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Garlic Shows Promise for Improving Some Cardiovascular Risk Factors
Ronald T. Ackermann, MD;
Cynthia D. Mulrow, MD, MSc;
Gilbert Ramirez, DrPH;
Christopher D. Gardner, PhD;
Laura Morbidoni, MD;
Valerie A. Lawrence, MD, MSc
Arch Intern Med. 2001;161:813-824.
Objectives To summarize the effects of garlic on several cardiovascular-related
factors and to note its adverse effects.
Methods English and non-English citations were identified from 11 electronic
databases, references, manufacturers, and experts from January 1966 through
February 2000 (depending on the database searched). Reports of cardiovascular-related
effects were limited to randomized controlled trials lasting at least 4 weeks.
Reports of adverse effects were not limited by study design. From 1798 pertinent
records, 45 randomized trials and 73 additional studies reporting adverse
events were identified. Two physicians abstracted outcomes and assessed adequacy
of randomization, blinding, and handling of dropouts. Standardized mean differences
of lipid outcomes from placebo-controlled trials were adjusted for baseline
differences and pooled using random effects methods.
Results Compared with placebo, garlic preparations may lead to small reductions
in the total cholesterol level at 1 month (range of average pooled reductions,
0.03-0.45 mmol/L [1.2-17.3 mg/dL]) and at 3 months (range of average pooled
reductions 0.32-0.66 mmol/L [12.4-25.4 mg/dL]), but not at 6 months. Changes
in low-density lipoprotein levels and triglyceride levels paralleled total
cholesterol level results; no statistically significant changes in high-density
lipoprotein levels were observed. Trials also reported significant reductions
in platelet aggregation and mixed effects on blood pressure outcomes. No effects
on glycemic-related outcomes were found. Proven adverse effects included malodorous
breath and body odor. Other unproven effects included flatulence, esophageal
and abdominal pain, allergic reactions, and bleeding.
Conclusions Trials suggest possible small short-term benefits of garlic on some
lipid and antiplatelet factors, insignificant effects on blood pressure, and
no effect on glucose levels. Conclusions regarding clinical significance are
limited by the marginal quality and short duration of many trials and by the
unpredictable release and inadequate definition of active constituents in
study preparations.
From the San Antonio Evidence-based Practice Center, University of
Texas Health Science Center (Drs Ackermann, Mulrow, Ramirez, and Lawrence),
Veterans Evidence-based Research Dissemination Implementation Center, Audie
L. Murphy Memorial Veterans Hospital, San Antonio (Drs Mulrow, Ramirez, and
Lawrence); Center for Research in Disease Prevention, Stanford University,
Palo Alto, Calif (Dr Gardner); and the Istituto di Clinica Medica Universita
degli Studi di Ancona, Ancona, Italy (Dr Morbidoni). Dr Gardner is now with
the Center for Advanced Studies in Nutrition and Social Marketing, University
of California, Davis.
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