Hawthorn
Crataegus monogyna, C. laevigata, C. pinnatifida
TL;DR
Hawthorn extract has the strongest botanical evidence base in heart failure, with a Cochrane review showing improved exercise tolerance and symptoms as adjunctive therapy. A large mortality trial found no survival benefit, which defines its role: symptomatic adjunct, not disease-modifying treatment.
Ideal For
- NYHA class II heart failure as adjunct to standard therapy
- Exercise intolerance and dyspnoea despite optimised treatment
- Mild cardiac symptoms under medical supervision
Avoid If
- Using it instead of guideline-directed heart failure therapy
- Taking digoxin without cardiology supervision
- Severe decompensated heart failure
- Pregnancy
Frequently Asked Questions
Overview
Hawthorn is the rare botanical that has been taken seriously by cardiology. A Cochrane review of randomised trials in chronic heart failure found that standardised extract added to conventional therapy improved maximal workload, exercise tolerance and symptoms such as dyspnoea and fatigue. Those are patient-relevant outcomes, not surrogate markers. Then came SPICE, a large trial in over 2,600 patients with reduced ejection fraction, which found no significant effect on the composite cardiac mortality endpoint — though a subgroup with less severely impaired ejection fraction showed some signal. The honest reading is that hawthorn makes people with heart failure feel and function somewhat better without changing how long they live. That is a legitimate role, provided it is genuinely adjunctive: heart failure has effective disease-modifying drugs and hawthorn is not a substitute for any of them. Effects build slowly, over six to twelve weeks, and the standardised extracts WS 1442 and LI 132 are the preparations with the trial data behind them.
How It Works
- Phosphodiesterase-3 inhibition gives a mild positive inotropic effect
- Extends effective refractory period, unlike other inotropes
- Endothelial nitric oxide release reduces afterload
- Flavonoid antioxidant protection of myocardium
Quick Facts
- Cochrane: improved exercise tolerance and symptoms in heart failure
- SPICE trial: no mortality benefit in 2,681 patients
- Effects take 6-12 weeks to build
- Adjunct only — never a substitute for heart failure drugs
Benefits & Outcomes
No linked outcomes yet. Research is ongoing.
Supporting Research6 studies
Hawthorn extract for treating chronic heart failure (Cochrane review)
Pittler MH, Guo R, Ernst E
Maximal workload increased significantly with hawthorn (weighted mean difference 5.35 watts).
The efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial
Holubarsch CJ, Colucci WS, Meinertz T +2 more
The primary composite endpoint of cardiac mortality and hospitalisation was not significantly reduced.
Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials
Pittler MH, Schmidt K, Ernst E
Maximal workload, pressure-heart rate product and symptom scores improved significantly with hawthorn.
Hawthorn extract for treating mild hypertension: a randomised controlled trial in patients with type 2 diabetes
Walker AF, Marakis G, Simpson E +4 more
Diastolic blood pressure fell significantly more with hawthorn than placebo (mean 2.6 mmHg).
Hawthorn (Crataegus spp.) in the treatment of cardiovascular disease: a review of pharmacology and clinical safety
Wang J, Xiong X, Feng B
Adverse events in trials were mild, mainly dizziness and gastrointestinal upset.
Fatal arrhythmia following ingestion of hawthorn root (Crataegus pubescens) extract: a case report
Villegas-Belman S, et al.
This case report illustrates the potentially fatal consequences of HRE for which the constituents have not yet been characterized.
Safety Information
Potential Side Effects
Usually mild: dizziness, nausea, gastrointestinal upset, headache and palpitations. Tolerability in trials was comparable to placebo.
Contraindications
Should never replace ACE inhibitors, beta blockers, mineralocorticoid antagonists or SGLT2 inhibitors in heart failure. Anyone with cardiac disease should involve their cardiologist before starting.
Drug Interactions
- Digoxin — potential additive inotropic effect; requires supervision
- Antihypertensives and nitrates — additive hypotension
- Beta blockers — theoretical additive effects on contractility
Pregnancy & Breastfeeding
Pregnancy: insufficient_data
Breastfeeding: insufficient_data
Dosage Guidelines
Dosage Used in Studies
300-1800 mg
Best Time to Take
Two or three divided doses daily
Best Form
Standardised leaf and flower extract (WS 1442 or equivalent)
Bioavailability
Procyanidins are moderately absorbed; standardised extracts are formulated to deliver consistent flavonoid content.
Forms Compared
WS 1442 standardised extract
LI 132 extract
Berry preparations
Food & Timing
With food to reduce nausea.
Medical Disclaimer
The information provided on this website is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any supplement regimen.
Individual results may vary. The statements on this website have not been evaluated by the Food and Drug Administration. Products and information are not intended to diagnose, treat, cure, or prevent any disease.