Herbal Folk Medicine for Heart Failure in Uzbekistan: Ethnopharmacology, Pharmacological Evidence, and Clinical Perspectives
Keywords:
heart failure; folk medicine; Uzbekistan; herbal medicine; cardioprotective plants; ethnopharmacology; phytotherapy; Central AsiaAbstract
Heart failure (HF) represents an escalating public health burden in Uzbekistan, where cardiovascular diseases account for the majority of adult mortality. Alongside evidence-based pharmacotherapy, traditional folk medicine remains deeply embedded in regional healthcare practices. This review synthesizes current ethnopharmacological and pharmacological evidence on herbal remedies employed for HF management in Uzbekistan, with particular focus on five widely used medicinal plants: Crataegus songarica, Astragalus membranaceus, Leonurus cardiaca, Glycyrrhiza glabra, and Peganum harmala. A structured literature search of PubMed, Scopus, Web of Science, and Google Scholar was conducted for publications from 2010 to 2024. Two comparative analytical tables evaluate active compounds, mechanisms of action, clinical dosages, efficacy, adverse effects, and limitations. The evidence indicates that several traditional herbal remedies possess scientifically supported cardioprotective properties; however, high-quality randomized controlled trials in Central Asian populations remain scarce. Rigorous integration of validated phytotherapies into formal cardiovascular care protocols in Uzbekistan requires further dedicated clinical investigation.
References
[1] P. A. Heidenreich et al., "2022 AHA/ACC/HFSA guideline for the management of heart failure," J Am Coll Cardiol., vol. 79, no. 17, pp. e263-e421, 2022.
[2] J. Feng, Y. Zhang, and J. Zhang, "Epidemiology and burden of heart failure in Asia," JACC Asia, vol. 4, no. 4, pp. 249-264, 2024.
[3] K. Tursunov et al., "The burden of cardiovascular diseases in Uzbekistan: a growing public health concern," J Multidiscip Sci Innov., 2025.
[4] D. Nugmanova et al., "Burden of cardiovascular diseases in Central Asia," Glob Heart, vol. 13, no. 1, pp. 37-43, 2018.
[5] L. Yeremenko et al., "Cardiovascular disease burden in rural Central Asia: a systematic review," Int J Environ Res Public Health, vol. 7, p. 10, 2025.
[6] World Health Organization, "Cardiovascular diseases (CVDs)," WHO Fact Sheets, 2023.
[7] B. Sobirov et al., "The main medicinal plants in arid regions of Uzbekistan and their traditional use in folk medicine," Plants, vol. 12, no. 16, p. 2950, 2023.
[8] S. W. Eisenman et al., "Medicinal plants of Uzbekistan and their traditional uses," in Exotic Fruits and Nuts in the New World, Springer, 2018, pp. 201-258.
[9] T. A. McDonagh et al., "2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure," Eur Heart J., vol. 42, no. 36, pp. 3599-3726, 2021.
[10] K. H. Kim et al., "Current research status and implication for further study of real-world data on East Asian traditional medicine for heart failure," Healthcare, vol. 12, no. 1, p. 61, 2024.
[11] M. C. Tassell, R. Kingston, D. Gilroy, M. Lehane, and A. Furey, "Hawthorn (Crataegus spp.) in the treatment of cardiovascular disease," Pharmacogn Rev., vol. 4, no. 7, pp. 32-41, 2010.
[12] D. Peixoto-Neves et al., "Effect of Crataegus usage in cardiovascular disease prevention: an evidence-based approach," Evid Based Complement Alternat Med., vol. 2014, p. 459763, 2014.
[13] M. Wald, M. Strehler, and M. Breuninger, "Crataegus extract WS 1442 stimulates cardiomyogenesis and angiogenesis from stem cells," Front Pharmacol., vol. 10, p. 1424, 2019.
[14] M. H. Pittler, K. Guo, and E. Ernst, "Hawthorn extract for treating chronic heart failure," Cochrane Database Syst Rev., no. 1, p. CD005312, 2008.
[15] X. Han et al., "Effect of Astragalus membranaceus on left ventricular remodeling in HFrEF: a systematic review and meta-analysis," Front Pharmacol., vol. 15, p. 1345797, 2024.
[16] Q. Chen et al., "Mechanism of Astragalus membranaceus (Huangqi, HQ) for treatment of heart failure based on network pharmacology and molecular docking," J Cell Mol Med., vol. 28, p. e18331, 2024.
[17] W. Tian et al., "Astragaloside IV alleviates doxorubicin-induced cardiotoxicity by inhibiting cardiomyocyte pyroptosis through the SIRT1/NLRP3 pathway," Am J Chin Med., vol. 52, no. 2, pp. 453-469, 2024.
[18] K. Wojtyniak, M. Szymanski, and I. Matławska, "The effect of Leonurus cardiaca herb extract and some of its flavonoids on mitochondrial oxidative phosphorylation in the heart," Phytomedicine, vol. 21, pp. 1101-1106, 2014.
[19] European Medicines Agency, "Community herbal monograph on Leonuri cardiacae herba," EMA/HMPC/261282/2009, 2010.
[20] N. Ahmad et al., "Glycyrrhiza glabra root extract attenuates doxorubicin-induced cardiotoxicity via alleviating oxidative stress," J Ethnopharmacol., vol. 274, p. 114102, 2021.
[21] G. Pastorino et al., "Glycyrrhiza glabra: a comprehensive review on its phytochemistry, biological activities, clinical evidence and toxicology," Plants, vol. 10, no. 12, p. 2751, 2021.
[22] M. V. Boranova et al., "Atheroprotective effects of Glycyrrhiza glabra L.," Int J Mol Sci., vol. 23, no. 16, p. 9404, 2022.
[23] M. Moloudizargari et al., "Pharmacological and therapeutic effects of Peganum harmala and its main alkaloids," Pharmacogn Rev., vol. 7, no. 14, pp. 199-212, 2013.
[24] A. Doskaliev et al., "Alkaloids of Peganum harmala L. and their pharmacological activity," Open Access Maced J Med Sci., vol. 9, no. A, pp. 766-775, 2021.
[25] G. Nazmiev et al., "Medicinal properties of Peganum harmala plant," BIO Web Conf., vol. 128, p. 02018, 2024.
[26] M. Zhang et al., "Astragalus propinquus and Salvia miltiorrhiza promote angiogenesis to treat myocardial ischemia via Ang-1/Tie-2/FAK pathway," Front Pharmacol., vol. 13, p. 1103557, 2023.
[27] L. Li et al., "Cross-talk between gut microbiota and the heart: a new target for herbal medicine treatment of heart failure?" Evid Based Complement Alternat Med., vol. 2020, p. 9097821, 2020.
[28] C. T. Liu et al., "Chinese herbal medicine reduces the risk of heart failure in hypertensive patients: a nationwide, retrospective, cohort study," Front Cardiovasc Med., vol. 9, p. 922728, 2022.
[29] Q. Chen et al., "Natural therapy for chronic heart failure: experience in traditional Chinese medicine before 2022," Front Med., 2025. doi:10.3389/fmed.2025.1522163.
[30] J. Zhao et al., "Effect of a combination of Leonurus japonicus extracts on respiratory function: a randomized, double-blind, placebo-controlled trial," Nutrients, vol. 16, no. 13, p. 2128, 2024.
