Bangladesh J. Plant Taxon. 26(1): 83–95, 2019 (June) © 2019 Bangladesh Association of Plant Taxonomists ETHNOMEDICINAL PLANTS FOR PREVENTION OF CARDIOVASCULAR DISEASES IN BANGLADESH MOHAMMAD ZASHIM UDDIN1, ATIYA BEGUM RIFAT, FARHANA YESMIN MITU AND TAHMINA HAQUE Department of Botany, University of Dhaka, Dhaka 1000, Bangladesh Keywords: Ethnomedicinal plants; Prevention; Cardiovascular diseases; Bangladesh. Abstract Cardiovascular diseases (CVD) are the major causes of death globally. The treatment of CVD by using modern medicines is very expensive. The present article mainly focuses the ethnomedicinal plants used by the local people for the prevention of cardiovascular diseases in Bangladesh. Information on the ethnomedicinal uses of plants was collected using semi-structured interviews with key informants during the year of 2017 and 2018. Group discussion with local people was also conducted for the promotion of data collection. A total of 41 medicinal plant species was recorded for the prevention of cardiovascular diseases. These species belong to 30 families. The most frequently used medicinal plant species for the prevention of cardiovascular diseases were Terminalia arjuna (Roxb. ex DC.) Wight & Arn., Terminalia bellirica (Gaertn.) Roxb., Terminalia chebula Retz., Allium sativum L., Tamarindus indica L. and Alternanthera sessilis (L.) R. Br. ex Roem. Informant consensus factor (Fic) has been calculated to determine the agreement of local people in the use of medicinal plants for the CVD. Among the ailments categories high Fic value was found in case of antioxidant followed by heartache, high blood pressure and blood purifier. Comparing with previous research Hylocereus undatus (Haw.) Briton and Rose, Alternanthera paronychioides Klotzsch ex Koch and Lactuca sativa L. were seem to be newly reported medicinal plants for the prevention of cardiovascular diseases in Bangladesh. The plant species with high citation, Fic and Fl values can be subjected to phytochemical investigation to find new class of active compounds for the treatment of cardiovascular diseases. The findings of the present study are very preliminary. Further long term studies are needed to validate the ethnomedicinal plants used by the local people for the prevention of cardiovascular diseases in Bangladesh. Introduction Cardiovascular diseases (CVD) refer to any disorders of the heart and blood vessels. The most common ones are disorder of the heart muscle, strokes, heart failure and those caused by high blood pressure (Olorunnisola et al., 2011). Worldwide, CVD is assuming an increasing role as a major cause of morbidity and mortality (Krisela, 2007). It is estimated at approximately 1.6 million deaths per annum worldwide (WHO, 2003). Between 1990 and 2020, the proportion of deaths from CVD is projected to increase from 28.9 to 36.3% (Gowri et al., 2011). Moreover, in terms of number of years of life lost, CVD is expected to jump in ranking from the fourth to first, while as a cause of premature death and disability, it will rise from fifth to first (Hennekens, 2000). The predisposing factors to CVD include cigarette smoking, elevated cholesterol, hypertension, obesity, physical inactivity and diabetes (Olorunnisola et al., 2011). According to the INTERHEART study, Bangladeshis had the highest prevalence of CVD risk factor among five South Asian countries with the prevalence of self-reported history of hypertension (14.3%), 1 Corresponding author, Email: zashim01@gmail.com mailto:zashim01@gmail.com 84 UDDIN et al. abdominal obesity (43.3%), current and former smoking (59.9%), and the lowest prevalence for regular physical activity (1.3%) and daily intake of fruits and vegetables (8.6%) (Joshi et al., 2007). In Bangladesh, 99.6% male and 97.9% females are exposed to at least one of the established risks of CVD and at risk of CVD at a younger age (below 40 years in men) (El-Saharty et al., 2013). The expected high incidence of the diseases, couple with high cost of modern pharmaceuticals and healthcare remedies, makes it all important to search for safe, effective and cheaper remedies from natural world. Before the discovery of modern medicines, many plants have been used by human in the management, treatment and the related complications of CVD. In Bangladesh a number of plants are reputed to possess cardio protective properties, resulting in their use by traditional healer for treatment of chest complaints, high cholesterol, high and low blood pressure and general heart problems. Plants may serve as the alternative sources for the development of new anticoagulant agents due to their biological activities. There is compelling scientific evidences demonstrating that the consumption of dietary anticoagulants or phytochemicals with anticoagulant properties can ultimately reduce or eliminate the risks of thromboembolic diseases (Kumar et al., 2011; Lee et al., 2012; Manicam et al., 2010). Currently, ethnomedicinal knowledge of plants has been eroding at alarming rate from the nature before proper documentation and evaluation. In order to protect such knowledge, documentation of ethnomedicinal plants is already started in Bangladesh. A number of articles published in this field included Mia and Haque (1988); Hassan and Khan (1986, 1996); Alam (1992); Alam et al. (1996); Uddin et al. (2001, 2006, 2012, 2017), Khan et al. (2002), Ghani (2003), Uddin et al. (2004), Yusuf and Uddin (2006); Yosuf (2006); Yusuf et al. (2009), Uddin and Roy (2007); Roy et al. (2008); Emily et al. (2010); Uddin (2013), Haque et al. (2014); Uddin et al. (2015a,b) and Haque et al. (2017). These articles listed a good number of medicinal plants of particular community or particular diseases or particular areas of Bangladesh. But there is no record of ethnomedicinal plant species useful for CVD management in Bangladesh. In order to document and validate ethnomedicinal plant species for CVD management in Bangladesh, an attempt was undertaken to achieve the following objectives: (a) to record, integrate and document all scattered traditional healthcare knowledge on ethnomedicinal plants for CVD management in Bangladesh, (b) to determine ethno-medically potential and culturally important and most cited plant species using statistical models, (c) to validate the folk knowledge of ethnomedicinal plants with thrombolytic agents. Materials and Methods Bangladesh is located in between 20°34' to 26°38' N and 88°01' to 92°41' E and total area is 147,570 sq. km. The country is bounded by India to the West, North, East, by Myanmar to the South-East corner and By the Bay of Bangle to the South. Bangladesh ornamented by different forest types including hill forest, plain land sal forest, mangrove forest, fresh water swamp forest and homestead vegetations. Among the forest types native flora is very diverse due to geo- morphological variations. Once Professor MS Khan estimated that the country may have 5000 angiosperm plant species. Very recently, the plant taxonomist compiled 3611 species from existing literature. Among them, more than 1000 plant species have been used by the local people as medicines. Bangladesh is the also dwelling place for a good number of ethnic communities. These communities have their own cultural tradition and heritage in their social life. For the primary health care they have been used native plant species. Seven sampling sites have been selected for the data collection in Bangladesh. These are Thakurgaon, Dinajpur, Sirajgonj, Dhaka, Brahmanbaria, Feni and Bhola. The sampling sites have been visited during the year of 2017 and 2018. Visit duration for each site was lasted for 4-5 days. The data on medicinal uses of plants were recorded through semi-structured interviews, key ETHNOMEDICINAL PLANTS FOR PREVENTION OF CARDIOVASCULAR DISEASES 85 informant discussions and also with the help of herbal practitioners (Alexiades, 1996). Field interview, plant interview and group discussion with local people were also conducted for the promotion of data collection. During the field survey, information on uses of plants to treat human, parts used, modes of preparation and administration was collected. The vernacular names have been collected with the help of local people whenever available. A total of 166 local informants including 66% males and 34% females were interviewed during the ethnobotanical survey. The local informants were housewives, herbalist, farmers, craftsmen, shopkeepers, teachers and also students. The informants were ranged within 21–70 years old. Voucher specimens for each medicinal plant species were collected and processed using standard herbarium techniques (Hyland, 1972). Identification of plant species have been done by the experts in both field and laboratory. In case of confusion in identity, standard literature was consulted and the relevant voucher specimens available at Dhaka University Salar Khan Herbarium (DUSH) were also compared. All voucher specimens were deposited at DUSH. Factor of informant consensus (Fic), Fidelity level (Fl) and Citation frequency was calculated using bio statistical formulas. Factor of informant consensus (Fic) was calculated applying the following equation: Fic = Nur – Ntaxa/Nur-1, Where Nur is the number of use reports in each category, Ntaxa is the number of species in each category (Trotter and Logan, 1986; Heinrich et al., 1998). Citation frequency was calculated using the following formula: frequency of citation for a particular species= (Number of citations for that particular species/ Number of all citations for all species) x 100 (Uddin et al., 2017). The Fidelity level, was calculated for the most frequently reported medicinal plant species as: Fl (%) = (Np / N) × 100; Where, Np = number of informants that claim a use of a plant species to treat a particular disease; N = number of informants that use the plants as a medicine to treat any given disease (Friedman et al., 1986). Results and Discussion The present ethnobotanical survey recorded a total of 41 medicinal plants belonging to 30 families that were acquired by conducting 166 interviews for the treatment of cardiovascular diseases with 70 formularies from different district of Bangladesh (Table 1). According to the habit diversity of recorded medicinal plant, 56% was tree, 34% was herb, 5% was shrub and 5% was climber (Fig.1). Leaves are the most commonly used part for medicinal plants or for the preparation of traditional medicine (Fig. 2). Similar trend of using leaves for medicinal use has also been reported from other studies from Bangladesh (Uddin et al., 2012; Biswas et al., 2010). According the citation frequency of all medicinal plants, the most frequently used plants were Terminalia arjuna (Roxb. ex DC.) Wight & Arn., Terminalia bellirica (Gaertn.) Roxb., Terminalia chebula Retz., Allium sativum L., Tamarindus indica L. and Alternanthera sessilis (L.) R. Br. ex Roem. In the present study 41 medicinal plant species have been found for the treatment of cardiac diseases. Medicinal plant from the families were found high number of species belong to Combretaceae, Ceasalpiniaceae and Apocyanaceae. The most cited species used to treat such ailments are Terminalia aurjuna, Terminalia bellirica, Alternanthera sessilis, Rauvolfia serpentina ,Tamarindus indica, Allium sativum, Zingiber officinale and Achyranthes aspera. To calculate the Factor of informant consensus (Fic) values total ailments were categorized into four groups viz: heartache, antioxidant, blood purifier and high blood pressure. The average Fic value for all ailment categories obtained was 0.78. Such value indicated that maximum people in the study area were well informed about the medicinal knowledge of plants. Among the four categories antioxidant group attained the highest Fic values (0.82) followed by heartache, high blood pressure (0.79) and blood purifier (0.74, Table 2). 86 UDDIN et al. ETHNOMEDICINAL PLANTS FOR PREVENTION OF CARDIOVASCULAR DISEASES 87 88 UDDIN et al. ETHNOMEDICINAL PLANTS FOR PREVENTION OF CARDIOVASCULAR DISEASES 89 90 UDDIN et al. ETHNOMEDICINAL PLANTS FOR PREVENTION OF CARDIOVASCULAR DISEASES 91 Fig.1. Habit diversity. Fig. 2. Proportion of parts used of medicinal plant species. Table 2. Factor of informant consensus (Fic) for each use category related to cardiovascular diseases. Category No. of species (Ntaxa) No. of use reports (Nur) Factor of informant consensus (Fic) Antioxidant 4 18 0.823529 High blood pressure 15 69 0.794118 Heartache 32 152 0.793333 Blood purifier 11 40 0.74359 Table 3. Fidelity level (Fl %) of most cited plant species. Scientific name Np N Fl% Achyranthes aspera L. 5 5 100 Terminalia bellirica (Gaertn.) Roxb. 18 19 94.73 Terminalia arjuna (Roxb. ex DC.) Wight & Arn. 42 45 93.33 Terminalia chebula Retz. 15 18 83.31 Tamarindus indica L. 33 38 86.84 Rauvolfia serpentina Benth. 14 18 77.78 Alternanthera sessilis (L.) R. Br. ex Roem. & Schult. 11 15 73.33 Allium sativum L. 14 20 70 Np = number of informants that claim a use of a plant species to treat a particular disease; N = number of informants that use the plants as a medicine to treat any given disease. During ethnobotanical survey the data of the other use of these medicinal plants which showed highest frequency further calculated for Fidelity level (Table 3). Among the most cited ethnomedicinal plant species eight species showed above 70% Fidelity level (Table 3). Achyranthes aspera showed 100% Fidelity level but with a low citation frequency (3.012) for the treatment of chest pain. In the present study Alternanthera sessilis was highly cited medicinal plant species for antioxidant category which scored highest Fic value. This plant is also used for the treatment of pox (Uddin et al., 2017), snake bite (Khan et al., 2002). In the present study Allium sativum (garlic) is used for the treatment of heart disease management. This plant is also used for gastric, cold, fever, chest pain, reduced pressure and ringworm (Uddin et al., 2015a,b, Uddin et al. 2017). Experimental and clinical studies showed that garlic produced hypertensive effects and also induced significant reduction in systolic and diastolic blood pressure. 92 UDDIN et al. Terminalia aurjuna is used for the treatment of heartache which is also used for the same purpose reported from different area from Bangladesh (Uddin et al., 2012, Uddin and Hassan, 2014). This plant is also used for stomachache, cough, diabetes, menstruation, gastric pain, and dysentery (Uddin et al., 2006, 2012, 2017; Islam et al., 2014; Uddin et al., 2015a,b). Terminalia arjuna is a popular Indian medicinal plant with its bark been used for over centuries as cardiotonic. The bark has been found to contain several bioactive compounds including saponins and flavonoids (Navjot et al., 2014). The cardio protective effects, particularly of bark of Terminalia arjuna are well known. Such effects include reported protective effects of plant bark against doxorubicin induced cardio toxicity reported significant inotropic and hypotensive effect of bark, also increased coronary artery flow and protection of myocardium against ischemic damage (Sing et al. 2008, Dwivedi 2007). Terminallia bellirica is used for the treatment of heart disease and also reported for stomachache, dysentery, appetizer, anemia, fever, bronchitis, constipation, asthma, vomiting, eye & menstrual disorder (Uddin et al., 2006, 2012, 2014, 2015 and 2017). Tamarindus indica is used for reducing blood pressure which is also reported from others studies from Bangladesh (Uddin et al., 2015, 2017). Rauvolfia serpentina is used for controlling high blood pressure and also used for hypertension, mental disorder, stomach ache and gastric (Islam et al., 2014; Roy et al., 2008; Uddin et al., 2004). Tamarindus indica is reported for controlling high blood pressure. This plant is also reported for the treatment of reducing pressure, diarrhea, dysentery, appetizer, constipation, impotence, abscess and jaundice (Khan et al., 2002; Uddin et al., 2012, 2015, 2017). Different parts of plant affect the LDL oxidation and macrophage inflammatory response and also nephrotoxic effects and also having antipsychotic potential helpful in preventing delaying clot formation and have immunostimulant activity (Narendra and Khurana, 2018). Compared with previous research (Ghani, 2003; Uddin et al., 2006, 2012, 2014, 2015, 2017; Haque et al. 2017; Sajib and Uddin, 2013; Uddin et al., 2013) Hylocereus undatus, Alternanthera paronychioides and Lactuca sativa seem to be newly reported medicinal plants for cardiovascular diseases treatment . Among the three plant species Lactuca sativa and Hylocereus undatus are not native to Bangladesh but local people used these plants for cardiovascular diseases. The plant species with high citation, Fic and Fl values can be subjected to phytochemical investigation to find new class of active compounds for the treatment of cardiovascular diseases. The findings of the present study are very preliminary. Further long term studies are needed to validate the ethnomedicinal plants used by the local people for the prevention of cardiovascular diseases in Bangladesh. 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