Document Type : Original Article(s)


1 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

2 Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor of Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

4 Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

5 Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran


BACKGROUND: Garlic may have anti-oxidanmayti-hypertensive and anti-hyperlipidemic properties. However, the effects of its administration on cardiac function in heart failure (HF) patients impact require further investigation. We aimed to evaluate garlic prescription effects on cardiac outcomes and quality of life scores in Iranian HF patients.
METHOD: From August to December 2020, a randomized, double-blind clinical trial was conducted. Individuals with heart failure (New York heart association (NYHA) functional class of II and III) referred to private clinics in Isfahan, Iran, were randomly assigned to intervention (n=80) and control (n=80) groups. They have received 500 mg of odorless garlic tablets or the same shape and dosage of placebo twice daily for three months. Laboratory data, cardiac outcomes (end-diastolic diameter, ventricular septal thickness, NYHA functional class, left ventricular ejection fraction), quality of life score (Minnesota living with HF questionnaire), and the Modified Borg Scale (MBS) were all evaluated at the baseline and the end of the trial.
RESULTS: The population’s mean age was 58.1±13.5 years (55% males). Patients who consumed garlic had remarkably improved functional class compared to placebo takers and their baseline (NYHA practical class of II, 79.4% vs. 50.6%, P<0.001 and 79.4% vs. 54%, P=0.006, respectively). MBS levels were significantly lower among garlic consumers (baseline: 2.52±0.5, after three months: 2.2±1.06, P= 0.040).
CONCLUSIONS: Garlic administration may improve cardiac function and breathe in HF patients. Complementary research is necessary to confirm our findings.


  1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2013; 62(16): e147-239.
  2. Schmid FA, Schlager O, Keller P, Seifert B, Huang R, Fröhlich GM, Lüscher TF, Ruschitzka F, Enseleit F. Prognostic value of long‐term blood pressure changes in patients with chronic heart failure. European journal of heart failure. 2017; 19(7): 837-42.
  3. Curtis LH, Whellan DJ, Hammill BG, Hernandez AF, Anstrom KJ, Shea AM, Schulman KA. Incidence and prevalence of heart failure in elderly persons, 1994-2003. Archives of internal medicine. 2008; 168(4): 418-24.
  4. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD. Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation. 2018; 137(12): e67-492.
  5. Moser DK, Yamokoski L, Sun JL, Conway GA, Hartman KA, Graziano JA, Binanay C, Stevenson LW, Escape Investigators. Improvement in health-related quality of life after hospitalization predicts event-free survival in patients with advanced heart failure. Journal of cardiac failure. 2009; 15(9): 763-9.
  6. Rodríguez-Artalejo F, Guallar-Castillón P, Pascual CR, Otero CM, Montes AO, García AN, Conthe P, Chiva MO, Banegas JR, Herrera MC. Health-related quality of life as a predictor of hospital readmission and death among patients with heart failure. Archives of internal medicine. 2005; 165(11): 1274-9.
  7. Cook C, Cole G, Asaria P, Jabbour R, Francis DP. The annual global economic burden of heart failure. International journal of cardiology. 2014; 171(3): 368-76.
  8. Amirpour A, Vakhshoori M, Zavar R, Zarei H, Sadeghi M, Yavari B. The effect of 3-month growth hormone administration and 12-month follow-up duration among heart failure patients four weeks after myocardial infarction: a randomized double-blinded clinical trial. Cardiovascular Therapeutics. 2021; 2021.
  9. Farsani AY, Vakhshoori M, Mansouri A, Heidarpour M, Nikouei F, Garakyaraghi M, Sarrafzadegan N, Shafie D. Relation between hemoconcentration status and readmission plus mortality rate among Iranian individuals with decompensated heart failure. International Journal of Preventive Medicine. 2020; 11.
  10. Hoseinbor M, Vakhshoori M, Babak A, Givi M, Heidarpour M, Nikouei F, Shafie D, Garakyaraghi M, Sarrafzadegan N. Frequency of readmission in Iranian heart failure patients within six months after discharge and its association with guideline directed medical treatment. Age (years). 2019; 70: 11-8.
  11. Rastogi S, Pandey MM, Rawat AK. Traditional herbs: a remedy for cardiovascular disorders. Phytomedicine. 2016; 23(11): 1082-9.
  12. Bradley JM, Organ CL, Lefer DJ. Garlic-derived organic polysulfides and myocardial protection. The Journal of Nutrition. 2016; 146(2): 403S-9S.
  13. Gorinstein S, Jastrzebski Z, Namiesnik J, Leontowicz H, Leontowicz M, Trakhtenberg S. The atherosclerotic heart disease and protecting properties of garlic: contemporary data. Molecular nutrition & food research. 2007; 51(11): 1365-81.
  14. Hara Y, Noda A, Miyata S, Minoshima M, Sugiura M, Kojima J, Otake M, Furukawa M, Cheng XW, Nagata K, Murohara T. Effects of aged garlic extract on left ventricular diastolic function and fibrosis in a rat hypertension model. Experimental animals. 2013; 62(4): 305-10.
  15. Middel B, Bouma J, de Jongste M, van Sonderen E, Niemeijer MG, van den Heuvel W. Psychometric properties of the Minnesota living with heart failure questionnaire (MLHF-Q). Clinical Rehabilitation. 2001; 15(5): 489-500.
  16. Kendrick KR, Baxi SC, Smith RM. Usefulness of the modified 0-10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma. Journal of Emergency Nursing. 2000; 26(3): 216-22.
  17. Hobbs FD, Kenkre JE, Roalfe AK, Davis RC, Hare R, Davies MK. Impact of heart failure and left ventricular systolic dysfunction on quality of life. A cross-sectional study comparing common chronic cardiac and medical disorders and a representative adult population. European heart journal. 2002; 23(23): 1867-76.
  18. Liu J, Zhang G, Cong X, Wen C. Black garlic improves heart function in patients with coronary heart disease by improving circulating antioxidant levels. Frontiers in physiology. 2018; 9: 1435.
  19. Ried K. Garlic lowers blood pressure in hypertensive subjects, improves arterial stiffness and gut microbiota: A review and meta-analysis. Experimental and Therapeutic Medicine. 2020; 19(2): 1472-8.
  20. Zeb I, Ahmadi N, Kadakia J, Larijani VN, Flores F, Li D, Budoff MJ, Nasir K. Aged garlic extract and coenzyme Q10 have favorable effect on inflammatory markers and coronary atherosclerosis progression: A randomized clinical trial. Journal of cardiovascular disease research. 2012; 3(3): 185-90.
  21. Larijani VN, Ahmadi N, Zeb I, Khan F, Flores F, Budoff M. Beneficial effects of aged garlic extract and coenzyme Q10 on vascular elasticity and endothelial function: the FAITH randomized clinical trial. Nutrition. 2013; 29(1): 71-5.
  22. Sobenin IA, Prianishnikov VV, Kunnova LM, Rabinovich EA, Orekhov AN. Allicor efficacy in lowering the risk of ischemic heart disease in primary prophylaxis. Terapevticheskii Arkhiv. 2005; 77(12): 9-13.
  23. Abdel-Daim MM, Khalifa HA, Ahmed AA. Allicin ameliorates doxorubicin-induced cardiotoxicity in rats via suppression of oxidative stress, inflammation and apoptosis. Cancer chemotherapy and pharmacology. 2017; 80(4): 745-53.
  24. Mukherjee S, Banerjee SK, Maulik M, Dinda AK, Talwar KK, Maulik SK. Protection against acute adriamycin-induced cardiotoxicity by garlic: Role of endogenous antioxidants and inhibition of TNF-α expression. BMC pharmacology. 2003; 3(1): 1-9.
  25. Vazquez-Prieto MA, Rodriguez Lanzi C, Lembo C, Galmarini CR, Miatello RM. Garlic and onion attenuates vascular inflammation and oxidative stress in fructose-fed rats. Journal of nutrition and metabolism. 2011; 2011.
  26. Sojitra B, Bulani Y, Putcha UK, Kanwal A, Gupta P, Kuncha M, Banerjee SK. Nitric oxide synthase inhibition abrogates hydrogen sulfide-induced cardioprotection in mice. Molecular and cellular biochemistry. 2012; 360(1): 61-9.
  27. Khatua TN, Adela R, Banerjee SK. Garlic and cardioprotection: insights into the molecular mechanisms. Canadian journal of physiology and pharmacology. 2013; 91(6): 448-58.
  28. Banerjee SK, Maulik SK. Effect of garlic on cardiovascular disorders: a review. Nutrition journal. 2002; 1(1): 1-4.
  29. Geng Z, Lau BH. Aged garlic extract modulates glutathione redox cycle and superoxide dismutase activity in vascular endothelial cells. Phytotherapy Research. 1997; 11(1): 54-6.