title: Adverse cardiovascular events temporally associated with ma huang, an herbal source of ephedrine.
abstract: OBJECTIVE
  To evaluate possible cardiovascular toxic effects associated with use of dietary supplements containing ma huang, an herbal source of ephedrine.
  
  
  METHODS
  We reviewed the comprehensive database Adverse Reaction Monitoring System of the Food and Drug Administration, which included clinical records, investigative reports, and autopsy reports related to ma huang use. The main outcome measurements were stroke, myocardial infarction, and sudden death.
  
  
  RESULTS
  From 1995 to 1997, 926 cases of possible ma huang toxicity were reported to the Food and Drug Administration. In 37 patients (23 women and 14 men with a mean +/- SD age of 43 +/- 13 years), use of ma huang was temporally related to stroke (in 16), myocardial infarction (in 10), or sudden death (in 11). Autopsies performed in 7 of the 11 patients who experienced sudden death showed a normal heart in 1, coronary atherosclerosis in 3, and cardiomyopathies in 3. In 36 of the 37 patients, use of ma huang was reported to be within the manufacturers' dosing guidelines.
  
  
  CONCLUSIONS
  Analysis of the 37 patients indicates the following findings: (1) ma huang use is temporally related to stroke, myocardial infarction, and sudden death; (2) underlying heart or vascular disease is not a prerequisite for ma huang-related adverse events; and (3) the cardiovascular toxic effects associated with ma huang were not limited to massive doses. Although the pathogenesis of the cardiac toxic effects of ma huang remains incompletely defined, available observational and circumstantial evidence indicates that use of the substance may be associated with serious medical complications.
authors.affiliation: Division of Cardiology, New England Medical Center, Boston, MA 02111, USA.
authors.forename: David
authors.initials: D
authors.lastname: Samenuk
authors.forename: Mark S
authors.initials: MS
authors.lastname: Link
authors.forename: Munther K
authors.initials: MK
authors.lastname: Homoud
authors.forename: Robert
authors.initials: R
authors.lastname: Contreras
authors.forename: Theoharis C
authors.initials: TC
authors.lastname: Theoharides
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Wang
authors.forename: N A Mark
authors.initials: NA
authors.lastname: Estes
authors.forename: Theoharis C
authors.initials: TC
authors.lastname: Theohardes
mesh_terms: D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000453:epidemiology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D019587:Dietary Supplements / Q000506:poisoning*; D004365:Drugs, Chinese Herbal / Q000506:poisoning*; D029790:Ephedra sinica / Q000506:poisoning*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000453:epidemiology; D020521:Stroke / Q000139:chemically induced / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014486:United States Food and Drug Administration
chemical_list: D004365:Drugs, Chinese Herbal