Efficacy and Safety of Shexiang Baoxin Pill for Coronary Heart Disease after Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis

Acupuncture for patients after percutaneous coronary intervention: A scoping review

OBJECTIVE

To summarize the current available evidence and to outline recommendations for the future research of acupuncture for patients after percutaneous coronary intervention (PCI).

DESIGN

Seven electronic databases were searched: China National Knowledge Infrastructure (CNKI), Wan Fang Database, Chongqing VIP Chinese Science and Technology Periodical Database (VIP), Chinese Biomedical Literature Database (CBM), Cochrane Library, PubMed, and EMBASE. All studies on acupuncture for patients after PCI were included. The search period was from the database establishment to June 13th, 2024.

SETTING

Using full-text and Medical Subject Headings (MeSH) searches, two personnel independently screened and checked articles strictly according to the inclusion and exclusion criteria, and they reached an agreement through discussion on articles with different opinions.

INTERVENTIONS

Post-PCI acupuncture.

MAIN OUTCOME MEASURES

Creating descriptive charts to visually express the research features.

RESULTS

38 eligible studies were included. Their main topic was the use of acupuncture in patients after PCI. The primary focus of these studies was the application of acupuncture in patients post-PCI. The majority of the included articles originated from China, with the majority published in the year 2023. The types of studies encompassed randomized controlled trials (RCTs) (25, 65.8 %), protocols (6, 15.8 %), review articles (6, 15.8 %), and case report (1, 2.6 %). The acupuncture methods utilized varied, with filiform needle therapy being the most common (14, 36.8 %), followed by auricular plaster therapy (7, 18.4 %), thumbtack needle therapy (7, 18.4 %), and eye acupuncture (1, 2.6 %). The acupoints most frequently used were Shenmen (TF4) in the auricular region and Neiguan (PC6). The needle retention time was predominantly 30 min, as reported in nine studies involving filiform needles. In the control groups of the included studies, secondary prevention measures were most commonly employed, appearing in thirteen studies. The Pittsburgh Sleep Quality Index (PSQI) was the most frequently measured outcome, featured in nine studies. Psychological issues were identified as the most prevalent condition following PCI, mentioned in seventeen studies.

CONCLUSION

The main focus of this scoping review was on psychological issues, cardiovascular problems, and exercise capacity or quality of life of patients after PCI. The majority of research has concentrated on psychological and cardiovascular issues. However, the outcomes related to varieties of acupuncture therapy methods, acupoints selection, retention time, treatment frequency, and other aspects of acupuncture practice were interconnected and complex within the clinical application of acupuncture. These interconnected elements collectively impacted the treatment of acupuncture in the post-PCI context, making it challenging to reach definitive conclusions. The heterogeneity in acupuncture practices highlighted the need for future research. It is recommended that future studies employ more rigorous designs, standardized methodologies, larger sample sizes, and higher quality to enhance our understanding of acupuncture's role in post-PCI care. This is particularly important for elucidating its potential in addressing psychological and cardiovascular problems, which are critical areas of concern for patients post-PCI.

REGISTRATION

This scoping review has been registered in the Open Science Framework Registry (https://doi.org/10.17605/OSF.IO/3HZFW). We drafted this paper following the PRISMA extension for Scoping Reviews (PRISMA-ScR) (https://www.prisma-statement.org/scoping) (Appendix 1).

Mitigation of myocardial ischemia/reperfusion-induced chronic heart failure via Shexiang Baoxin Pill-mediated regulation of the S1PR1 signaling pathway

BACKGROUND

Well-defined and effective pharmacological interventions for clinical management of myocardial ischemia/reperfusion (MI/R) injury are currently unavailable. Shexiang Baoxin Pill (SBP), a traditional Chinese medicine Previous research on SBP has been confined to single-target treatments for MI/R injury, lacking a comprehensive examination of various aspects of MI/R injury and a thorough exploration of its underlying mechanisms.

PURPOSE

This study aimed to investigate the therapeutic potential of SBP for MI/R injury and its preventive effects on consequent chronic heart failure (CHF). Furthermore, we elucidated the specific mechanisms involved, contributing valuable insights into the potential pharmacological interventions for the clinical treatment of MI/R injury.

METHODS

We conducted a comprehensive identification of SBP components using high-performance liquid chromatography. Subsequently, we performed a network pharmacology analysis based on the identification results, elucidating the key genes influenced by SBP. Thereafter, through bioinformatics analysis of the key genes and validation through mRNA and protein assays, we ultimately determined the centralized upstream targets. Lastly, we conducted in vitro experiments using myocardial and endothelial cells to elucidate and validate potential underlying mechanisms.

RESULTS

SBP can effectively mitigate cell apoptosis, oxidative stress, and inflammation, as well as promote vascular regeneration following MI/R, resulting in improved cardiac function and reduced CHF risk. Mechanistically, SBP treatment upregulates sphingosine-1-phosphate receptor 1 (S1PR1) expression and activates the S1PR1 signaling pathway, thereby regulating the expression of key molecules, including phosphorylated Protein Kinase B (AKT), phosphorylated signal transducer and activator of transcription 3, epidermal growth factor receptor, vascular endothelial growth factor A, tumor necrosis factor-α, and p53.

CONCLUSION

This study elucidated the protective role of SBP in MI/R injury and its potential to reduce the risk of CHF. Furthermore, by integrating downstream effector proteins affected by SBP, this research identified the upstream effector protein S1PR1, enhancing our understanding of the pharmacological characteristics and mechanisms of action of SBP. The significance of this study lies in providing compelling evidence for the use of SBP as a traditional Chinese medicine for MI/R injury and consequent CHF prevention.

Assessment of left atrial function by two-dimensional speckle tracking echocardiography in patients with metabolic-associated fatty liver disease

BACKGROUND

Metabolic-associated fatty liver disease (MAFLD) and cardiovascular diseases have mutual risk factors that contribute to pathogenic processes, increasing mortality and morbidity. This study aimed to evaluate variations in left ventricular (LV) structure and diastolic function among different subtypes and severity degrees of MAFLD patients, allowing early identification, intervention, and prevention of severe cardiac outcomes in high-risk populations.

RESULTS

The cross-sectional study included 142 MAFLD patients and 142 non-MAFLD participants as a control group. All participants underwent abdominal ultrasound, transient elastography, transthoracic echocardiography, tissue Doppler, and strain imaging. The results showed a significant impairment in the diastolic left ventricular function, as assessed with tissue Doppler, and the left atrial (LA) function, as evaluated with strain imaging, in the MAFLD group. Additionally, the left atrial stiffness was significantly higher in the MAFLD group.

CONCLUSION

The use of strain imaging facilitated the detection of subtle impairments of the left atrial reservoir, contraction, conduit function, and left ventricular diastolic function in MAFLD patients.

Study on the Therapeutic Value of Shexiang Tongxin Dropping Pills in Patients with Stable Angina Pectoris of Coronary Heart Disease Complicated with Cognitive Impairment

BACKGROUND

There is a pressing need to identify pharmaceuticals that are both safe and efficacious, with lower toxicity, for the treatment of stable angina pectoris in individuals suffering from coronary heart disease. The aim of this paper is to explore the therapeutic value of Shexiang Tongxin Dropping Pills in patients with stable angina pectoris of coronary heart disease complicated with cognitive impairment.

METHODS

200 patients with stable angina pectoris combined with cognitive dysfunction and coronary heart disease admitted to our hospital from January 2022 to June 2023 were retrospectively selected as the study objects. According to the treatment method, the subjects were divided into a control group and a study group, with 100 cases in each group. The control group received conventional oral Western medicine, and the study group underwent treatment with Shexiang Tongxin Dropping Pills in addition to traditional Western medicine. The course of treatment was eight weeks. The enhancement in angina pectoris, cognitive function level, self-care ability, and clinical efficacy of both groups were assessed by comparing the conditions before and after the treatment.

RESULTS

After treatment, the frequency and duration of angina pectoris attacks in both groups were significantly lower than before, and the study group was lower than the control group (p < 0.05). The Montreal Cognitive Assessment (MoCA) score of both groups was higher than before, and the score of the study group was significantly higher than that of the control group (p < 0.05). Neuropsychiatric Inventory (NPI) scores in both groups were significantly lower than before, and the scores of the study group were significantly lower than those of the control group (p < 0.05). Traditional Chinese Medicine (TCM) syndrome scores in both groups were significantly lower than before, and the scores of the study group were significantly lower than those of the control group (p < 0.05). After treatment, the total effective rate of the control group and the study group was 81.00% and 93.00%, respectively, and the total clinical effective rate of the study group was significantly higher than that of the control group (p < 0.05).

CONCLUSION

Shexiang Tongxin Dropping Pills can effectively reduce the incidence of angina pectoris in patients with stable angina pectoris complicated with coronary heart disease and cognitive dysfunction. It can also regulate the patient's neurological function, improve their cognitive level, and significantly improve clinical efficacy.

Efficacy and safety of oral Chinese patent medicines in the treatment of coronary heart disease combined with hyperlipidemia: a systematic review and network meta-analysis of 78 trials

AIM OF THE STUDY

To evaluate the clinical efficacy and safety of commonly used oral Chinese patent medicines for the treatment of coronary heart disease combined with hyperlipidemia in clinical practice through a network meta-analysis.

MATERIALS AND METHODS

PubMed, Embase, Cochrane Library, Web of Science, Wanfang, VIP, SinoMed, and CNKI databases were searched for all published randomized controlled trials (RCTs) on the treatment of coronary heart disease combined with hyperlipidemia using Chinese patent medicines. NoteExpress software was used to screen the literature obtained from the databases according to the inclusion and exclusion criteria. The Cochrane risk of bias assessment tool was used to evaluate the quality of the included studies. A network meta-analysis was performed using R 4.2.1. Subgroup analyses of outcome indicators were made based on conventional treatment (CT) methods. The incidence of adverse events in the included RCTs was statistically analyzed. A funnel plot was drawn using RevMan 5.4.1 software for the assessment of bias in the total clinical effectiveness rate. Finally, the quality of evidence for interventions with statistically significant differences was evaluated using the GRADE system.

RESULTS

A total of 78 RCTs were included, involving 7,955 cases and 8 types of Chinese patent medicines, which were Tongxinluo Capsule, Naoxintong Capsule, Compound Danshen Dripping Pill, Shexiangbaoxin Pill, Songling Xuemaikang Capsule, Xuezhikang Capsule, Yindan Xinnaotong Capsule, and Zhibitai Capsule. A total of 24 RCTs reported the incidence of adverse events, but no statistically significant difference in the incidence of adverse events was found between the experimental and control groups in each study (P > 0.05). There was no obvious publication bias in all studies, but the overall quality of evidence in the included RCTs was low. Comparison of different intervention measures showed that Naoxintong Capsule + CT improved the cardiac index and cardiac output, and lowered the low-density lipoprotein cholesterol and total cholesterol levels. Tongxinluo Capsule + CT raised high-density lipoprotein cholesterol levels and reduced triglyceride levels. Xuezhikang Capsule + CT improved the total clinical effectiveness rate. Subgroup analyses showed that differences in CT did not cause heterogeneity in the results.

CONCLUSION

Compared with the use of CT alone, the combined use of Chinese patent medicines with CT can effectively improve the symptoms in patients with both coronary heart disease and hyperlipidemia.

Mechanisms of ferroptosis regulating oxidative stress and energy metabolism in myocardial ischemia-reperfusion injury and a novel perspective of natural plant active ingredients for its treatment

Acute myocardial infarction remains the leading cause of death in humans. Timely restoration of blood perfusion to ischemic myocardium remains the most effective strategy in the treatment of acute myocardial infarction, which can significantly reduce morbidity and mortality. However, after restoration of blood flow and reperfusion, myocardial injury will aggravate and induce apoptosis of cardiomyocytes, a process called myocardial ischemia-reperfusion injury. Studies have shown that the loss and death of cardiomyocytes caused by oxidative stress, iron load, increased lipid peroxidation, inflammation and mitochondrial dysfunction, etc., are involved in myocardial ischemia-reperfusion injury. In recent years, with the in-depth research on the pathology of myocardial ischemia-reperfusion injury, people have gradually realized that there is a new form of cell death in the pathological process of myocardial ischemia-reperfusion injury, namely ferroptosis. A number of studies have found that in the myocardial tissue of patients with acute myocardial infarction, there are pathological changes closely related to ferroptosis, such as iron metabolism disorder, lipid peroxidation, and increased reactive oxygen species free radicals. Natural plant products such as resveratrol, baicalin, cyanidin-3-O-glucoside, naringenin, and astragaloside IV can also exert therapeutic effects by correcting the imbalance of these ferroptosis-related factors and expression levels. Combining with our previous studies, this review summarizes the regulatory mechanism of natural plant products intervening ferroptosis in myocardial ischemia-reperfusion injury in recent years, in order to provide reference information for the development of targeted ferroptosis inhibitor drugs for the treatment of cardiovascular diseases.

Chinese patent medicines for coronary microvascular disease: clinical evidence and potential mechanisms

Coronary microvascular disease (CMVD) is a high risk factor for many cardiovascular events. Due to the limited understanding of its pathophysiological mechanism, modern medicine still lacks therapeutic drugs for CMVD. Existing clinical studies have shown that traditional Chinese medicine (TCM) can effectively improve the clinical symptoms and quality of life of CMVD patients. As an indispensable part of TCM, Chinese patent medicines (CPMs) are widely used in clinical practice. In the face of numerous oral CPMs for treatment of CMVD, how to choose a reasonable medication regimen is one of the important issues in clinic. Based on this, this paper reviewed the clinical efficacy and recommended level of 12 CPMs in the treatment of CMVD, which are recommended by expert consensus on diagnosis and treatment of coronary microvascular disease with integrated Chinese and Western medicine (WM). In addition, this study also systematically summarized the possible mechanisms of CPMs in the treatment of CMVD by protecting coronary microvascular endothelial cells, improving vascular endothelial function, inhibiting inflammation, reducing oxidative stress, promoting angiogenesis, and improving hemorheology, aiming to provide meaningful information for its clinical application.

Single-nucleus ribonucleic acid-sequencing and spatial transcriptomics reveal the cardioprotection of Shexiang Baoxin Pill (SBP) in mice with myocardial ischemia-reperfusion injury

Aim: The Shexiang Baoxin Pill (SBP) has been extensively used to treat cardiovascular diseases in China for four decades, and its clinical efficacy has been widely approved. However, the mechanism by which this is achieved remains largely unexplored. Research attempting to understand the underlying mechanism is ongoing, but the findings are controversial. Here, we aimed to explore the possible mechanism of SBP in myocardial ischemia-reperfusion (I/R) injury using heart single-nucleus and spatial ribonucleic acid (RNA) sequencing. Methods: We established a murine myocardial I/R injury model in C57BL/6 mice by ligating and recanalizing the left coronary artery anterior descending branch. Subsequently, single-nucleus RNA-seq and spatial transcriptomics were performed on mice cardiac tissue. We initially assessed the status of cell types and subsets in the model administered with or without SBP. Results: We used single-nucleus RNA sequencing to comprehensively analyze cell types in the cardiac tissue of sham, I/R, and SBP mice. Nine samples from nine individuals were analyzed, and 75,546 cells were obtained. We classified the cells into 28 clusters based on their expression characteristics and annotated them into seven cell types: cardiomyocytes, endothelial cells, fibroblasts, myeloid cells, smooth muscle cells, B cells, and T cells. The SBP group had distinct cellular compositions and features than the I/R group. Furthermore, SBP-induced cardioprotection against I/R was associated with enhanced cardiac contractility, reduced endocardial cell injury, increased endocardial-mediated angiogenesis, and inhibited fibroblast proliferation. In addition, macrophages had active properties. Conclusion: SBP improves the early LVEF of I/R mice and has a cardioprotective effect. Through sequencing analysis, we observed that SBP can increase the gene expression of Nppb and Npr3 in the infarct area of the heart. Npr3 is related to vascular generation mediated by endocardial cells and requires further research. In addition, SBP increases the number of fibroblasts, inhibits the expression of genes related to fibroblast activation and proliferation, and increases the transformation of endothelial cells into fibroblasts. These findings will help to indicate directions for further research.

Efficacy and safety of acupuncture combined with Xuefu Zhuyu Decoction on major adverse cardiovascular events after percutaneous coronary intervention: A protocol for systematic review and meta-analysis

BACKGROUND

Percutaneous coronary intervention (PCI) is an effective treatment for coronary heart disease (CHD). With the merits of small trauma and high success rate, PCI can promote the fast recovery of CHD patients and greatly improve their prognosis and quality of life. However, because PCI does not eliminate the pathogenic factors that lead to atherosclerosis, major adverse cardiovascular events (MACEs) often occur after PCI. These events have become one of the principal factors affecting the long-term outcome of patients after PCI. In China, increasing attention is paid to the use of acupuncture combined with Xuefu Zhuyu Decoction (XFZYD) for the treatment of post-PCI MACEs in clinical practice. Nevertheless, this treatment approach still lacks evidence-based medical evaluation. In this study, a meta-analysis was conducted to evaluate the effectiveness and safety of acupuncture combined with XFZYD in the treatment of MACEs after PCI.

METHODS

Randomized controlled trials on the efficacy and safety of acupuncture combined with XFZYD for the treatment of MACEs after PCI were retrieved from CNKI, WanFang, PubMed, Embase, Cochrane Library, Google Scholar and Web of Science databases from the time of database establishment to October 2022. The papers were screened strictly according to the inclusion and exclusion criteria, and the quality of the included studies was assessed using the Risk of Bias 2 (RoB 2) tool. Raw data were extracted from the studies and then a meta-analysis was made using RevMan 5.3 software.

RESULTS

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

CONCLUSION

This study will summarize the latest evidence for the efficacy and safety of acupuncture combined with XFZYD in the treatment of MACEs after PCI.REGISTRATION NUMBER: CRD42022365657.

Efficacy and safety of Shexiang Baoxin Pill for stable coronary artery disease: A systematic review and meta-analysis of 42 randomized controlled trials

Objective: Patients with stable coronary artery disease (SCAD) still have a higher risk of adverse cardiovascular events. Shexiang Baoxin Pill (SBP) is widely used as a complementary and alternative treatment for SCAD. This study aimed to further verify the therapeutic effect and safety of SBP on SCAD. Methods: Seven databases were involved in this meta-analysis as of 1 June 2022. Data was collected from all the randomized controlled trials (RCTs) of the combination of SBP and conventional western medicine (CWM) in treating SCAD which was conducted by two independent authors. Risk of bias was assessed using the Cochrane risk-of-bias 2.0 (RoB2.0) tool, and the meta-analysis was accomplished with Review Manager 5.3. Furthermore, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) profiler 3.2.2 software was selected to grade the current evidence in our findings. Results: 42 articles, involving 6,694 patients were screened among all the 1,374 records in the analysis. The results demonstrated that the combination therapy was more efficient than CWM alone in lowering the incidence of major adverse cardiovascular events (MACE, RR = 0.50, 95% CI: 0.37 to 0.68, p < 0.00001) and ameliorating the total effective rate of angina symptom improvement (RR = 1.23, 95% CI: 1.19 to 1.28, p < 0.00001), the effective rate of electrocardiogram improvement (RR = 1.34, 95% CI: 1.26 to 1.43, p < 0.00001), the frequency of angina pectoris (MD = -2.83, 95% CI: -3.62 to -2.05, p < 0.00001), and the duration of angina pectoris (MD = -1.32, 95% CI: -2.04 to -0.61, p = 0.0003). We also found that, after SBP treatment, a more positive blood lipid level and left ventricular ejection fraction without the increase in adverse cases were calculated in our meta-analysis. What's more, Subgroup analysis indicated that treatment duration may be the source of heterogeneity. The certainty of the evidence for MACE, and electrocardiogram improvement exhibited moderate certainty, and the certainty of the evidence for the remaining outcomes was judged as low certainty. The trial sequential analysis further affirmed the clinical efficacy of SBP. Conclusion: The available evidence indicates that SBP may be an effective therapeutic option in patients with SCAD. However, considering the inferior quality and inconsistent results in the included trials, further rigorous RCTs are required. Systematic Review Registration: https://www.crd.york.ac.uk/prospero, identifier [CRD42022334529].

Metabolic dysfunction-associated fatty liver disease and cardiovascular disease: A meta-analysis

BACKGROUND

Metabolic dysfunction-associated fatty liver disease [MAFLD, formerly known as nonalcoholic fatty liver disease (NAFLD)] is one of the most important causes of liver disease worldwide, while cardiovascular disease (CVD) is still one of the main causes of morbidity and mortality worldwide, and the two are closely related. This study aimed to investigate the risk of CVD incidence or CVD-related mortality (CVD mortality) in patients diagnosed with MAFLD under new concepts and new diagnostic criteria.

METHODS

We searched English databases PubMed, Web of Science, Embase, and Cochrane Library for relevant literature. The language was restricted to English.

RESULTS

By 22 January 2022, 556 published studies were obtained through preliminary retrieval, and 10 cohort studies were included in this study. All statistical analyses were performed using Review Manager 5.2 software. Compared with the control group, patients in the MAFLD group had a significantly higher relative risk of CVD incidence or CVD mortality during the follow-up, with an RR rate of 1.95 (95% CI 1.76-2.17, p < 0.01). The incidence of CVD in the MAFLD group was more than twice that in the control group (RR 2.26, 95% CI 2.00-2.54, p < 0.01). The mortality rate of CVD was 1.57 times higher than that in the control group (RR 1.57, 95% CI 1.42-1.72, p < 0.01).

CONCLUSIONS

Patients diagnosed with MAFLD alone had higher cardiovascular mortality than those diagnosed with NAFLD alone based on the available data.