Cochrane Summary of Findings: Horse Chestnut Seed Extract for Chronic Venous Insufficiency by GlobAdvHealthMed

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Vigdis Underland, MS; Ingvil S�terdal, PhD; and Elin Str�mme Nilsen, MS, are researchers at the Nordic Cochrane Centre’s Norwegian branch, Norwegian Knowledge Centre for Health Services, Oslo, Norway.

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                                REVIEW


                                Cochrane Summary of Findings: Horse Chestnut Seed Extract
                                for Chronic Venous Insufficiency
                                Vigdis Underland, MS; Ingvil Sæterdal, PhD; Elin Strømme Nilsen, MS




                                A
        Author Affiliation              s part of its efforts to disseminate the results of                           vent blood clots from forming. The unprocessed seeds
     Vigdis Underland, MS;
 Ingvil Sæterdal, PhD; and
                                        Cochrane reviews to a wider audience, the                                     are poisonous, and symptoms associated with horse
 Elin Strømme Nilsen, MS,               Cochrane Complementary and Alternative                                        chestnut seed poisoning include vomiting, diarrhea,
      are researchers at the    Medicine (CAM) Field develops Summary of Findings                                     headache, confusion, weakness, muscle twitching,
 Nordic Cochrane Centre’s
                                (SoF) tables and then uses these tables as a basis for its                            poor coordination, coma, and paralysis. Horse chest-
        Norwegian branch,
    Norwegian Knowledge         Plain Language Summaries. In each SoF table, the                                      nut seeds are therefore processed to remove the toxic
Centre for Health Services,     most important outcomes of the review, the effect of                                  component, resulting in purified horse chestnut seed
              Oslo, Norway.     the intervention on each outcome, and the quality of                                  extract (HCSE).
          Correspondence
                                the evidence for each outcome are presented. The pro-                                      The active component of HCSE is called escin
  Elin Strømme Nilsen, MS       cess of developing the SoF table involves deciding                                    (also spelled aescin). Escin appears to promote blood
              esn@nokc.no       which outcomes to present for which time points and                                   circulation through the veins and thereby reduce
                                evaluating the strength and quality of the evidence for                               swelling and inflammation of the legs. It is not
                Citation
  Global Adv Health Med.
                                the outcomes. The Cochrane CAM Field contacted the                                    exactly clear how escin works, but theories include
      2012;1(1):100-101.        authors of this review to request clarification on any                                that it works by “sealing” leaking capillaries, improv-
                                points that are not understood in the Cochrane review                                 ing the elastic strength of veins, preventing the
              Key Words
                                and also to request their review of the SoF. In this arti-                            release of enzymes that damage the blood vessels,
     Summary of findings,
  Cochrane, CAM, review,        cle, review authors in the Cochrane Collaboration                                     and blocking other various physiological events that
      horse chestnut seed       reviewed the effects of horse chestnut seed extract for                               lead to vein damage.
    extract, HCSE, chronic      chronic venous insufficiency.                                                              The most common dosage of horse chestnut is 300
 venous insufficiency, CVI,
    collaboration, GRADE
                                                                                                                      mg HCSE twice daily, standardized to contain 50 mg
                                CHRONIC VENOUS INSUFFICIENCY AND HORSE                                                escin per dose, for a total daily dose of 100 mg escin.
       Acknowledgment           CHESTNUT SEED EXTRACT                                                                      In theory, horse chestnut may increase the risk of
  This article was prepared
                                     Chronic venous insufficiency (CVI) is character-                                 bleeding. In addition, animal studies suggest that
            on behalf of the
Cochrane Complementary          ized by a chronic inability of veins in the lower leg to                              HCSE may cause lowered blood sugar.
 and Alternative Medicine       transport blood back toward the heart due to damage
    Field and with funding      to the one-way valves within the leg veins. This dam-                                 WHAT DOES THE RESEARCH SAY?
      from the US National
Center for Complementary
                                age is caused by blood clots (deep vein thromboses) or                                     Not all research provides the same quality of evi-
 and Alternative Medicine       other factors, such as congenital disorders. This results                             dence. The higher the quality, the more certain we are
          of the US National    in venous hypertension, an increase in pressure with-                                 about what the research says about an effect. The
         Institutes of Health
                                in the veins in the leg.                                                              words will (high-quality evidence), probably (moder-
        (grant number R24
                 AT001293).
                                     The signs of CVI include swelling of the leg, feel-                              ate-quality evidence), and may (low-quality evidence)
                                ings of tired and painful legs, dry scaly skin, varicose                              describe how certain we are about the effect.
                                veins, hardening of the skin, and leg ulcers (open                                         After searching for all relevant studies, the review
                                wounds on the lower legs that do not heal after 6                                     authors found 17 studies that they included in the
                                weeks). CVI severity is often graded into 3 categories:                               review. Ten of these studies were placebo-controlled
                                stage I, swelling (edema); stage II, swelling (edema)                                 trials. The trials showed that for people with chronic
                                plus skin changes; stage III, the presence of open or                                 venous insufficiency, horse chestnut seed extract
                                healed leg ulcers. Stage III is considered the most
                                severe stage of CVI. About 10% to 15% of adult men                                        • pr
								
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