. 2020;14(27):45–52.
  48. Seca AM, Pinto DC. Biological potential of phenolic compounds. Int J Mol Sci. 2018;19(4):1030.
  49. Libby P, Hansson GK. From focal lipid storage to systemic inflammation. J Am Coll Cardiol. 2019;74(12):1594–1607.
  50. Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics update. Circulation. 2019;139(10):e56–e528.
  51. Braunwald E. The war against heart failure: the Lancet lecture. Lancet. 2015;385(9970):812–824.
  52. McMurray JJV, Pfeffer MA. Heart failure. Lancet. 2005;365(9474):1877–1889.
  53. Prabhakar PK, Doble M. Mechanism of action of natural products in cardioprotection. Phytother Res. 2011;25(3):311–321.
  54. Ojha S, Al Taee H, Goyal SN, et al. Cardioprotective effects of phytochemicals. Oxid Med Cell Longev. 2016; 2016:9057591.
  55. Dwivedi S. Terminalia arjuna: a useful drug for cardiovascular disorders. J Ethnopharmacol. 2007;114(2):114–129.
  56. Gupta R, Sharma AK, Dobhal MP, et al. Antidiabetic and antioxidant potential of herbal drugs. J Ethnopharmacol. 2011;137(1):113–120.
  57. Li H, Sureda A, Devkota HP, et al. Curcumin, the golden spice in cardioprotection. Nutrients. 2020;12(11):3168.
  58. Singh N, Dhalla AK, Seneviratne C, Singal PK. Oxidative stress and heart failure. Mol Cell Biochem. 1995;147(1-2):77–81.
  59. World Health Organization. WHO global report on traditional and complementary medicine 2019. Geneva: WHO; 2019.
  60. Bansal SS, Goel M, Aqil F, et al. Advanced drug delivery systems of herbal drugs. Drug Discov Today. 2011;16(1-2):47–54.
  61. Piepoli MF, Hoes AW, Agewall S, et al. 2016 European guidelines on cardiovascular disease prevention. Eur Heart J. 2016;37(29):2315–2381.
  62. Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics—2020 update. Circulation. 2020;141(9):e139–e596.
  63. Libby P. Inflammation in atherosclerosis. Nature. 2002;420(6917):868–874.
  64. Oparil S, Acelajado MC, Bakris GL, et al. Hypertension. Nat Rev Dis Primers. 2018; 4:18014.
  65. Tang WHW, Hazen SL. The contributory role of gut microbiota in cardiovascular disease. J Clin Invest. 2014;124(10):4204–4211.
  66. Thippeswamy BS, Mahendran S, Biradar MI, et al. Protective effect of herbal extracts in myocardial ischemia. Indian J Pharmacol. 2009;41(2):86–90.
  67. Ojha SK, Arya DS. Rauvolfia serpentina and cardiovascular disorders: A review. Journal of Ethnopharmacology. 2009;123(1):1–7.
  68. Upadhyay AK, Kumar K, Kumar A, Mishra HS. Tinospora cordifolia (Guduchi): Pharmacological and therapeutic aspects. Journal of Ethnopharmacology. 2010;128(3):409–415.
  69. Chhatre S, Nesari T, Somani G, Kanchan D, Sathaye S. Phytopharmacological overview of Tribulus terrestris. Pharmacognosy Reviews. 2014;8(15):45–51.
  70. McKay DL, Chen CY, Saltzman E, Blumberg JB. Hibiscus sabdariffa L. tea (anthocyanin-rich) and blood pressure: A clinical trial. Journal of Nutrition. 2010;140(2):298–303.
  71. Bamosa AO, Ali BA, Sowayan SA. Effect of Nigella sativa on lipid profile and cardiovascular risk factors. International Journal of Clinical Practice. 2002;56(8):588–590.
  72. Dwivedi S. Terminalia arjuna Wight & Arn. —A useful drug for cardiovascular disorders. Journal of Ethnopharmacology. 2007;114(2):114–129.
  73. Ried K, Frank OR, Stocks NP. Garlic (Allium sativum) and cardiovascular disease: A systematic review and meta-analysis. BMC Cardiovascular Disorders. 2013; 13:54.
  74. Basu A, Lucas EA. Mechanisms and effects of green tea on cardiovascular health. Nutrition Reviews. 2007;65(8):361–375.
  75. Antony B, Merina B, Sheeba V, Mukkadan J. Cardioprotective effect of Curcuma longa on myocardial ischemia. Indian Journal of Clinical Biochemistry. 2008;23(2):168–171.
  76. Kar P, Laight D, Rooprai HK, Shaw KM, Cummings M. Effects of Ginkgo biloba on cardiovascular function. Human Psychopharmacology. 2006;21(6):451–456.

Reference

  1. World Health Organization. Cardiovascular diseases (CVDs). Geneva: WHO; 2023.
  2. Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases. J Am Coll Cardiol. 2020;76(25):2982–3021.
  3. Gupta R, Mohan I, Narula J. Trends in coronary heart disease epidemiology in India. Ann Glob Health. 2016;82(2):307–315.
  4. Yusuf S, Hawken S, Ounpuu S, et al. Effect of modifiable risk factors. Lancet. 2004;364(9438):937–952.
  5. Dwivedi S. Terminalia arjuna in cardiovascular disease. J Ethnopharmacol. 2007;114(2):114–129.
  6. Bharani A, Ganguli A, Mathur LK. Efficacy of Terminalia arjuna in chronic stable angina. Indian Heart J. 2002;54(2):170–175.
  7. Singh N, Bhalla M, Jager PD, Gilca M. Withania somnifera—An overview. Altern Med Rev. 2011;16(1):46–66.
  8. Banerjee SK, Maulik SK. Effect of Withania somnifera on oxidative stress. Phytother Res. 2003;17(6):647–652.
  9. Rahman K. Effects of Allium sativum on cardiovascular disorders. J Nutr. 2001;131(3):977S–979S.
  10. Amagase H. Clarifying the real bioactive constituents of Allium sativum. J Nutr. 2006;136(3):716S–725S.
  11. Cohen MM. Ocimum sanctum: a review. J Ayurveda Integr Med. 2014;5(4):251–259.
  12. Chatterjee TK. Boerhavia diffusa cardioprotective effect. Indian Drugs. 1994;31(10):450–452.
  13. Satoskar RS, Bhandarkar SD, Ainapure SS. Pharmacology and Pharmacotherapeutics. 24th ed. Mumbai: Popular Prakashan; 2015.
  14. Harborne JB. Phytochemical Methods. 3rd ed. London: Chapman & Hall; 1998.
  15. Kokate CK. Practical Pharmacognosy. 5th ed. Pune: Nirali Prakashan; 2010.
  16. WHO. Quality control methods for medicinal plant materials. Geneva; 2011.
  17. Benzie IF, Strain JJ. FRAP assay. Anal Biochem. 1996;239(1):70–76.
  18. Blois MS. DPPH assay. Nature. 1958; 181:1199–1200.
  19. Re R, Pellegrini N, Proteggente A. ABTS assay. Free Radic Biol Med. 1999;26(9–10):1231–1237.
  20. Wexler BC. Isoproterenol-induced myocardial infarction model. Circ Res. 1978;42(1):55–63.
  21. Octavia Y, Tocchetti CG. Doxorubicin-induced cardiomyopathy. J Mol Cell Cardiol. 2012;52(6):1213–1225.
  22. Upaganlawar A, Gandhi C, Balaraman R. Cardioprotective effect of plant extracts. Pharmacol Rep. 2011;63(2):345–352.
  23. Ojha S, Nandave M, Kumari S. Cardioprotective activity of herbal extracts. Exp Toxicol Pathol. 2008;60(4–5):255–261.
  24. Ekor M. Safety of herbal medicines. Front Pharmacol. 2014; 4:177.
  25. Parasuraman S, Thing GS, Dhanaraj SA. Polyherbal formulation concept. J Young Pharm. 2014;6(3):1–6.
  26. Williamson EM. Synergy in herbal medicines. Phytomedicine. 2001;8(5):401–409.
  27. Wagner H. Synergy research in phytomedicine. Fitoterapia. 2011;82(1):34–37.
  28. Chopra RN, Nayar SL, Chopra IC. Glossary of Indian Medicinal Plants. CSIR; 2006.
  29. Trease GE, Evans WC. Pharmacognosy. 16th ed. Saunders; 2009.
  30. Rang HP, Dale MM, Ritter JM. Pharmacology. 8th ed. Elsevier; 2016.
  31. Hansson GK. Inflammation and atherosclerosis. N Engl J Med. 2005;352(16):1685–1695.
  32. Madamanchi NR, Vendrov A, Runge MS. Oxidative stress and vascular disease. Arterioscler Thromb Vasc Biol. 2005;25(1):29–38.
  33. Siti HN, Kamisah Y, Kamsiah J. The role of oxidative stress in cardiovascular diseases. Vasc Pharmacol. 2015; 71:40–56.
  34. Goyal BR, Agrawal BB, Goyal RK, Mehta AA. Phyto-pharmacology of Terminalia arjuna. Phytother Res. 2007;21(8):727–736.
  35. Maulik SK, Kumar S. Oxidative stress and cardiac hypertrophy. Indian J Exp Biol. 2012;50(2):83–91.
  36. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors. Lancet. 2004;364(9438):937–952.
  37. Kannel WB. Risk factors in coronary heart disease. Am Heart J. 1987;114(4):918–925.
  38. Tiwari AK. Antioxidants: new-generation therapeutics. Curr Sci. 2001;80(9):1179–1187.
  39. Anand P, Kunnumakkara AB, Sundaram C, et al. Cancer is a preventable disease. Pharm Res. 2008;25(9):2097–2116.
  40. Patel SS, Acharya A, Ray RS, et al. Cardioprotective potential of medicinal plants. J Tradit Complement Med. 2021;11(5):432–445.
  41. Salehi B, Ata A, Anil Kumar NV, et al. Antioxidants from natural sources. Antioxidants. 2018;7(12):180.
  42. Newman DJ, Cragg GM. Natural products as sources of new drugs. J Nat Prod. 2020;83(3):770–803.
  43. Atanasov AG, Waltenberger B, Pferschy-Wenzig EM, et al. Discovery of plant-derived compounds. Biotechnol Adv. 2015;33(8):1582–1614.
  44. Kumar S, Pandey AK. Chemistry and biological activities of flavonoids. Sci World J. 2013; 2013:162750.
  45. Gupta SK, et al. Herbal medicines in cardiovascular disorders. Curr Pharm Des. 2018;24(30):3571–3582.
  46. Rangarajan P, Karthikeyan A. Herbal cardioprotective agents review. J Pharm Sci Res. 2019;11(3):823–829.
  47. Sharma A, Gupta R. Polyherbal formulations in cardioprotection. Pharmacogn Rev. 2020;14(27):45–52.
  48. Seca AM, Pinto DC. Biological potential of phenolic compounds. Int J Mol Sci. 2018;19(4):1030.
  49. Libby P, Hansson GK. From focal lipid storage to systemic inflammation. J Am Coll Cardiol. 2019;74(12):1594–1607.
  50. Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics update. Circulation. 2019;139(10):e56–e528.
  51. Braunwald E. The war against heart failure: the Lancet lecture. Lancet. 2015;385(9970):812–824.
  52. McMurray JJV, Pfeffer MA. Heart failure. Lancet. 2005;365(9474):1877–1889.
  53. Prabhakar PK, Doble M. Mechanism of action of natural products in cardioprotection. Phytother Res. 2011;25(3):311–321.
  54. Ojha S, Al Taee H, Goyal SN, et al. Cardioprotective effects of phytochemicals. Oxid Med Cell Longev. 2016; 2016:9057591.
  55. Dwivedi S. Terminalia arjuna: a useful drug for cardiovascular disorders. J Ethnopharmacol. 2007;114(2):114–129.
  56. Gupta R, Sharma AK, Dobhal MP, et al. Antidiabetic and antioxidant potential of herbal drugs. J Ethnopharmacol. 2011;137(1):113–120.
  57. Li H, Sureda A, Devkota HP, et al. Curcumin, the golden spice in cardioprotection. Nutrients. 2020;12(11):3168.
  58. Singh N, Dhalla AK, Seneviratne C, Singal PK. Oxidative stress and heart failure. Mol Cell Biochem. 1995;147(1-2):77–81.
  59. World Health Organization. WHO global report on traditional and complementary medicine 2019. Geneva: WHO; 2019.
  60. Bansal SS, Goel M, Aqil F, et al. Advanced drug delivery systems of herbal drugs. Drug Discov Today. 2011;16(1-2):47–54.
  61. Piepoli MF, Hoes AW, Agewall S, et al. 2016 European guidelines on cardiovascular disease prevention. Eur Heart J. 2016;37(29):2315–2381.
  62. Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics—2020 update. Circulation. 2020;141(9):e139–e596.
  63. Libby P. Inflammation in atherosclerosis. Nature. 2002;420(6917):868–874.
  64. Oparil S, Acelajado MC, Bakris GL, et al. Hypertension. Nat Rev Dis Primers. 2018; 4:18014.
  65. Tang WHW, Hazen SL. The contributory role of gut microbiota in cardiovascular disease. J Clin Invest. 2014;124(10):4204–4211.
  66. Thippeswamy BS, Mahendran S, Biradar MI, et al. Protective effect of herbal extracts in myocardial ischemia. Indian J Pharmacol. 2009;41(2):86–90.
  67. Ojha SK, Arya DS. Rauvolfia serpentina and cardiovascular disorders: A review. Journal of Ethnopharmacology. 2009;123(1):1–7.
  68. Upadhyay AK, Kumar K, Kumar A, Mishra HS. Tinospora cordifolia (Guduchi): Pharmacological and therapeutic aspects. Journal of Ethnopharmacology. 2010;128(3):409–415.
  69. Chhatre S, Nesari T, Somani G, Kanchan D, Sathaye S. Phytopharmacological overview of Tribulus terrestris. Pharmacognosy Reviews. 2014;8(15):45–51.
  70. McKay DL, Chen CY, Saltzman E, Blumberg JB. Hibiscus sabdariffa L. tea (anthocyanin-rich) and blood pressure: A clinical trial. Journal of Nutrition. 2010;140(2):298–303.
  71. Bamosa AO, Ali BA, Sowayan SA. Effect of Nigella sativa on lipid profile and cardiovascular risk factors. International Journal of Clinical Practice. 2002;56(8):588–590.
  72. Dwivedi S. Terminalia arjuna Wight & Arn. —A useful drug for cardiovascular disorders. Journal of Ethnopharmacology. 2007;114(2):114–129.
  73. Ried K, Frank OR, Stocks NP. Garlic (Allium sativum) and cardiovascular disease: A systematic review and meta-analysis. BMC Cardiovascular Disorders. 2013; 13:54.
  74. Basu A, Lucas EA. Mechanisms and effects of green tea on cardiovascular health. Nutrition Reviews. 2007;65(8):361–375.
  75. Antony B, Merina B, Sheeba V, Mukkadan J. Cardioprotective effect of Curcuma longa on myocardial ischemia. Indian Journal of Clinical Biochemistry. 2008;23(2):168–171.
  76. Kar P, Laight D, Rooprai HK, Shaw KM, Cummings M. Effects of Ginkgo biloba on cardiovascular function. Human Psychopharmacology. 2006;21(6):451–456.

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Snehal Kale
Corresponding author

RJS College of Pharmacy Kokamthan, Kopargaon

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Vijay Jadhav
Co-author

RJS College of Pharmacy Kokamthan, Kopargaon

Snehal Kale*, Vijay Jadhav, Cardioprotective Potential of Polyherbal Formulations: A Critical Review, Int. J. Sci. R. Tech., 2026, 3 (4), 283-287. https://doi.org/10.5281/zenodo.19509382

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