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Original Article

Effect of Terminalia Arjuna on Total Platelet Count and Lipid

Profile in Patients of Coronary Artery Disease
Nidhi Priya, K. C. Mathur1, A. Sharma2, R. P. Agrawal2, V. Agarwal2, Jitendra Acharya3
Department of Pathology, RUHS Medical College, Jaipur, 1Departments of Physiology, 2Medicine, and 3Dentistry, Sardar Patel Medical College, Bikaner, Rajasthan, India

Abstract
Objective: Our study was undertaken to observe the effect of Terminalia arjuna on total platelet count, lipid profile, clinical parameters in
patients of coronary artery disease (CAD) and their usefulness in the same patient group. Materials and Methods: One hundred patients
having CAD were selected and randomised to study group (to receive Arjuna Chhal Powder) and control group (not receiving any medication).
After the therapy of 1 month with Arjuna Chhal Powder, patients of both study and control groups evaluated for body weight, blood pressure,
pulse rate, total platelet count and lipid profile. Observations were analysed with use of appropriate statistical test. Results: We observed
0.22% decrease in body weight in study group although insignificant. The systolic blood pressure decreased by 10.28% and diastolic blood
pressure by 4.8% in the study group which was statistically significant in comparison to control group. The pulse rate has shown a decrement
of 4.85% of baseline and total platelet count decreased by 10.81% with statistically significant difference. Lipid profile improved with 10.2%
reduction in total cholesterol level, 17.9% reduction in serum triglyceride level, 9.59% reduction in serum low‑density lipoprotein (LDL)
level, 16% reduction in serum very LDL level and 10.48% increase in serum high‑density lipoprotein level, all being statistically significant.
Conclusions: T. arjuna bark extract can significantly reduce blood pressure and favourably modify lipid profile. It might also have antioxidant
properties and may be beneficial for cardiac as well as overall health.

Keywords: Alternative medicine, blood pressure, lipid profile, Terminalia arjuna

Introduction be reversed by taking the herb.[7,8] Arjuna bark powder taken

Coronary artery disease (CAD; also known as atherosclerotic
heart disease) is the most common type of heart disease and
a frequent cause of cardiac events.[1] An Indian shrub known
as Arjuna has been used mainly in ayurvedic medicine to
support cardiovascular health.[2] Extract of this plant contains
variety of flavonoids and polyphenols, which help to reduce
inflammation that causes plaque formation in arteries.[3]
The extract also supports healthy lipid profile.[4] Oligomeric
proanthocyanidins and flavonoids present in Terminalia arjuna
extract boost the natural antioxidant defence system of the heart
and strengthen the vascular system of the body. It might prevent
atherothrombosis by inhibiting platelet aggregation in CAD
patients.[5,6] It helps to treat angina, lower the blood pressure, to
treat in congestive heart failure and improves lipid profile and
prevents atherosclerosis. In a small clinical trial, it was found
that frequency and severity of angina could be reduced and onset
could be delayed with the use of Arjuna. In people with mild
angina, changes in the heart muscles owing to ischaemia might
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along with vasodilator and diuretics improves the symptoms
of heart failure.[9] Findings in the animal studies show that
therapy with Arjuna bark reduces total cholesterol, low‑density
lipoprotein (LDL) and triglycerides and increases high‑density
lipoprotein (HDL) or good cholesterol in blood.[10] In a study,
it was found that the rabbits receiving T. arjuna had a marked
reduction in total cholesterol than control rabbits.[11] Arjuna bark
powder could protect the heart from adverse effect of chronic
high blood pressure by lowering the systolic blood pressure
levels. The herb might help to boost cardiovascular endurance.[12]
Keeping in mind all these medicinal use of T. arjuna, we decided
to study the effect of herb on total platelet count, lipid profile
and other clinical parameters in patients of CAD.
Address for correspondence: Dr. Jitendra Acharya,
Sardar Patel Medical College, Bikaner, Rajasthan, India.
E‑mail: drjitendraacharya@yahoo.in
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For reprints contact: reprints@medknow.com

How to cite this article: Priya N, Mathur KC, Sharma A, Agrawal RP,
DOI: Agarwal V, Acharya J. Effect of Terminalia arjuna on total platelet count
10.4103/AIHB.AIHB_8_18 and lipid profile in patients of coronary artery disease. Adv Hum Biol
2019;9:98-101.

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Priya, et al.: Terminalia Arjuna in patients of CAD

Materials and Methods • Arjuna Chhal Powder was collected from Mohta
Rasayanshala, Bikaner.
One hundred patients were selected from the patients attending
Haldiram Moolchand Government Centre for cardiovascular Statistical analysis
research and Mohta Rasayanshala, Bikaner. The study was For statistical comparison of data, appropriate model was
conducted at Department of Physiology, Sardar Patel Medical applied and the results with P <  0.05 were considered
College, Bikaner. Approval from the institutional ethical significant. Since the study was conducted at one place, only
committee was taken for the study. Selected patients were geographical and climatic condition remained unchanged. The
randomised to two groups of 50 patients no.ad/ec 18 as study data are expressed as mean ± standard deviation.
and control group. Baseline parameters such as pulse rate, body
weight, blood pressure, total platelet count and lipid profile Results
were obtained from the patient of both groups after detailed
The body weight in study group decreased slightly from
history taking and general physical examination. Patients of
79.40  ±  7.63 to 79.22  ±  8.04 though the change was
the study group were asked to take 3 g of Arjuna Chhal Powder
statistically insignificant. Systolic and diastolic blood
mixed in 250 ml of milk heated till it is boiling, twice daily
pressure decreased from 163.22 ± 19.91 and 93.74 ± 10.86
for a period of 1 month. Both the groups were evaluated after
to 146.44  ±  18.64 and 89.02  ±  10.71 both of which were
1 month for all the baseline parameters [Table 1].
statistically significant. Pulse rate changed favourably from
Exclusion criteria 82.46 ± 3.63 to 78.46 ± 3.97 (P = 0.0001). Total platelet count
Patient suffering from liver disease, arthritis, asthma, decreased from 4.429 ± 0.83 to 3.95 ± 0.71 (P = 0.002). Serum
pulmonary tuberculosis, malabsorption and patient not giving cholesterol decreased from 235.02 ± 47.58 to 210.82 ± 41.36
consent. and serum triglyceride level decreased from 151.3 ± 49.92 to
124.08 ± 39.86. Serum HDL cholesterol (HDL‑C) increased
Patients were examined for: from 42.34 ± 9.27 to 46.78 ± 6.52 and serum LDL and serum
• Blood pressure: Average of two readings 5 min apart by very LDL cholesterol level decreased from 134.40 ± 25.16,
mercury sphygmomanometer in sitting position 36.78  ±  11.93 to 121.5  ±  21.45, 30.86  ±  7.64. Change in
• Pulse rate: In right radial artery in sitting position all parameters of lipid profile was statistically significant
• Platelet count: By Rees–Ecker method [Table 2]. Baseline data of both the study and control groups
• Lipid prof ile: By complete automatic chemistr y were matched.
autoanalyser
Discussion
Table 1: Baseline distribution of both study and control Arjuna has been a part of Ayurveda since 2500 BC as a heart
groups tonic. It is used to treat cardiovascular disease including
Age group Controls Cases Total angina pectoris, ischaemic heart disease, cardiomyopathy and
(years)
Male Female Male Female Male Female congestive heart failure and act as cardioprotective agent in
41‑50 4 1 2 0 6 1
hypertension.
51‑60 9 6 8 7 17 13 In the present study, it was found that use of T. arjuna is
61‑70 14 5 13 5 27 10 beneficial in patient of CAD. A  report published in journal
>70 8 3 8 7 16 10 of research in education in Indian medicine (1988) has stated
Total 35 15 31 19 66 34 Arjuna to be possessing antihypertensive, cardiotonic and

Table 2: Effect of Terminalia arjuna on different parameters after 1 month of therapy

Parameters Case Controls
Before study After study P Before study After study P
Body weight (kg) 79.40±7.63 79.22±8.04 0.912 78.54±8.00 78.62±7.51 0.95
Systolic blood pressure (mmHg) 163.22±19.91 146.44±18.64 0.0001 152.26±18.38 148±17.85 0.265
Diastolic blood pressure (mmHg) 93.74±10.86 89.02±10.71 0.031 92.5±7.24 89.24±8.36 0.038
Pulse rate (pulse/min) 82.46±3.63 78.46±3.97 0.0001 82.4±5.45 84.0±4.42 0.11
Platelet count (lac/cumm) 4.429±0.83 3.95±0.71 0.002 4.66±0.66 4.53±0.67 0.33
Total cholesterol (mg/dl) 235.02±47.58 210.82±41.36 0.007 227.38±44.14 217.78±52.28 0.34
Serum triglyceride (mg/dl) 151.3±49.92 124.08±39.86 0.003 134.18±41.82 132.6±54.28 0.87
Serum HDL (mg/dl) 42.34±9.27 46.78±6.52 0.006 41.36±4.84 42.62±5.09 0.210
Serum LDL (mg/dl) 134.40±25.16 121.5±21.45 0.007 130.62±29.60 125.62±31.12 0.414
Serum VLDL (mg/dl) 36.78±11.93 30.86±7.64 0.003 34.66±9.69 30.80±6.82 0.023
LDL: Low‑density lipoprotein, HDL: High‑density lipoprotein, VLDL: Very low‑density lipoprotein

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Priya, et al.: Terminalia Arjuna in patients of CAD
diuretic properties. It has been shown to increase the HDL‑C
levels. Indian Medical Gazette (1998) has stated that Arjuna
bark extract in dose of 500  mg with other drug given for
3 months improves treadmill test and exercise tolerance
considerably without any side effects in angina pectoris. It was
observed that aortic prostaglandin E2 (PGE2)‑like activity was
enhanced after administration of T. arjuna. PGE2 is known to
produce coronary vasodilation and increased coronary flow
in patients of CAD.[12] In a 1995 double‑blind study in the
international journal of cardiology, patients who had taken
Arjuna for 2 weeks experienced a 19% lower heart rate than
those who took a placebo. Symptoms such as fatigue, high blood
pressure, heart rate and frequent contractions also improved.[13]
In our study, we found that systolic and diastolic blood pressure
decreased after 1 month of T. arjuna therapy. The extract of
T. arjuna might contain active compound possessing adrenergic
β2 receptor agonistic action and/or direct action on the heart.[14]
One month of treatment of 500 mg/kg Arjuna bark powder
extract to normal and diabetic rats, reflex bradycardia was
improved in diabetic rats. The alteration in reflex tachycardia
was not improved by Arjuna over 30 days.[15] Sandhu JS and
Shah B stated that Arjuna bark powder could protect the heart
from the adverse effect of chronic high blood pressure by
lowering the systolic blood pressure levels and our results are
in close conformity in their statement.
In the present study, whole lipid profile changed favourably
after 1 month therapy of T. arjuna. Dwivedi reports that a
study described in a thesis by S. Khalil in 2005 found that
Arjuna bark powder along with statin for 3 months resulted
in a 15% decrease in total cholesterol, 11% decrease in serum
triglyceride level and 16% decrease in LDL cholesterol. There
was a minimal decline in lipoprotein and nitrite levels. The
result suggests that Arjuna may work synergistically with statin
in hyperlipidaemia.[16]
The cardioprotective effects of Arjuna are partly related to
its antioxidant activities, and several studies have shown
that Arjuna protects the heart against myocardial ischaemic
reperfusion injury.[17‑19] Arjunolic acid has furthermore been
shown to prevent the decrease in the levels of superoxide
dismutase, catalase, glutathione peroxidase, ceruloplasmin,
alpha‑tocopherol, glutathione (GSH), ascorbic acid, lipid
peroxide and myeloperoxidase in experimental myocardial
necrosis in rats and to restore the electrocardiographic changes
towards normalcy.[20] More recently, arjuna has been shown
to enhance the cardiac intracellular antioxidant activity.
Histological studies also supported the protective role of
arjuna.[21] On the evaluation at the end of 3 months therapy
with bark of T. arjuna, it was found that treadmill test grading
of positivity was reduced significantly and exercise tolerance
of patients increased.[22]
Conclusions
It can be concluded that in patients of CAD, T. arjuna can
significantly reduce blood pressure and favourably modify lipid
100
profile. It might also have antioxidant properties and may be
beneficial for cardiac as well as overall health.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Fowkes FG, Price JF, Rumley A, Lowe GD. Hemostatic Heart Attack/
Coronary Artery Disease. New York: Mount Sinai Hospital; 1977.
2. Dwivedi S. Terminalia arjuna Wight & Arn – A useful drug for
cardiovascular disorders. J Ethnopharmacol 2007;114:114‑29.
3. Seneviratine CK, Thabrew MI, Abeysekra AM. Antiradical and
antiperoxidative effect of some plant extract used by Sri Lankan
traditional medical practitioners for cardioprotection. Pyhtother Rev
2001;15:519‑23.
4. Ram A, Lauria P, Gupta R, Kumar P, Sharma VN. Hypocholesterolaemic
effects of Terminalia arjuna tree bark. J Ethnopharmacol 1997;55:165‑9.
5. Terminalia arjuna. Altern Med Rev 1999;4:436‑7.
6. Malik N, Dhawan V, Bahl A, Kaul D. Inhibitory effects of Terminalia
arjuna on platelet activation in vitro in healthy subjects and patients
with coronary artery disease. Platelets 2009;20:183‑90.
7. Dwivedi  S, Agarwal  MP. Antianginal and cardioprotective effects of
Terminalia arjuna, an indigenous drug, in coronary artery disease.
J Assoc Physicians India 1994;42:287‑9.
8. Bharani  A, Ganguli  A, Mathur  LK, Jamra  Y, Raman  PG. Efficacy
of Terminalia arjuna in chronic stable angina: A double‑blind,
placebo‑controlled, crossover study comparing Terminalia arjuna with
isosorbide mononitrate. Indian Heart J 2002;54:170‑5.
9. Bharani A, Ganguly A, Bhargava KD. Salutary effect of Terminalia
arjuna in patients with severe refractory heart failure. Int J Cardiol
1995;49:191‑9.
10. Subramaniam  S, Subramaniam  R, Rajapandian  S, Uthrapathi  S,
Gnanamanickam VR, Dubey GP, et al. Anti‑atherogenic activity of
ethanolic fraction of Terminalia arjuna bark on hypercholesterolemic
rabbits. Evid Based Complement Alternat Med 2011;2011:487916.
11. Tiwari AK, Gode JD, Dubey GP. Effect of Terminalia arjuna on lipid
profiles of rabbit fed hypercholesterolemic diet. Int J Crude Drug Res
1990;28:43‑7.
12. Bhatia J, Bhattacharya SK, Mahajan P, Dulivedi S. Effect of Terminalia
arjuna on coronary flow – An experimental study. Indian J Pharmacol
1998;30:118.
13. Verma SK, Bordia A, et al. Efficacy of Terminalia arjuna in chronic
stable angina; a double blind placebo – Controlled, crossover study. J
Res Edu Ind Med 1995;9:180‑4.
14. Namm S, Guda Valli R, Babu BS, Lodagala DS. Possible mechanism
of hypotension produced 70% alcoholic extract of Terminalia arjuna in
anaesthetized dogs. BMC Complement Altern Med. 1999;7:56‑61.
15. Dall’Ago P, Fernandes TG, Machado UF, Belló AA, Irigoyen MC.
Baroreflex and chemoreflex dysfunction in streptozotocin-diabetic rats.
Braz J Med Biol Res 1997;30:119-24.
16. Khalil S. Effect of Statin Versus Terminalia arjuna on Acute Myocardial
Infarction. DNB Thesis (medicine). New Delhi, India: National Board
of Examination; 2005.
17. Gauthaman  K, Maulik  M, Kumari  R, Manchanda  SC, Dinda  AK,
Maulik SK, et al. Effect of chronic treatment with bark of Terminalia
arjuna: A study on the isolated ischemic‑reperfused rat heart.
J Ethnopharmacol 2001;75:197‑201.
18. Karthikeyan K, Bai BR, Gauthaman K, Sathish KS, Devaraj SN.
Cardioprotective effect of the alcoholic extract of Terminalia arjuna
bark in an in vivo model of myocardial ischemic reperfusion injury. Life
Sci 2003;73:2727‑39.
19. Gauthaman K, Banerjee SK, Dinda AK, Ghosh CC, Maulik SK. Terminalia
arjuna (Roxb.) protects rabbit heart against ischemic‑reperfusion injury:
Role of antioxidant enzymes and heat shock protein. J Ethnopharmacol
2005;96:403‑9.
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Priya, et al.: Terminalia Arjuna in patients of CAD

20. Sumitra M, Manikandan P, Kumar DA, Arutselvan N, Balakrishna K,
Manohar BM, et al. Experimental myocardial necrosis in rats: Role
of arjunolic acid on platelet aggregation, coagulation and antioxidant
status. Mol Cell Biochem 2001;224:135‑42.
21. Manna P, Sinha M, Sil PC. Phytomedicinal activity of Terminalia
arjuna against carbon tetrachloride induced cardiac oxidative stress.
Pathophysiology 2007;14:71‑8.
22. Jain V, Poonia A, Agrawal RP, Panwar RB, Kochar DK, Mishra SN.
Effect of Terminalia arjuna in patients of angina pectoris (A clinical
trial). Indian Med Gaz 1992;2:56‑9.

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