Hawthorn (Crataegus)
EMA-monograph leaf-and-flower extract with Cochrane signal as adjunct in NYHA II mild heart failure, under clinical care.
Why
Hawthorn (Crataegus monogyna and oxyacantha) leaf and flower extract carries an EMA Well-Established Use monograph for symptomatic relief in temporary nervous cardiac complaints. In NYHA II mild heart failure, the Cochrane review found symptomatic and exercise-capacity benefits as an adjunct to standard heart-failure therapy. The large SPICE trial in 2,681 patients reported no mortality benefit but maintained the symptomatic improvement signal.
How it works
Oligomeric procyanidins and flavonoids (vitexin, hyperoside) produce mild positive inotropy via Na+/K+-ATPase modulation, peripheral vasodilation through endothelial nitric oxide release, and weak ACE inhibition. Antioxidant effects protect cardiomyocytes from ischaemia-reperfusion damage in preclinical work.
Expected onset · Symptomatic improvement over 4–12 weeks of daily intake
How to take
Dosage
Standardised extract WS 1442: 900 mg/day divided. Cardiac use should always be under clinical supervision alongside guideline-directed therapy.
Timing
Divided morning and evening with meals
On the label
WS 1442 (Crataegutt) is the most-studied extract, standardised to 18.75% oligomeric procyanidins. Generic preparations vary widely.
Ideal for
Adults with NYHA Class II symptomatic mild heart failure, as adjunct to standard pharmacotherapy under clinical supervision.
Safety
Evidence
Cochrane 2008 SR (14 RCTs, n=855): hawthorn extract as adjunct improved exercise tolerance, reduced shortness of breath and fatigue vs placebo in NYHA II mild heart failure. Holubarsch 2008 SPICE RCT (n=2,681 NYHA II–III): no all-cause mortality benefit but maintained symptomatic effect. EMA classifies the leaf-and-flower extract as Well-Established Use for nervous cardiac symptoms.
Where to get it
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