Hawthorn

What Is Hawthorn?

Hawthorn is a handsome tree, growing to just a few meters in height and sporting small white flowers and bright red berries. It’s popular in gardens across North America and in parts of Europe and Australia.

The flowers and berries of the tree are used in Western herbal medicine to treat a range of cardiovascular conditions and can be used as a preventative measure against heart disease.

Today, cardiovascular disease remains the number one killer in developed parts of the world. The benefits hawthorn offers to cardiovascular function, together with the plant’s worldwide prevalence, make it an outstanding candidate for future heart-disease medicines.

Aside from cardiovascular disease, hawthorn is commonly used to treat anxiety conditions and topically to treat acne and dry skin.

What Is Hawthorn Used For?

The main use of hawthorn is for treating cardiovascular disease. The flowers and berries contain a slurry of chemicals with well-studied effects on the cardiovascular system. Hawthorn dilates the coronary arteries, provides arteriole protection through antioxidant activity, regulates abnormal heart rhythms, and improves microcirculation.

All of these effects from a single plant make hawthorn an important herb for treating and preventing a range of cardiovascular conditions. Hawthorn is used to lower cholesterol and triglycerides, treat heart palpitations and other forms of arrhythmia, improve the contractibility of the heart for congestive heart failure and improve diminished blood flow with COPD.

Traditional Uses

Western Herbal Medicine

There is a lot of reference to hawthorn in older texts, and much of the indications are towards cardiac diseases and circulation. It was used in the past to treat conditions including tachycardia, hypertension, angina pectoris, and myocardial weakness. The berries were also used as an astringent for sore throats, and as a diuretic. ^{3Reference 3Bone K · 2013Principles and Practice of Phytotherapy}.

Traditionally the berry was mainly used, however more recent findings suggest the leaves to have a stronger action medicinally ^{3Reference 3Bone K · 2013Principles and Practice of Phytotherapy}.

Hawthorn has also been extensively used as a source of wood, and the berries as a flavouring of liquor. ^{3Reference 3Bone K · 2013Principles and Practice of Phytotherapy}.

The British herbal pharmacopoeia lists crataegus as cardiotonic, coronary vasodilator, and hypotensive specific for cardiac failure, myocardial weakness, hypertension, arteriosclerosis, Buerger’s disease, and paroxysmal tachycardia ^{13Reference 13British Herbal Medicine Association · 1983British Herbal Pharmacopoeia}.

Traditional Chinese Medicine

In Chinese medicine, the fruit was often used to improve digestion, stimulate circulation, and treat blood stasis. ^{3Reference 3Bone K · 2013Principles and Practice of Phytotherapy}.

Botanical Information

Hawthorn is a member of the Rosaceae family of plants, which comprises some 91 genera and 4828 different species. The Crataegus genus contains 260 different species, several of which are used medicinally.

Crataegus is a deciduous, thorny shrub or small tree that can grow up to 10m tall. ^{3Reference 3Bone K · 2013Principles and Practice of Phytotherapy}.

The leaves are broad and have 3-5 lobes. ^{3Reference 3Bone K · 2013Principles and Practice of Phytotherapy}.

The flowers are white, have red anthers, and arranged in groups of 5 or 10 ^{3Reference 3Bone K · 2013Principles and Practice of Phytotherapy}.

The fruit is contained within a larger, dark red colored false fruit ^{3Reference 3Bone K · 2013Principles and Practice of Phytotherapy}.

There is extensive hybridization of Crataegus in general, which has led to some confusion with the classification of many species contained in the genus ^{3Reference 3Bone K · 2013Principles and Practice of Phytotherapy}.

Harvesting, Collection & Preparation

Although traditionally the berries were preferred, in general it has been found that the leaves offer the most benefit towards cardiovascular disease ^{3Reference 3Bone K · 2013Principles and Practice of Phytotherapy}.

Pharmacology & Medical Research

Cardiovascular System

The German Federal Ministry of Health conducted a four year study on Crataegus and its activity on the cardiovascular system, which resulted in the inclusion of Crataegus as a recognized cardiac medication in Europe. ^{1Reference 1Hoffmann · 2003Medical herbalism: The science and practice of herbal medicine}.

Much of the research on hawthorn has been aimed at its activity on the cardiovascular system.

To date, evidence towards crataegus benefits on the entirety of the cardiovascular system includes:

• Coronary artery dilation ^{3,4Reference 3Bone K · 2013Principles and Practice of PhytotherapyReference 4Occhiuto et al. · 1986Comparative study of the cardiovascular activity of shoots, leaves and flowers of Crataegus oxyacantha: 2}
• Antioxidant activity [24]
• Positively inotropic ^{3,4Reference 3Bone K · 2013Principles and Practice of PhytotherapyReference 4Occhiuto et al. · 1986Comparative study of the cardiovascular activity of shoots, leaves and flowers of Crataegus oxyacantha: 2}

• improves the availability and utilization of energy in the myocardium rather than directly impacting contractile fibers like cardiac glycosides ^{1Reference 1Hoffmann · 2003Medical herbalism: The science and practice of herbal medicine}.

Coronary Artery Dilation

The coronary artery dilation has been found to be through the crataegolic acid and ursolic acid content, and various flavonoids (such as vitexin-2”-O-rhamnoside, luteolin-7-glucoside, hyperoside, rutin, and vitexin), and the oligomeric procyanidins (OPCs) ^{4Reference 4Occhiuto et al. · 1986Comparative study of the cardiovascular activity of shoots, leaves and flowers of Crataegus oxyacantha: 2}.

The ability for hawthorn to improve coronary blood flow was reproduced in dogs (with oral administration) ^{8Reference 8Roddewig et al. · 1977Roddewig, C., & Hensel, H. (1977). [Reaction of local myocardial blood flow in non-anesthetized dogs and anesthetized cats to the oral and parenteral administration of a Crateagus fraction (oligomere procyanidines)]. Arzneimittel-Forschung, 27(7), 1407-1410.}.

Antioxidant Activity

The antioxidant activity of Crataegus is suggested to be mainly due to the flavonoids present in the leaves, flowers, and berries. These chemicals are strong antioxidant chemicals and have also been shown to produce the ability to increase collagen cross-linking in the walls of vascular tissue. This strengthens the blood vessels and can significantly reduce the risk of cardiovascular disease. ^{1Reference 1Hoffmann · 2003Medical herbalism: The science and practice of herbal medicine}.

Positively Inotropic

The inotropic activity was found to be due to the crataegolic acid, ursolic acid, and vitexin-2”-O-rhamnoside (flavonoid) content in an older study ^{4Reference 4Occhiuto et al. · 1986Comparative study of the cardiovascular activity of shoots, leaves and flowers of Crataegus oxyacantha: 2}. The action was found in another study to be through an increase in the contraction amplitude of the cardiac myocytes in an in vitro study ^{5Reference 5Petkov et al. · 1981AnimalInhibitory effect of some flavonoids and flavonoid mixtures on cyclic AMP phosphodiesterase activity of rat heart}.

This activity has been reproduced in several studies using standardized leaf and flower extracts ^{7Reference 7Trunzler et al. · 1962Trunzler, G., & Schuler, E. (1962). [Comparative studies on the effect of a Crataegus extract, of digitoxin, digoxin and gstrophanthin on the isolated mammalian heart.]. Arzneimittel-Forschung, 12, 198-202.}.

Antiarrhythmic

The antiarrhythmic activity of Crataegus was explored through in vitro testing of cardiac tissue. The mechanism was suggested to be likely through a prolonged refractory period brought on by the beta-adrenergic agonist activity of crataegus constituents ^{6Reference 6Pöpping et al. · 1995AnimalEffect of a hawthorn extract on contraction and energy turnover of isolated rat cardiomyocytes}.

Microcirculation

The OPC content of Crataegus was shown in several studies to promote bloodflow in both the aorta and microcirculation, through nitric-oxide mediated relaxation and inhibitory action on angiotensin converting enzyme (ACE) both in-vitro and in vivo ^{9,10,11,12Reference 9Kim et al. · 2000AnimalProcyanidins in crataegus extract evoke endothelium-dependent vasorelaxation in rat aortaReference 10Brixius et al. · 2006Crataegus special extract WS® 1442 induces an endothelium-dependent, NO-mediated vasorelaxation via eNOS-phosphorylation at serine 1177Reference 11Anselm et al. · 2009Crataegus special extract WS 1442 causes endothelium-dependent relaxation via a redox-sensitive Src-and Akt-dependent activation of endothelial NO synthase but not via activation of estrogen receptorsReference 12Lacaille-Dubois et al. · 2001Search for potential angiotensin converting enzyme (ACE)-inhibitors from plants}.

Phytochemistry

Hawthorn’s cardiovascular reputation rests on three groups acting together: the oligomeric procyanidins (OPCs), the flavonoids — chiefly vitexin, hyperoside, and rutin — and the triterpene acids ursolic, oleanolic, and crataegolic (maslinic) acid. These are the constituents repeatedly tied to coronary dilation, positive inotropy, and antioxidant protection of the vessel wall ^{1,2,3,4Reference 1Hoffmann · 2003Medical herbalism: The science and practice of herbal medicineReference 2Blumenthal et al. · 2003The ABC clinical guide to herbsReference 3Bone K · 2013Principles and Practice of PhytotherapyReference 4Occhiuto et al. · 1986Comparative study of the cardiovascular activity of shoots, leaves and flowers of Crataegus oxyacantha: 2}. The leaves and flowers are richer in flavonoids and OPCs than the berries, which is why modern extracts favour them.

Hawthorn Berries

The berries contain flavonoids, amines, catechols, carboxylic acid, and triterpene acids ^{3Reference 3Bone K · 2013Principles and Practice of Phytotherapy}.

Hawthorn Leaves & Flowers

The leaves contain flavonoids up to 1.78% (including vitexin, quercetin, hyperoside, rutin), oligomeric procyanidins (1–2.4%), triterpene acids up to 0.6% (ursolic acid, oleanolic acid, crataegolic acids), and phenolic acids (caffeic, chlorogenic, and related phenolcarboxylic acids) ^{1,2,3Reference 1Hoffmann · 2003Medical herbalism: The science and practice of herbal medicineReference 2Blumenthal et al. · 2003The ABC clinical guide to herbsReference 3Bone K · 2013Principles and Practice of Phytotherapy}.

Constituent Summary

Figures are % of dried leaf/flower, the part used in standardised cardiac extracts; content varies with species, plant part, and harvest ^{1,2,3Reference 1Hoffmann · 2003Medical herbalism: The science and practice of herbal medicineReference 2Blumenthal et al. · 2003The ABC clinical guide to herbsReference 3Bone K · 2013Principles and Practice of Phytotherapy}.

A Note on Concentrated Extracts of Hawthorn

There have been multiple reports of studies using isolated constituents showing very little or no significant activity when compared to the whole herb extract. The whole extract has been found to consistently produce noticeable, and broad actions, especially on the cardiovascular system ^{1Reference 1Hoffmann · 2003Medical herbalism: The science and practice of herbal medicine}. For this reason, only the whole herb extract should be used.

Clinical Applications

The coronary artery dilating activity of hawthorn makes it useful for treating coronary artery disease and angina. The high level of safety with this herb and a broad range of other cardiovascular effects have made this a staple in those at risk for cardiovascular disease or those who have suffered a myocardial infarct in the past. Hawthorn is also useful for lowering high cholesterol levels, high triglyceride levels, treating atherosclerosis, heart palpitations, arrhythmias, and congestive heart failure.

Cautions & Safety

Due to the action around heart function, crataegus may enhance the activity of cardiac glycosides such as digitalis, or Convellaria majalis. This may improve the effectiveness of these drugs/herbs, and allow for smaller, more effective doses. Caution is advised when using these medications. ^{1Reference 1Hoffmann · 2003Medical herbalism: The science and practice of herbal medicine}.

Toxicity

There are no reported long term adverse effects with using hawthorn in the therapeutic dosage range, and long term use is recommended for cardiovascular disease with this herb ^{3Reference 3Bone K · 2013Principles and Practice of Phytotherapy}.

Synergy

Often used in conjunction with Tilia platyphyllos, Allium sativum, or Viburnum opulus for arteriosclerosis ^{1Reference 1Hoffmann · 2003Medical herbalism: The science and practice of herbal medicine}. There may be possible synergy here.

Combines well with Tilia and Scutellaria for hypertension ^{1Reference 1Hoffmann · 2003Medical herbalism: The science and practice of herbal medicine}.

Crataegus has been reported to have synergy with digitalis glycosides and beta-blockers. No adverse interactions have been reported with digoxin. ^{3Reference 3Bone K · 2013Principles and Practice of Phytotherapy}.

The British herbal pharmacopeia suggests crataegus has possible synergy with Selenicereus grandiflorus, Tilia, Viscum, or Scutellaria ^{13Reference 13British Herbal Medicine Association · 1983British Herbal Pharmacopoeia}.

References

1. Hoffmann, D. (2003). Medical herbalism: The science and practice of herbal medicine. Rochester, VT: Healing Arts Press
2. Blumenthal, M., Brinckmann, J., & Wollschlaeger, B. (2003). The ABC clinical guide to herbs. Austin, TX: American Botanical Council.
3. Bone K, Mills S. (2013). Principles and Practice of Phytotherapy. Elsevier health. China. (Pg. 392-398).
4. Occhiuto, F., Circosta, C., Costa, R., Briguglio, F., & Tommasini, A. (1986). Comparative study of the cardiovascular activity of shoots, leaves and flowers of Crataegus oxyacantha: 2. Action of extracts and isolated pure active principles on the isolated rabbit heart. Plantes medicinales et phytotherapie, 20, 52-63.
5. Petkov, E., Nikolov, N., & Uzunov, P. (1981). Inhibitory effect of some flavonoids and flavonoid mixtures on cyclic AMP phosphodiesterase activity of rat heart. Planta Medica, 43(10), 183-186.
6. Pöpping, S., Rose, H., Ionescu, I., Fischer, Y., & Kammermeier, H. (1995). Effect of a hawthorn extract on contraction and energy turnover of isolated rat cardiomyocytes. Arzneimittel-Forschung, 45(11), 1157-1161.
7. Trunzler, G., & Schuler, E. (1962). [Comparative studies on the effect of a Crataegus extract, of digitoxin, digoxin and gstrophanthin on the isolated mammalian heart.]. Arzneimittel-Forschung, 12, 198-202.
8. Roddewig, C., & Hensel, H. (1977). [Reaction of local myocardial blood flow in non-anesthetized dogs and anesthetized cats to the oral and parenteral administration of a Crateagus fraction (oligomere procyanidines)]. Arzneimittel-Forschung, 27(7), 1407-1410.
9. Kim, S. H., Kang, K. W., Kim, K. W., & Kim, N. D. (2000). Procyanidins in crataegus extract evoke endothelium-dependent vasorelaxation in rat aorta. Life sciences, 67(2), 121-131.
10. Brixius, K., Willms, S., Napp, A., Tossios, P., Ladage, D., Bloch, W., … & Schwinger, R. H. (2006). Crataegus special extract WS® 1442 induces an endothelium-dependent, NO-mediated vasorelaxation via eNOS-phosphorylation at serine 1177. Cardiovascular drugs and therapy, 20(3), 177-184.
11. Anselm, E., Socorro, V. F. M., Dal-Ros, S., Schott, C., Bronner, C., & Schini-Kerth, V. B. (2009). Crataegus special extract WS 1442 causes endothelium-dependent relaxation via a redox-sensitive Src-and Akt-dependent activation of endothelial NO synthase but not via activation of estrogen receptors. Journal of cardiovascular pharmacology, 53(3), 253-260.
12. Lacaille-Dubois, M. A., Franck, U., & Wagner, H. (2001). Search for potential angiotensin converting enzyme (ACE)-inhibitors from plants. Phytomedicine, 8(1), 47-52.
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15. Broken source
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17. Veveris, M., Koch, E., & Chatterjee, S. S. (2004). Crataegus special extract WS® 1442 improves cardiac function and reduces infarct size in a rat model of prolonged coronary ischemia and reperfusion. Life Sciences, 74(15), 1945-1955.
18. Krzeminski, T., & Chatterjee, S. S. (1993). Ischemia and early reperfusion induced arrhythmias: beneficial effects of an extract of Crataegus oxyacantha L. Pharm Pharmacol Lett, 3, 45-48.
19. Al Makdessi, S., Sweidan, H., Dietz, K., & Jacob, R. (1999). Protective effect of Crataegus oxyacantha against reperfusion arrhythmias after global no-flow ischemia in the rat heart. Basic research in cardiology, 94(2), 71-77.
20. Holubarsch, C. J., Colucci, W. S., Meinertz, T., Gaus, W., & Tendera, M. (2008). The efficacy and safety of Crataegus extract WS® 1442 in patients with heart failure: The SPICE trial. European journal of heart failure, 10(12), 1255-1263.
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