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Ma XH, Chen Y, Huang XY, Jiang JR, Liu X, An DQ, He RR. Characteristics and efficacy of traditional Chinese medicine in the therapeutic strategy of chronic coronary syndrome: A systematic review and meta-analysis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 129:155579. [PMID: 38574427 DOI: 10.1016/j.phymed.2024.155579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND AND AIMS Chronic coronary syndrome (CCS) has always been controversial in its therapeutic strategy. Although invasive treatment and optimal medication therapy (OMT) are the most commonly used treatments, doctors continue to debate the best strategy. However, traditional Chinese medicine (TCM) for CCS is effective clinically. METHODS To identify potentially eligible observational and experimental studies, we searched Pubmed, the Web of Science, and the China National Knowledge Internet. To be eligible, studies had to report with end-of treatment outcomes, such as major adverse cardiac events (MACE), deaths from myocardial infarctions (MI), all-cause mortality, angina, cardiac mortality, the effectiveness rate of electrocardiographs, and the reduction rate of the Nitroglycerin tablets. Risk differences (RDs) and 95 % confidence intervals (95 % CIs) were calculated based on random-effects models or fixed-effects models. Citation screening, data abstraction, risk assessment, and strength-of-evidence grading were completed by 2 independent reviewers. RESULTS In Section 1 (13 studies, involving 17,287 patients), showed no significant difference between invasive treatment and medication treatment in MACE (RD = -0.04, 95% CI = -0.08 to 0.00, I2 = 76.4 %), all-cause mortality (RD = -0.01, 95%CI = -0.022 to 0.01, I2 = 73.44 %), MI (RD = 0.00, 95%CI = -0.00 to 0.01, I2 = 0.00 %) and cardiac mortality (RD = 0.00, 95 %CI = -0.01 to 0.01, I2 = 34.9 %). In Section 2 (21 studies, including 1820 patients), compared with WM treatment, TCM + WM treatment increased ECG effectiveness by 18 %, angina effectiveness by 20 %, and stopping or reducing Nitroglycerin tablets by 20 %. In Section 3 (25 studies, including 2859 patients) showed that TCM revealed a better electrocardiogram effective rate (RD = 0.10, 95 %CI = 0.05 to 0.14, I2 = 44.7 %) and angina effective rate (RD = 0.12, 95 %CI = 0.09 to 0.15, I2 = 44.9 %). We identified that TCM treatment properties of "Circulating blood and transforming stasis" and application of warm/heat-properties medicines were frequently used in CCS treatment. CONCLUSIONS TCM treatment has shown superior beneficial cardioprotective in CCS therapy strategy, among which "Circulating blood and transforming stasis" and the application of warm/heat-properties medicine are its characteristics.
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Affiliation(s)
- Xiao-Hui Ma
- Institute of Traditional Chinese Medicine, Xinjiang Medical University, Urumqi 830054, China; Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi 830054, China; National Traditional Chinese Medicine Inheritance and Innovation Center, Xinjiang Medical University, Urumqi 830054, China; Key Laboratory of High Incidence Diseases in Xinjiang Region, Ministry of Education (MOE), Xinjiang Medical University, Urumqi 830054, China; Guangdong Engineering Research Center of Chinese Medicine & Disease Susceptibility, Jinan University, Guangzhou 510632, China; Guangdong Province Key Laboratory of Pharmacodynamic Constituents of TCM and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou 510632, China; International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education (MOE), Jinan University, Guangzhou 510632, China.
| | - Yang Chen
- Institute of Traditional Chinese Medicine, Xinjiang Medical University, Urumqi 830054, China; Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi 830054, China; National Traditional Chinese Medicine Inheritance and Innovation Center, Xinjiang Medical University, Urumqi 830054, China; Key Laboratory of High Incidence Diseases in Xinjiang Region, Ministry of Education (MOE), Xinjiang Medical University, Urumqi 830054, China
| | - Xiao-Yao Huang
- Institute of Traditional Chinese Medicine, Xinjiang Medical University, Urumqi 830054, China; Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi 830054, China; National Traditional Chinese Medicine Inheritance and Innovation Center, Xinjiang Medical University, Urumqi 830054, China; Key Laboratory of High Incidence Diseases in Xinjiang Region, Ministry of Education (MOE), Xinjiang Medical University, Urumqi 830054, China
| | - Jia-Rong Jiang
- Institute of Traditional Chinese Medicine, Xinjiang Medical University, Urumqi 830054, China; Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi 830054, China; National Traditional Chinese Medicine Inheritance and Innovation Center, Xinjiang Medical University, Urumqi 830054, China; Key Laboratory of High Incidence Diseases in Xinjiang Region, Ministry of Education (MOE), Xinjiang Medical University, Urumqi 830054, China
| | - Xin Liu
- Institute of Traditional Chinese Medicine, Xinjiang Medical University, Urumqi 830054, China; Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi 830054, China; National Traditional Chinese Medicine Inheritance and Innovation Center, Xinjiang Medical University, Urumqi 830054, China; Key Laboratory of High Incidence Diseases in Xinjiang Region, Ministry of Education (MOE), Xinjiang Medical University, Urumqi 830054, China
| | - Dong-Qing An
- Institute of Traditional Chinese Medicine, Xinjiang Medical University, Urumqi 830054, China; Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi 830054, China; National Traditional Chinese Medicine Inheritance and Innovation Center, Xinjiang Medical University, Urumqi 830054, China.
| | - Rong-Rong He
- Institute of Traditional Chinese Medicine, Xinjiang Medical University, Urumqi 830054, China; Guangdong Engineering Research Center of Chinese Medicine & Disease Susceptibility, Jinan University, Guangzhou 510632, China; Guangdong Province Key Laboratory of Pharmacodynamic Constituents of TCM and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou 510632, China; International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education (MOE), Jinan University, Guangzhou 510632, China.
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Wald NJ, Hingorani AD, Vale SH, Bestwick JP, Morris J. The polypill in the primary prevention of heart attacks and strokes: Overcoming barriers to implementation. J Med Screen 2024; 31:66-69. [PMID: 38486476 PMCID: PMC11083723 DOI: 10.1177/09691413241235486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/07/2024] [Indexed: 05/12/2024]
Abstract
This commentary, linked to our paper in the same issue of the Journal of Medical Screening, discusses the reluctance to consider and adopt the polypill in the primary prevention of heart attacks and strokes, access to the polypill as a public health service, the formulation of the polypill in current use, its prescription as an unlicensed medicine, and what can be done to facilitate the adoption of the polypill approach as a routine public health service.
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Affiliation(s)
- Nicholas J Wald
- Institute of Health Informatics, University College London, London, UK
- Population Health Research Institute, St Georges University of London, London, UK
| | - Aroon D Hingorani
- Institute of Health Informatics, University College London, London, UK
- 3Institute of Cardiovascular Science, University College London, London, UK
| | | | - Jonathan P Bestwick
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Joan Morris
- Population Health Research Institute, St Georges University of London, London, UK
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Di Fusco SA, Aquilani S, Spinelli A, Alonzo A, Matteucci A, Castello L, Imperoli G, Colivicchi F. The polypill strategy in cardiovascular disease prevention: It's time for its implementation. Prog Cardiovasc Dis 2023; 79:37-40. [PMID: 36931543 DOI: 10.1016/j.pcad.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
A polypill strategy has been demonstrated to improve treatment adherence in several cardiovascular disease (CVD) settings. However, data on the prognostic impact in the secondary prevention setting have been scarce. The Secondary Prevention of Cardiovascular Disease in the Elderly trial, the results of which have been recently published, has demonstrated a benefit in terms of major adverse CVD event reduction. This finding, in addition to previous evidence, should lead to a broader polypill implementation in CVD prevention.
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Affiliation(s)
- Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy.
| | - Stefano Aquilani
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
| | - Antonella Spinelli
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
| | - Alessandro Alonzo
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
| | - Andrea Matteucci
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
| | - Lorenzo Castello
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
| | - Giuseppe Imperoli
- Internal Medicine Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
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Asiimwe IG, Pirmohamed M. Drug-Drug-Gene Interactions in Cardiovascular Medicine. Pharmgenomics Pers Med 2022; 15:879-911. [PMID: 36353710 PMCID: PMC9639705 DOI: 10.2147/pgpm.s338601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022] Open
Abstract
Cardiovascular disease remains a leading cause of both morbidity and mortality worldwide. It is widely accepted that both concomitant medications (drug-drug interactions, DDIs) and genomic factors (drug-gene interactions, DGIs) can influence cardiovascular drug-related efficacy and safety outcomes. Although thousands of DDI and DGI (aka pharmacogenomic) studies have been published to date, the literature on drug-drug-gene interactions (DDGIs, cumulative effects of DDIs and DGIs) remains scarce. Moreover, multimorbidity is common in cardiovascular disease patients and is often associated with polypharmacy, which increases the likelihood of clinically relevant drug-related interactions. These, in turn, can lead to reduced drug efficacy, medication-related harm (adverse drug reactions, longer hospitalizations, mortality) and increased healthcare costs. To examine the extent to which DDGIs and other interactions influence efficacy and safety outcomes in the field of cardiovascular medicine, we review current evidence in the field. We describe the different categories of DDIs and DGIs before illustrating how these two interact to produce DDGIs and other complex interactions. We provide examples of studies that have reported the prevalence of clinically relevant interactions and the most implicated cardiovascular medicines before outlining the challenges associated with dealing with these interactions in clinical practice. Finally, we provide recommendations on how to manage the challenges including but not limited to expanding the scope of drug information compendia, interaction databases and clinical implementation guidelines (to include clinically relevant DDGIs and other complex interactions) and work towards their harmonization; better use of electronic decision support tools; using big data and novel computational techniques; using clinically relevant endpoints, preemptive genotyping; ensuring ethnic diversity; and upskilling of clinicians in pharmacogenomics and personalized medicine.
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Affiliation(s)
- Innocent G Asiimwe
- The Wolfson Centre for Personalized Medicine, MRC Centre for Drug Safety Science, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Munir Pirmohamed
- The Wolfson Centre for Personalized Medicine, MRC Centre for Drug Safety Science, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
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