ETHNOMEDICINAL PLANTS FOR CARDIOVASCULAR DISEASES MANAGEMENT IN MANIKGANJ DISTRICT

The present research deals with the identification of ethnomedicinal plants used by the local people for curing cardiovascular diseases in Manikganj district, Bangladesh. The present study aimed to record and validate the ethnomedicinal knowledge used by the local people for cardiovascular disease (CVD) management in Manikganj district, Bangladesh using recent ethnobotanical survey methods. The record of 131 ethnomedicinal plant species with diverse use patterns reflected the traditional knowledge richness in the study area. Among the ethnomedicinal plants, 10 plant species, including Phyllanthus emblica L., Allium sativum L., Terminalia arjuna (Roxb. Ex DC.) Wight & Arn, Achyranthes aspera L., Terminalia chebula Retz., Allium cepa L., Adhatoda zeylanica Nees, Cinnamomum tamala Nees & Eberm, Cajanus cajan (L.) Millsp, and Ipomea aquatica Forssk, were cited most frequently by the local people. Among the disease categories, the highest Fic (factor of informant consensus) value was obtained in cardiac complaints, followed by blood purifiers, chest pain, high blood pressure, and antioxidants. In this research, 131 plant species were recorded, and 45 plants obtained the highest Fl (fidelity level) value of 100%. The members of the most common medicinal plants were from the families of Fabaceae, Amaranthaceae, Asteraceae, Cucurbitaceae, and Apocynaceae. This result provides baseline data to link the local population, including traditional health professionals and scientific communities, which could be significant in drug discovery and is very important for the sustainable development program and conservation management in Bangladesh.


Introduction
Cardiovascular disease (CVD), a group of heart and vascular diseases, is a leading cause of death and disability worldwide.In the past, there was a scarcity of modern drugs that bound people to depend on medicinal plant parts, which was so helpful for the local people at that time, especially the poor, who were not able to afford any kind of modern medicine because of its expenses.Many ancient herbs and their parts are shown to possess medicinal properties and can be used to prevent, alleviate, or cure several human diseases, especially cardiovascular diseases.It's calculable that between 70% and 80% of individuals worldwide rely on traditional, largely herbal medicine to meet their primary healthcare needs (Farnsworth and Soejarto 1991;Shengji 2001).It has been ascertained that a lot of trendy medicines are derived from the plants used by indigenous peoples (Balick and Cox, 2011;Rahmatullah, et al., 2010).Worldwide, CVD plays a bigger role in being a significant explanation for morbidity and mortality (Krisela 2007).Historically, Bangladesh may have been burdened with infectious diseases like several low-income countries in *Corresponding author, E-mail: zashim@du.ac.bd the world.Compared to different ethnic groups, South Asians, like those from Bangladesh, Pakistan, Nepal, and other Asian nations and states, have a better prevalence of CAD and connected risks (Yusuf et al., 2001).Southern Asians have a 3-5fold higher risk of myocardial infarction (Gupta et al., 2006).Bangladesh has 99.6% of males and 97.9% of females exposed to one of the established risks of CVD, with CVD at a young age (males below 40 years of age) (El-Saharty et al., 2013, Islam et al., 2014, Enas et al., 1995), and several plants are known to possess cardioprotective properties, resulting in their use by traditional healers for the treatment of chest complaints, high cholesterol, high and low blood pressure, and general heart problems.Although some plants have been used in various systems of ancient and traditional medicine to treat thrombolytic diseases or as antithrombotic agents, such plants claimed in ancient systems are still not scientifically proven (Kumar et al., 2011;Manicam et al., 2010).To safeguard this data, documentation of ethnic medicinal plants is already starting in Bangladesh.Several articles were revealed in this field, including Hassan and Khan (1986); Alam (1992); Alam et al. (1996); Uddin et al. (2001Uddin et al. ( , 2006Uddin et al. ( , 2012Uddin et al. ( , 2017)); Khan et al. (2002); Ghani (2003); Islam and Uddin et al. (2009); Uddin and Roy (2007); Roy et al. (2008); Uddin (2013); Haque et al. (2014); Uddin et al. (2015); Haque et al. (2017); Uddin et al. (2019); Uddin et al. (2023).This article lists several medicinal plants from specific communities, specific diseases, or specific regions in Asia.However, this study provides insufficient documentation of ethnomedicinal plant species contributing to the treatment of cardiovascular disease management in Manikganj district because, in previous years, only specific disease-related medicinal plants were documented in this specific region of Bangladesh (Eneh et al., 2013).Further study is needed to identify the effectiveness of the medicinal plants in this district because the younger generation is not aware of the richness of medicinal plants in this area.Further analysis and conservation are needed for the prevention and treatment of cardiovascular diseases.

Materials and Method
The Manikganj District (Dhaka Division) spans 1383.66 square kilometers and is situated between latitudes 23°38' and 24°03' north and longitudes 89°41' and 90°08' east.The total area of Manikganj is 1,383.66km 2 (534.23 sq mi) and the average annual temperature is between 36.5 °C and 12.7 °C, with 2,376 mm (93.5 in) of rainfall falling on average each year.The Padma, Kalinga, Jamuna, Dashwari and Ichamati Rivers are among the several rivers that flow through the Manikganj District.There are seven Upazilas in the District of Manikganj.This District is surrounded by the upazilas of Saturia to the north, Singair to the east, Harirampur to the south, Shivalaya and Ghior to the west, and Harirampur to the east.This district has a range of humidity levels from 56% to 83%.Silty and sandy alluvial soil, represented by the Brahmaputra Floodplain, makes up the majority of the surface soil associated with agriculture.The main river that flows through the research region is the Kaliganga River.43.43% of the dwelling families in the research region rely on agriculture as their primary source of income, with 15.94% working in agriculture and 27.49% in cropland, livestock, forestry, and fishing (Sayed et al., 2015).
The sampling sites were visited during the years 2018 and 2019 (Table 1).The visit duration for each site lasted for 4-5 days.The data on the medicinal uses of plants was recorded through semi-structured interviews with the help of herbal practitioners and also through key informant discussions (Alexiades, 1996).Field interviews, plant interviews, and group discussions with local people were also conducted for the promotion of data collection.During the field survey, information on the uses of plants to treat humans, modes of preparation, parts used, and mode of administration was documented.A total of 300 local informants, including 67% of males and 33% of females, were interviewed during the ethnobotanical survey.The local informants include housewives, herbalists, farmers, rickshaw-pullers, job-holders, craftspeople, shopkeepers, teachers and students aged between 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 was confirmed using standard literature (Siddiqui et al., 2007and Ahmed et al., 2008-2009).All voucher specimens were deposited at DUSH.For estimating the diversity of medicinal plants and determining which plants are particularly valuable in the search for bioactive compounds, the factor of informant consensus (Fic) was calculated (Heinrich et al., 1998).Fic is calculated in the following equation: Fic = N ur -N taxa /N ur -1, where N ur is the number of use-reports in each category and N taxa is the number of species in each category (Trotter and Logan, 1986;Heinrich et al., 1998).A Fic-Value provides a range from 0 to 1, where a high Fic-Value (close to 1) means that there is a well-defined group of species used to cure a particular ailment-category and that information is exchanged between informants.On the other hand, a low Fic value (close to 0) indicates that informants disagree over which plants to use, due to random choice or a lack of exchange of information about the use of informants.Such analyses classified disorders into groups, such as plant species with a high Fic value, which can be considered more pharmacologically effective than plant species with a low Fic value (Ragupathy et al., 2008).The credibility level was calculated for the foremost reported medicinal plant species as: Fl (%) = (Np / N) × 100; wherever Np = the number of informants that claim the use of a plant species to treat a specific disease.N = the number of informants that use the plants as medicine to treat any given disease (Friedman et al., 1986).The Fidelity Level (Fl) varies from 0 to 100%.Medicinal plants, that are widely used by local individuals for certain ailments, have higher Flvalues, instead of those, that are less well-liked for being considered good remedies.Citation frequency (Cf) was calculated using the following method: Frequency of citation for a particular species = (Number of citations for that particular species/Number of all citations for all species) x 100.

Results and Discussion
The present ethnobotanical survey has recorded a total of 131 medicinal plants with 114 formularies belonging to 61 families that were acquired by conducting 300 interviews for the treatment of cardiovascular disease.For each species, the scientific name and voucher number, local name, family, habit, ailments, part(s), and treatment mode have been provided (Table 2).

High blood pressure
Fruit is taken with salt.

Cardiac complaints
Ripe Fruit is taken.

High blood pressure
Fruit juice is taken.

Blood purifier
Fruit is preserved as pickles.

Cardiac complaints
Fruit juice is taken.
For the treatment of cardiovascular disorders, 61 families of medicinal plants have been identified in the current study.The top five families, including Fabaceae, Amaranthaceae, Asteraceae, Cucurbitaceae, and Apocynaceae, were found to contain many species that are medicinal (Fig. 1).Those were the most dominant, with the maximum number of medicinal plant species in the study area.
To calculate the factor of informant consensus (Fic) values, total ailments were categorized into five groups, such as cardiac complaints, blood purifiers, chest pain, high blood pressure, and antioxidants.The average Fic value for all ailment categories obtained was 0.8492, with Phyllanthus emblica L., Allium sativum L., Terminalia arjuna (Roxb.ex DC.) Wight and Arn., Achyranthes aspera L., Terminalia chebula Retz, and Allium cepa L. as the most cited plants.Such a value indicated that the maximum number of people in the study area were well informed about the medicinal knowledge of plants.Among the five categories, the cardiac complaints group attained the highest FIC values (0.8640), followed by blood purifier (0.8590), chest pain (0.8492), high blood pressure (0.7164), and antioxidant (0.6667).The medicinal plant species that have been extensively used by the people of the locality had an excessive fidelity level (Fl) compared to the ones that have been less vital.For figuring out medicinally vital plant species in the study area, the fidelity level (Fl) was calculated.In general, the high Fl of a species suggests the superiority of a particular disorder in a place and the usage of plant species by the population to deal with it (Bibi et al., 2014;Srithi et al., 2009).Among the 131 plant species, 45 scored Fl values of 100%.The fidelity level of the most cited plant species was turned into a category (Table 3).
According to the citation frequency of all medicinal plants, the most frequently used plants were Phyllanthus emblica L., Allium sativum L., Terminalia arjuna (Roxb.ex DC.) Wight and Arn., Achyranthes aspera L., and Terminalia chebula Retz (Table 4).The highest Cf value means that such species were very popular plant species in the study area and were used for the treatment of cardiac diseases.Among the disease categories, the highest (Fic) value was obtained in cardiac complaints, followed by blood purifiers, chest pain, high blood pressure, and antioxidants.The cardiac complaints were managed by a total of 80 medicinal plant species.Among the medicinal plants, the most cited were Phyllanthus emblica L., Allium sativum L., and Terminalia arjuna (Roxb.ex DC).Wight and Arn., Achyranthes aspera L., Terminalia chebula Retz, and Allium cepa L. In the blood purifier category, 76 species were used, and Phyllanthus emblica L., Terminalia chebula Retz, and Allium cepa L. were most cited.In the chest pain category, 20 species were used, and the most cited were Terminalia arjuna (Roxb.Ex DC).Wight and Arn. and Achyranthes aspera L. In the high blood pressure category, 39 species were used, and the most cited were Phyllanthus emblica L., Allium sativum L., and Terminalia arjuna (Roxb.ex DC).Wight and Arn., Terminalia chebula Retz, Allium cepa L. In the antioxidant category, 36 species were used, and Phyllanthus emblica L. was the most cited plant.Among the 131 plant species, 45 species scored a 100% fidelity level as culturally important plant species.The record of 131 ethnomedicinal plant species with diverse use patterns reflected the traditional knowledge richness in the study area.Since the dawn of society, humans have relied on plants to create new fields for the discovery of drugs derived from plants.These medicines are effective in curing several ailments and have changed the focus on herbal medicines in new ways.It is estimated that about 30% of pharmaceutical products are made from plant derivatives (Leta et al., 2002;Gillman et al., 1995).Several studies have been conducted to find plants, natural food sources, and their supplements that have antithrombotic effects such as anticoagulants and antiplatelets.There are indications that consumption of these foods leads to the prevention of coronary disease and stroke (Ratnasooriya et al., 2008;Liu et al., 2000;Joshipura et al., 1999;Bazzano et al., 2002).Although there are several thrombolytic drugs derived from those obtained with recombinant DNA technology, the side effects associated with some of these drugs have been reported to cause further difficulties (Baruah et al., 2006;Gallus et al., 1998;Capstick et al., 2005).The Ethnomedicinal plants were also used for the treatment of Covid-19 pandemic in and around Dhaka City (Uddin et al., 2023).However, herbal preparations with the right dosage can be an alternative and a better choice for curing various diseases.
Based on observations and local people's perceptions, the most cited species, named Achyranthes aspera L., Cajanus cajan (L.) Millsp., Andrographis paniculata Nees., Aquilaria malaccensis Lam., Dioscorea alata L., and Rauvolfia serpentina (L.) Benth.ex Kurz., were found to be very rare in the habitat and were also in danger because of anthropogenic pressure, deforestation, lack of knowledge about plants, and mismanagement of plantations in the study area.This survey has significant value for conservation managers and policymakers for the sustainable management of medicinal plant species that are threatened in nature.This species should be conserved before being eliminated from nature.There is an urgent need to document this knowledge before it becomes extinct.These herbal remedies can be further tested against various diseases to discover their unexplored capacity and may be a potential source of biologically important drug components.

Fig. 1 .
Fig. 1.Ethnomedicinal plant families according to the high number of plant species for the treatment of cardiovascular diseases in Bangladesh.
Among the ethnomedicinal plants, 10 plant species, including Phyllanthus emblica L., Allium sativum L., Terminalia arjuna (Roxb.ex DC.) Wight and Arn, Achyranthes aspera L., Terminalia chebula Retz., Allium cepa L., Adhatoda zeylanica Nees, Cinnamomum tamala Nees and Eberm, Cajanus cajan (L.) Millsp, and Ipomoea aquatic Forssk, were cited the most times by the local people.The study resulted in the recording a total of 131 ethnomedicinal plant species under 61 families with 114 formularies documented by the local people around the study area of Manikganj district for the treatment of cardiovascular diseases.Although modern health services are available, the local people still rely on traditional medicine, highlighting the importance of traditional herbal treatment methods.