Search JIM Advanced Search

Journal of Chinese Integrative Medicine ›› 2011, Vol. 9 ›› Issue (7): 702-710.doi: 10.3736/jcim20110702

• Systematic Review • Previous Articles     Next Articles

A review of the use of bromelain in cardiovascular diseases

Chit Moy Ley1, Amalia Tsiami1, Qing Ni2Nicola Robinson3()   

  1. 1. Social Care and Human Sciences, School of Psychology, University of West London, Middlesex, TW8 9GA, UK
    2. Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
    3. Faculty of Health and Social Care, London South Bank University, London SE1 0AA, UK
  • Received:2011-03-05 Accepted:2011-05-05 Online:2011-07-20 Published:2011-06-15

Background: In 2004 an estimated 17.1 million people died from cardiovascular diseases (CVDs) worldwide, representing 29% of all global deaths. According to the American Heart Association, heart disease and stroke are the main cause of death and disability among people with type 2 diabetes. Additional safe and effective approaches are needed for the prevention and management of CVDs which may include nutritional supplements.
Objective: To identify the potential of bromelain (a food supplement) on the risk factors associated with CVDs.
Search strategy: An electronic and manual search was conducted during November 2009 to March 2010. The databases searched included: Ovid MEDLINE; All EBM Reviews — Cochrane Database of Systematic Reviews (Cochrane DSR), American College of Physicians (ACP) Journal Club, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CCTR), Cochrane Methodology Register (CMR), Health Technology Assessment (HTA) and National Health Service Economic Evaluation Database (NHSEED); Allied and Complementary Medicine (AMED); British Nursing Index and Archive; EMBASE; Health Management Information Consortium (HMIC); ScienceDirect and Electronic Thesis Online Services (ETHOS). Only papers in the English language were included.
Inclusion criteria: Randomised controlled trials (RCTs), human studies, animal studies and experimental studies related to bromelain for CVDs.
Data extraction and analysis: The quality assessment of all the selected studies was conducted by the authors. Data from 3 animal trials and 3 human trials were included in the review. Data collected included: type of trial, drug dosage, duration, outcome measures, characteristics of bromelain used, significance of results and conclusion.
Results: Out of 223 papers retrieved, 6 papers met the inclusion criteria and could be included in the review. These comprised of 3 animal and 3 human trials, each of which investigated the use of bromelain for CVDs. Results suggested that bromelain could be used for treating acute thrombophlebitis, as it decreases aggregation of blood platelets, has a cardio-protective effect, ameliorates rejection-induced arterial wall remodelling, prevents thrombin-induced human platelet aggregation as well as reduces thrombus formation.
Conclusion: No substantive study of bromelain and clinical CVDs has been carried out in human populations. Only a few studies on bromelain and CVDs were published from 1948 to 2010. This may be an area worthy to be explored in future CVDs research.

Key words: cardiovascular diseases, bromelains, review

Figure 1

Review flow diagram"

[1] World Health Organization. Cardiovascular diseases. ( 2011)[ 2011-02-03]. 2011) [2011-02-03].
[2] World Health Organization. Cardiovascular diseases (CVDs). (2011-01)[ 2011-02-03]. Cardiovascular diseases (CVDs). (2011-01) [2011-02-03].
[3] British Heart Foundation , 1999-2009: a decade of achievements. ( 2010)[ 2011-02-03]. 2010) [2011-02-03]. .
[4] American Heart Association. Diabetes and cardiovascular disease. (2010-09-08)[ 2011-02-03]. Diabetes and cardiovascular disease. (2010-09-08) [2011-02-03]. .
[5] Jackson PPR, Aarabi M, Wallis E .Aspirin for primary prevention of coronary heart disease[J].Cochrane Database Syst Rev, 2004,(1):CD004586
doi: 10.1002/14651858.CD004586
[6] Lip GY, Felmeden DC .Antiplatelet agents and anticoagulants for hypertension[J].Cochrane Database Syst Rev, 2004,( 3):CD003186
doi: 10.1002/14651858.CD003186.pub3 pmid: 22161375
[7] Perez MI, Musini VM, Wright JM .Effect of early treatment with anti-hypertensive drugs on short and long-term mortality in patients with an acute cardiovascular event[J].Cochrane Database Syst Rev, 2009,( 4):CD006743
[8] Taylor F, Ward K, Moore TH, Burke M, Davey Smith G, Casas JP , Ebrahim S.Statins for the primary prevention of cardiovascular disease[J].Cochrane Database Syst Rev, 2011,( 1):CD004816
[9] King DE, Ellis TM, Everett CJ, Mainous AG3rd .Medication use for diabetes, hypertension, and hypercholesterolemia from 1988-1994 to 2001-2006[J]. South Med J, 2009,102(11):1127-1132
doi: 10.1097/SMJ.0b013e3181bc74c8 pmid: 19864974
[10] Heinicke RM, Gortner WA . Stem bromelain — a new protease preparation from pineapple plants[J]. Econ Bot, 1957,11(3):225-234
doi: 10.1007/BF02860437
[11] Kelly GS . Bromelain: a literature review and discussion of its therapeutic applications[J]. Alt Med Rev, 1996,1(4):243-257
[12] Guimarães-Ferreira CA, Rodrigues EG, Mortara RA, Cabral H, Serrano FA, Ribeiro-dos-Santos R, Travassos LR . Antitumor effects in vitro and in vivo and mechanisms of protection against melanoma B16F10-Nex2 cells by fastuosain, a cysteine proteinase from Bromelia fastuosa[J]. Neoplasia, 2007,9(9):723-733
doi: 10.1593/neo.07427
[13] Heinicke RM, van der Wal L, Yokoyama M . Effect of bromelain(Ananase) on human platelet aggregation[J]. Experientia, 1972,28(7):844-845
doi: 10.1007/BF01923166 pmid: 4658882
[14] Metzig C, Grabowska E, Eckert K, Rehse K, Maurer HR . Bromelain proteases reduce human platelet aggregation in vitro, adhesion to bovine endothelial cells and thrombus formation in rat vessels in vivo[J]. In Vivo, 1999,13(1):7-12
[15] Felton GE . Fibrinolytic and antithrombotic action of bromelain may eliminate thrombosis in heart patients[J]. Med Hypotheses, 1980,6(11):1123-1133
doi: 10.1016/0306-9877(80)90134-6 pmid: 6256612
[16] Pirotta F, De Giuli-Morghen C .Bromelain — a deeper pharmacological study. NoteⅠ. Antiinflammatory and serum fibrinolytic activity after oral administration in the rat[J]. Drugs Exp Clin Res, 1978,4:1-20
[17] Brien S, Lewith G, Walker A, Hicks SM, Middleton D . Bromelain as a treatment for osteoarthritis: a review of clinical studies[J]. Evid Based Complement Alternat Med, 2004,1(3):251-257
doi: 10.1093/ecam/neh035 pmid: 538506
[18] Brien S, Lewith G, Walker AF, Middleton R, Prescott P, Bundy R . Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study[J]. QJM, 2006,99(12):841-850
doi: 10.1093/qjmed/hcl118
[19] Rosenberg L, Lapid O, Bogdanov-Berezovsky A, Glesinger R, Krieger Y, Silberstein E, Sagi A, Judkins K, Singer AJ . Safety and efficacy of a proteolytic enzyme for enzymatic burn debridement: a preliminary report[J]. Burns, 2004,30(8):843-850
doi: 10.1016/j.burns.2004.04.010
[20] Neumayer C, Fügl A, Nanobashvili J, Blumer R, Punz A, Gruber H, Polterauer P, Huk I . Combined enzymatic and antioxidative treatment reduces ischemia-reperfusion injury in rabbit skeletal muscle[J]. J Surg Res, 2006,133(2):150-158
doi: 10.1016/j.jss.2005.12.005
[21] Bahde R, Palmes D, Minin E, Stratmann U, Diller R, Haier J, Spiegel HU . Bromelain ameliorates hepatic microcirculation after warm ischemia[J]. J Surg Res, 2007,139(1):88-96
doi: 10.1016/j.jss.2006.10.004 pmid: 17292418
[22] Gutfreund AE, Taussig SJ, Morris AK . Effect of oral bromelain on blood pressure and heart rate of hypertensive patients[J]. Hawaii Med J, 1978,37(5):143-146
pmid: 659096
[23] Taussig SJ . The mechanism of the physiological action of bromelain[J]. Med Hypotheses, 1980,6(1):99-104
doi: 10.1016/0306-9877(80)90038-9 pmid: 7382892
[24] Tochi BN, Wang Z, Xu SY, Zhang WB . Therapeutic application of pineapple protease(bromelain): a review[J]. Pakistan J Nutr, 2008,7(4):513-520
doi: 10.3923/pjn.2008.513.520
[25] Joanna Briggs Institute . JBI comprehensive systematic review training program: Module 3 — The appraisal, extraction and pooling of quantitative Data. 2010.
[26] Stevinson C, Lawlor DA . Searching multiple databases for systematic reviews: added value or diminishing returns?[J]. Complement Ther Med, 2004,12(4):228-232
doi: 10.1016/j.ctim.2004.09.003 pmid: 15649836
[27] Juhasz B, Thirunavukkarasu M, Pant R, Zhan L, Penumathsa SV, Secor ER Jr, Srivastava S, Raychaudhuri U, Menon VP, Otani H, Thrall RS, Maulik N . Bromelain induces cardioprotection against ischemia-reperfusion injury through Akt/FOXO pathway in rat myocardium[J]. Am J Physiol Heart Circ Physiol, 2008,294(3):H1365-H1370
doi: 10.1152/ajpheart.01005.2007
[28] Gaciong Z, Paczek L, Bojakowski K, Socha K, Wisniewski M, Heidland A . Beneficial effect of proteases on allograft arteriosclerosis in a rat aortic model[J]. Nephrol Dial Transplant, 1996,11(6):987-989
doi: 10.1093/oxfordjournals.ndt.a027521 pmid: 8671957
[29] Nieper HA . Effect of bromelain on coronary heart disease and angina pectoris[J]. Acta Med Empirica, 1978,5:274-278
[30] Seligman B . Oral bromelains as adjuncts in the treatment of acute thrombophlebitis[J]. Angiology, 1969,20(1):22-26
doi: 10.1177/000331976902000103 pmid: 4885019
[31] Maurer HR . Bromelain: biochemistry, pharmacology and medical use[J]. Cell Mol Life Sci, 2001,58(9):1234-1245
doi: 10.1007/PL00000936 pmid: 11577981
[32] Malezieux E . Global network for pineapple research[J]. Acta Hortic, 2000,529:35-47
doi: 10.17660/ActaHortic.2000.529.2
[1] Ming-min Xu, Pei Guo, Qing-yu Ma, Xuan Zhou, Yu-long Wei, Lu Wang, Yue Chen, Yu Guo. Can acupuncture enhance therapeutic effectiveness of antidepressants and reduce adverse drug reactions in patients with depression? A systematic review and meta-analysis. Journal of Integrative Medicine, 2022, 20(4): 305-320.
[2] Ting-ting Lu, Cun-cun Lu, Mei-xuan Li, Li-xin Ke, Hui Cai, Ke-hu Yang. Reporting and methodological quality of meta-analyses of acupuncture for patients with migraine: A methodological investigation with evidence map. Journal of Integrative Medicine, 2022, 20(3): 213-220.
[3] Witoo Dilokthornsakul, Ramanya Kosiyaporn, Rattanamanee Wuttipongwaragon, Piyameth Dilokthornsakul. Potential effects of propolis and honey in COVID-19 prevention and treatment: A systematic review of in silico and clinical studies. Journal of Integrative Medicine, 2022, 20(2): 114-125.
[4] Jun-peng Yao, Li-ping Chen, Xian-jun Xiao, Ting-hui Hou, Si-yuan Zhou, Ming-min Xu, Kai Wang, Yu-jun Hou, Lin Zhang, Ying Li. Effectiveness and safety of acupuncture for treating functional constipation: An overview of systematic reviews. Journal of Integrative Medicine, 2022, 20(1): 13-25.
[5] Yi Yuan, Rui-Ting Wang, Jun Xia, Hui-Juan Cao. Interventions for preventing influenza: an overview of Cochrane systematic reviews and a Bayesian network meta-analysis. Journal of Integrative Medicine, 2021, 19(6): 503-514.
[6] Meng-zhu Zhao, Chen Zhao, Shuang-shuang Tu, Xu-xu Wei, Hong-cai Shang. Evaluating the methodology of studies conducted during the global COVID-19 pandemic: A systematic review of randomized controlled trials. Journal of Integrative Medicine, 2021, 19(4): 317-326.
[7] Dastan M. Khoshnaw, Abhijit A. Ghadge. Yoga as a complementary therapy for metabolic syndrome: A narrative review. Journal of Integrative Medicine, 2021, 19(1): 6-12.
[8] Liang Dai, Ka Kei Chan, Jian-chun Mao, Yu Tian, Jun-hua Gu, Jun Zhou, Linda L.D. Zhong. Modified Zhibai Dihuang pill, a traditional Chinese medicine formula, on steroid withdrawal in systemic lupus erythematosus: A systematic review and meta-analysis. Journal of Integrative Medicine, 2020, 18(6): 478-491.
[9] Arthur Yin Fan, Sherman Gu, Sarah Faggert Alemi, Research Group for Evidence-based Chinese Medicine. Chinese herbal medicine for COVID-19: Current evidence with systematic review and meta-analysis. Journal of Integrative Medicine, 2020, 18(5): 385-394.
[10] Xian-jun Xiao, Lei-xiao Zhang, Yun-zhou Shi, Jun-peng Yao, Wei Cao, Ying Liu, Zi-hao Zou, Si-yuan Zhou, Ming-ling Chen, Chun-xiao Li, Qian-hua Zheng, Ying Li. Cupping therapy for patients with chronic urticaria: A systematic review and meta-analysis. Journal of Integrative Medicine, 2020, 18(4): 303-312.
[11] Dong-dong Yu, Liang-zhen You, Wan-qiu Huang, Hui Cao, Fan-jing Wang, Xiu-qin Tang, Zhao-hui Fang, Guo-ming Shen, Yu-xiang Guan. Effects of traditional Chinese exercises on blood glucose and hemoglobin A1c levels in patients with prediabetes: A systematic review and meta-analysis. Journal of Integrative Medicine, 2020, 18(4): 292-302.
[12] Dona Nirmani Ann Wijewickrama Samarakoon, Deepthi Inoka Uluwaduge, Malith Aravinda Siriwardhene. Mechanisms of action of Sri Lankan herbal medicines used in the treatment of diabetes: A review. Journal of Integrative Medicine, 2020, 18(1): 13-20.
[13] Lena Grönblom Lundström, Ulrika Aasa, Yan Zhang, Tobias Sundberg. Health care in light of different theories of health—A proposed framework for integrating a social humanistic perspective into health care. Journal of Integrative Medicine, 2019, 17(5): 321-327.
[14] Jia Xu, Fu-qing Zhang, Jian Pei, Jun Ji . Acupuncture for migraine without aura: A systematic review and meta-analysis. Journal of Integrative Medicine, 2018, 16(5): 312-321.
[15] Wen-jie Xu, Ling-tai Wang, Zhi-ping Zhao, Li-ming Zhu, Liang-hua Zu, Qi Zhang, Dan-bo Dou. Prospects of a comprehensive evaluation system for traditional Chinese medicine services. Journal of Integrative Medicine, 2017, 15(6): 426-432.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] Wei-xiong Liang. Problems-solving strategies in clinical treatment guideline for traditional Chinese medicine and integrative medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 1-4
[2] Zhao-guo Li. Discussion on English translation of commonly used sentences in traditional Chinese medicine: part one. Journal of Chinese Integrative Medicine, 2008, 6(1): 107-110
[3] Jun Hu, Jian-ping Liu. Non-invasive physical treatments for chronic/recurrent headache. Journal of Chinese Integrative Medicine, 2008, 6(1): 31
[4] Xue-mei Liu, Qi-fu Huang, Yun-ling Zhang, Jin-li Lou, Hong-sheng Liu, Hong Zheng. Effects of Tribulus terrestris L. saponion on apoptosis of cortical neurons induced by hypoxia-reoxygenation in rats. Journal of Chinese Integrative Medicine, 2008, 6(1): 45-50
[5] . Uniform requirements for manuscripts submitted to biomedical journals: Writing and editing for biomedical publication (Chinese version, part two). Journal of Chinese Integrative Medicine, 2010, 8(11): 1001-1005
[6] Daniel Weber, Janelle M Wheat, Geoffrey M Currie. Inflammation and cancer: Tumor initiation, progression and metastasis,and Chinese botanical medicines. Journal of Chinese Integrative Medicine, 2010, 8(11): 1006-1013
[7] Hong Liu , Guo-liang Zhang, Li Shen , Zhen Zeng, Bao-luo Zhou, Cheng-hai Liu, Guang Nie . Application and evaluation of a pseudotyped virus assay for screening herbs for anti-H5Nl avian influenza virus. Journal of Chinese Integrative Medicine, 2010, 8(11): 1036-1040
[8] Zhao-guo Li . A discussion of English translation of 1995 and 1997 Chinese National Standards of Traditional Chinese Medical Terminologies for Clinical Diagnosis and Treatment. Journal of Chinese Integrative Medicine, 2010, 8(11): 1090-1096
[9] Rui Jin, Bing Zhang. A complexity analysis of Chinese herbal property theory: the multiple formations of herbal property (Part 1). Journal of Chinese Integrative Medicine, 2012, 10(11): 1198-1205
[10] Hui-min Liu, Xian-bo Wang, Yu-juan Chang, Li-li Gu. Systematic review and meta-analysis of randomized controlled trials of integrative medicine therapy for treatment of chronic severe hepatitis. Journal of Chinese Integrative Medicine, 2012, 10(11): 1211-1228