Traditional chinese herbal products for coronary heart disease: an overview of cochrane reviews

Complementary and alternative therapies for stable angina pectoris of coronary heart disease: A protocol for systematic review and network meta-analysis

BACKGROUND

Stable angina pectoris in patients with coronary heart disease is a clinical syndrome of rapid transient ischemia and hypoxia of myocardium due to the increase of myocardial load on the basis of fixed severe coronary artery stenosis. In recent years, the incidence rate of this disease has been rising steadily, which seriously threatens human life and health. When the disease occurs, its complementary and alternative therapy can relieve chest pain, improve cardiac function, and reduce adverse events. However, in retrospect of all the studies, we lack systematic analysis of the efficacy and safety of various complementary and alternative therapies. The curative effects were ranked. On the basis of these findings, we conducted a study of complementary and alternative therapy in patients with coronary heart disease, and proposed a network meta-analysis (NMA) protocol to explore the efficacy of different complementary and alternative therapies.

METHODS

We will comprehensively search the Chinese and English databases from the creation date to January 15, 2022. The randomized controlled trials of the supplementary and alternative treatment of stable angina pediatrics in patients with coronary heart disease and the relevant literature of the ongoing trials will be published. The 2 researchers will conduct literature screening and data extraction independently, using Cochrane system evaluator manual 5 3. The recommended bias risk assessment tool was used to evaluate the quality of the included study, Q-test was used and combined with heterogeneity analysis, and the analysis sensitivity was observed. The Review Manager 5.4 software provided by Cochrane Collaboration Network is used to statistically analyze the included literature, and the obtained results are made into forest map and funnel map for data analysis and processing. It is suggested that the evaluation will be used to formulate and evaluate the level, so as to classify the quality of NMA evidence.

RESULTS

Through analysis, we will get the efficacy and safety ranking of different complementary and alternative therapies in the treatment of stable angina pediatrics in patients with coronary heart disease, so as to provide further reference for the selection of clinical treatment methods.

CONCLUSION

The complementary and alternative treatment of stable angina peptis in patients with coronary heart disease has a positive effect on improving its symptoms. This study can provide evidence support for clinicians and patients.

INPLASY REGISTRATION NUMBER

INPLASY202210066.

The efficacy and safety of Shenzhu Guanxin Recipe Granules for the treatment of patients with coronary artery disease: protocol for a double-blind, randomized controlled trial

Background

Coronary artery disease (CAD) is one of the most common types of the cardiovascular disease. Previous pilot trials have suggested that Traditional Chinese Medicine (TCM) has brought clinical benefits for patients with CAD. We will conduct this trial to determine the efficacy and safety of Shenzhu Guanxin Recipe Granules (SGR) for the treatment of patients with CAD.

Methods

This randomized controlled trial recruited 190 patients who were diagnosed with CAD by clinical manifestation and examination and in which coronary computed tomography angiography (CCTA) showed 50–70% stenosis, with soft or mixed plaque types. The included participants were randomly assigned to the case group and control group using a 1:1 allocation ratio; patients in the case group received SGR and usual care, and those in the control group received placebo (6 g/day for 6 months) and usual care. The endpoint of the study included Calcium Coverage Score (CCS), C-reactive protein (CRP) level, and the levels of blood lipids, tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), and ATP-binding membrane cassette transporter A1 (ABCA1) were calculated before recruiting and at the sixth month. The indicators were Seattle Angina Questionnaire (SAQ) and TCM Syndrome Questionnaire scores at 0, 3, and 6 months.

Discussion

This clinical trial may provide reliable evidence regarding the clinical effectiveness and safety of SGR therapy for patients with CAD diagnosed by clinical manifestation and examination, in which CCTA showed 50–70% stenosis, with soft or mixed plaque types.

Trial registration

ClinicalTrials.gov, ID: ChiCTR1900020501. The trial was registered on 25 December 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3629-4) contains supplementary material, which is available to authorized users.

Efficacy and safety of Xinnaoning capsule in treating chronic stable angina (qi stagnation and blood stasis syndrome): Study protocol for a multicenter, randomized, double-blind, placebo-controlled trial

BACKGROUND

Chronic stable angina (CSA) is a cardiovascular disease with high prevalence. At present, drug treatment is still the main measure of stable angina pectoris. Traditional Chinese medicine has a long history in the treatment of CSA. Qi stagnation and Blood stasis syndrome is a common syndrome of CSA. Xinnaoning (XNN) capsule is considered as an effective adjuvant treatment for CSA with the efficacy of promoting qi and blood circulation but lack of high-quality clinical evidence. The purpose of this study is to evaluate the efficacy and safety of XNN capsule compared with placebo by clinical trial.

METHODS

This multicenter, randomized, double-blind, placebo-controlled trial will be conducted with a total of 240 participants diagnosed with chronic stable angina (qi stagnation and blood stasis syndrome). The participants will be randomized (1:1) into groups receiving either XNN or placebo for 12 weeks. After a 2-week run-in period, they will receive either XNN or placebo (3 pills, 3 times daily) for 12 weeks on the basis of conventional therapy. The primary outcomes include changes in the integral scores of angina symptoms. The secondary outcome measures include changes in the total score of traditional Chinese medicine syndrome, severity grading of angina pectoris, the number of angina pectoris per week, nitroglycerin dosage, score of seattle angina scale, serum homocysteine, incidence of cardiovascular events. Safety outcomes will also be assessed. Adverse events will be monitored throughout the trial.

RESULTS

This study will investigate whether XNN capsule can alleviate clinical symptoms, and improve quality of life of patients with chronic stable angina (qi stagnation and blood stasis syndrome). The results of this study will provide clinical evidence for the application of XNN capsule in the treatment of chronic stable angina.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03914131.

Shenzhu Guanxin Recipe Granules () for Improving Exercise Tolerance in Patients with Stable Angina (SERIES Trial): A Protocol of Multicenter, Randomized, Double-Blind, Placebo Parallel Controlled Clinical Trial

BACKGROUND

Many patients with chronic angina experience anginal episodes despite successful recanalization, antianginal and antiischemic medications. Empirical observations suggested that Shenzhu Guanxin Recipe Granules (, SGR), a Chinese herbal compound, exerted potential impacts on increased treadmill exercise performance and angina relieve. However, there has been no systematic study to clarify the impact of SGR on exercise tolerance in patients with stable angina. The SERIES (ShEnzhu guanxin Recipe for Improving Exercise tolerance in patients with Stable angina) trial is designed to determine the effects of SGR on exercise duration, electrocardiographic (ECG) evidence of myocardial ischemia, and incidence of major adverse cardiac events (MACE) in stable anginal patients.

METHODS

A total of 184 eligible patients with stable angina will be randomly assigned to receive placebo or SGR (10 g/day for 12 weeks) in a 1:1 ratio. The primary outcome will be the change from baseline in total exercise tolerance duration, time to onset of angina and ECG ischemia during exercise treadmill testing performed over a 12-week study period. The secondary outcome will include ECG measures, the occurrence and composite of MACE and the Seattle Angina Questionnaire score. Moreover, the coronary microcirculation will be evaluated to explore the possible effects in response to treatment of SGR. After the procedure, all participants will be followed up by interview at 3 and 6 months, enquiring about any cardiac events, hospitalizations, cardiac functional level and medication usage. Additionally, the occurrence of adverse events will be evaluated at each follow-up.

DISCUSSION

This study may provide novel evidence on the efficacy of SGR in improving exercise tolerance and potentially reducing clinical adverse events. (Trial registration No. ChiCTR-TRC-14004504).

Quantitative and systems pharmacology 4. Network-based analysis of drug pleiotropy on coronary artery disease

Despite recent advance of therapeutic development, coronary artery disease (CAD) remains one of the major issues to public health. The use of genomics and systems biology approaches to inform drug discovery and development have offered the possibilities for new target identification and in silico drug repurposing. In this study, we propose a network-based, systems pharmacology framework for target identification and drug repurposing in pharmacologic treatment and chemoprevention of CAD. Specifically, we build in silico models by integrating known drug-target interactions, CAD genes derived from the genetic and genomic studies, and the human protein-protein interactome. We demonstrate that the proposed in silico models can successfully uncover approved drugs and novel natural products in potentially treating and preventing CAD. In case studies, we highlight several approved drugs (e.g., fasudil, parecoxib, and dexamethasone) or natural products (e.g., resveratrol, luteolin, daidzein and caffeic acid) with new mechanism-of-action in chemical intervention of CAD by network analysis. In summary, this study offers a powerful systems pharmacology approach for target identification and in silico drug repurposing on CAD.

Protective effect of Suxiao jiuxin pill, a traditional Chinese medicine, against acute myocardial ischemia in dogs

Background

The purpose of this study was to investigate the effect of Suxiao Jiuxin Pill (SX), a traditional Chinese medicine, on acute myocardial ischemia induced by coronary occlusion in anesthetized dogs.

Methods

Acute myocardial ischemia model was established by ligating the left anterior descending artery to reduce flow by 90 %. Adult mongrel dogs were randomly divided into six groups: model, SX high dose, SX middle dose, SX low dose, Isosorbide dinitrate (ISD) and Sham groups. Adult mongrel dogs were anesthetized and instrumented for measurements of heart rate (HR), mean arterial pressure (MAP), left ventricular systolic pressure (LVSP), left ventricular dP/dt, coronary blood flow (CBF), myocardial blood flow (MBF), coronary vascular resistance (CVR), and epicardial electrocardiogram (EECG). After administration with SX, changes in hemodynamics were recorded. Serum enzymes and blood gas analysis were also detected.

Results

SX has a dose-dependent effect on the reduction of infarct size. Besides, SX exerted a notable inhibition on the elevation of serum creatine kinase MB (CK-MB), lactate dehydrogenase (LDH), malondialdehyde (MDA), and elevation in the superoxide dismutase (SOD) activity. SX also showed a capacity to recover myocardial function by significantly reducing MAP, CVR, LVSP, left ventricular systolic pressure (LVEDP), systolic blood pressure (SBP), diastolic blood pressure (SDP), and increasing CBF and myocardial blood flow (MBF). In addition, SX high dose group markedly reduced total mV of ST segment elevation (Σ-ST), total number of sites with this degree of ST segment elevation (N-ST) and oxygen extraction ratio (O₂ Extr).

Conclusion

SX can improve hemodynamic and myocardial oxygen metabolism, reduce the degree and scope of myocardial ischemia, and hence exert notable anti-anginal ischaemic effect.

Tongguan capsule ameliorates coronary artery stenosis in a 40-year-old woman

Cardiovascular disease is the leading cause of death worldwide, with coronary heart disease as the major contributor to this related mortality. There is a growing trend in the application of Chinese medicine in clinical practice for the treatment of coronary heart disease. However, there is a lack of knowledge surrounding the pharmacological, toxicological, and biological profiles of Chinese medicine. In this case report, we describe the therapeutic effects of Tongguan capsule in a 40-year-old woman diagnosed with stable angina pectoris. To the best of the authors' knowledge, this is the first case documented of the therapeutic effect of Tongguan capsule in the treatment of coronary heart disease.

CUPID: a protocol of a randomised controlled trial to identify characteristics of similar Chinese patent medicines

INTRODUCTION

Traditional Chinese medicine (TCM) has accumulated some experience in curing stable angina pectoris (SAP) and efficacy has been demonstrated. Chinese patent medicines, known as modern dosage forms of TCM, can attain the desired effect in clinical application only with the guidance of TCM syndrome theory. However, due to their use by a large number of persons with little knowledge of TCM theories and practices, their efficacy and reputation have been seriously affected.

METHOD AND ANALYSIS

Two common syndrome types of SAP in TCM, 'qi deficiency and blood stasis' and 'qi stagnation and blood stasis', will be studied in 144 subjects from four TCM hospitals in Tianjin in China using a partial crossover design. The two syndromes will be broken down into six symptom combinations; patients will select a combination of the most distressing to them, and then will be randomised into two groups. Each group, on the basis of routine medication, will be administered one kind of Chinese patent drug: Qishenyiqi Dripping Pills or Compound Danshen Dripping Pills. The treatment characteristics of the two medicines will be evaluated with the COME-PIO method developed by our research team.

ETHICS AND DISSEMINATION

This protocol has been approved by the medical ethics committee of Tianjin University of TCM (registration number TJUTCM-EC20130005). The study is safe and reliable.

TRIAL REGISTRATION NUMBER

Chinese clinical trials register ChiCTR-TTRCC-14004406.

Integrative Western and chinese medicine on coronary heart disease: where is the orientation?

Coronary heart disease (CHD) is the leading cause of death. As the main treatment of CHD, modern medicine has improved dramatically in recent years. Although researches of TCM and integrative medicine on CHD are witnessed encouraging progress in many respects, the role TCM playing in the prevention and treatment of CHD has been unprecedentedly challenged under such circumstance of the very fast development of modern medicine. In order to share mutual complementary advantages of TCM and western medicine, this review summarizes the relatively prominent researches of TCM and integrative medicine on CHD in recent years, and illuminates the issue of the orientation of the further research of integrative medicine on CHD, including (1) original innovation of TCM etiology and pathogenesis, (2) combination of disease and TCM syndrome, (3) biological basis of TCM syndrome of CHD, (4) clinical design and quality control of integrative medicine research, (5) herb-drug interaction, (6) difficulties and hot issues of modern medicine.

Herb-herb combination for therapeutic enhancement and advancement: theory, practice and future perspectives

Herb-herb combinations have been used in Chinese medicine practice for thousands of years, yet scientific evidence of their therapeutic benefits is lacking. With increasing interest in shifting from the one-drug-one-target paradigm to combination therapy or polypharmacy to achieve therapeutic benefits for a number of diseases, there is momentum to explore new knowledge by tapping the past empirical experiences of herb-herb combinations. This review presents an overview of the traditional concept and practice of herb-herb combination in Chinese medicine, and highlights the available scientific and clinical evidence to support the combined use of herbs. It is hoped that such information would provide a lead for developing new approaches for future therapeutic advancement and pharmaceutical product development. Very likely modern technologies combined with innovative research for the quality control of herbal products, identification of active components and understanding of the molecular mechanism, followed by well-designed animal and clinical studies would pave the way in advancing the wealth of empirical knowledge from herb-herb combination to new therapeutic modalities.

Herb-herb combination for therapeutic enhancement and advancement: theory, practice and future perspectives

Herb-herb combinations have been used in Chinese medicine practice for thousands of years, yet scientific evidence of their therapeutic benefits is lacking. With increasing interest in shifting from the one-drug-one-target paradigm to combination therapy or polypharmacy to achieve therapeutic benefits for a number of diseases, there is momentum to explore new knowledge by tapping the past empirical experiences of herb-herb combinations. This review presents an overview of the traditional concept and practice of herb-herb combination in Chinese medicine, and highlights the available scientific and clinical evidence to support the combined use of herbs. It is hoped that such information would provide a lead for developing new approaches for future therapeutic advancement and pharmaceutical product development. Very likely modern technologies combined with innovative research for the quality control of herbal products, identification of active components and understanding of the molecular mechanism, followed by well-designed animal and clinical studies would pave the way in advancing the wealth of empirical knowledge from herb-herb combination to new therapeutic modalities.

The need for multicentre cardiovascular clinical trials in Asia

Historically, the USA and European countries have been the dominant figures in medical research. However, in the past 10 years, Asia has emerged as a new 'hot spot' for clinical research owing to the tremendous potential generated by steady economic growth, remarkable advances in research and development capacity, and an expanding population. However, investigators involved with the set-up and conduct of multicentre trials in such a vast and heterogeneous continent face huge challenges-bridging the fundamental differences between the Asian countries, such as languages, resources, regulatory procedural timelines, and the general understanding of clinical research. In this Perspectives article, we explain why Asia should be established as a hub for large multicentre trials, discuss the challenges involved, and highlight the importance of a strong collaborative infrastructure for multiple investigational sites in this culturally diverse continent.

Outcome measures of chinese herbal medicine for hypertension: an overview of systematic reviews

Objective. The aim of this overview was to summarize the outcome measures of Chinese herbal medicine (CHM) for the treatment of hypertension based on available systematic reviews (SRs), so as to evaluate the potential benefits and advantages of CHM on hypertension. Methods. Literature searches were conducted in the Cochrane Database of Systematic Reviews, MEDLINE, and 4 databases in Chinese. SRs of CHM for hypertension were included. Two independent reviewers (J. Wang and X. J. Xiong) extracted the data. Results. 10 SRs were included. 2 SRs had primary endpoints, while others focused on secondary endpoints to evaluate CHM for hypertension such as blood pressure (BP) and Traditional Chinese Medicine (TCM) syndrome. 6 SRs have reported the adverse effects, whereas the other 4 SRs have not mentioned it at all. Many CHM appeared to have significant effect on improving BP, TCM syndrome, and so on. However, most SRs failed to make a definite conclusion for the effectiveness of CHM for hypertension due to poor evidence. Conclusion. Primary endpoints have not been widely used currently. The benefits of CHM for hypertension need to be confirmed in the future with randomized controlled trials (RCTs) of more persuasive primary endpoints and high-quality SRs.