Traditional Chinese medicine for acute coronary syndrome: A meta-analysis of clinical manifestations and objective indicators.
Journal
Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R
Informations de publication
Date de publication:
20 Aug 2021
20 Aug 2021
Historique:
received:
06
12
2020
accepted:
27
07
2021
entrez:
20
8
2021
pubmed:
21
8
2021
medline:
3
9
2021
Statut:
ppublish
Résumé
Modern clinical trials and experimental researches of traditional Chinese medicine (TCM) have been conducted for decades and provided support for the prevention and treatment of acute coronary syndrome (ACS). However the level of evidence and the proper application of TCM were still barely satisfactory. In this study, we divided ACS into 3 different stages, including unstable angina, acute myocardial infarction, and post myocardial infarction. Then we systematically reviewed and meta-analyzed the existing randomized controlled trials on both clinical manifestations and objective indicators, in these 3 aspects. The results indicate that TCM can both improve the clinical manifestations and ameliorate the objective parameters in different courses of ACS, including C-reactive protein in unstable angina, left ventricular ejection fraction in acute myocardial infarction and post myocardial infarction. And the incidence of short-term cardiovascular events are lower in TCM intervention group. Some of the improvements lead to potential long-term benefits. TCM treatment is beneficial to different courses of ACS. To acquire more solid and comprehensive evidence of TCM in treating ACS, more rigorously designed randomized controlled trials with longer follow-up duration are warranted.
Sections du résumé
BACKGROUND
BACKGROUND
Modern clinical trials and experimental researches of traditional Chinese medicine (TCM) have been conducted for decades and provided support for the prevention and treatment of acute coronary syndrome (ACS). However the level of evidence and the proper application of TCM were still barely satisfactory.
METHODS
METHODS
In this study, we divided ACS into 3 different stages, including unstable angina, acute myocardial infarction, and post myocardial infarction. Then we systematically reviewed and meta-analyzed the existing randomized controlled trials on both clinical manifestations and objective indicators, in these 3 aspects.
RESULTS
RESULTS
The results indicate that TCM can both improve the clinical manifestations and ameliorate the objective parameters in different courses of ACS, including C-reactive protein in unstable angina, left ventricular ejection fraction in acute myocardial infarction and post myocardial infarction. And the incidence of short-term cardiovascular events are lower in TCM intervention group. Some of the improvements lead to potential long-term benefits.
CONCLUSION
CONCLUSIONS
TCM treatment is beneficial to different courses of ACS. To acquire more solid and comprehensive evidence of TCM in treating ACS, more rigorously designed randomized controlled trials with longer follow-up duration are warranted.
Identifiants
pubmed: 34414950
doi: 10.1097/MD.0000000000026927
pii: 00005792-202108200-00020
pmc: PMC8376385
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e26927Informations de copyright
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors have no conflicts of interests to disclose.
Références
GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388:1459–544.
Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol 2017;70:01–25.
University of Washington Institute of Health Metrics and Evaluation. GBD Compare VizHub. 2017. Available at: https://vizhub.healthdata.org/gbd-compare/ . Accessed December 17, 2018.
Ibanez B, James S, Agewall S, et al. ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018;39:119–77.
Martel J, Ojcius DM, Chang CJ, et al. Anti-obesogenic and antidiabetic effects of plants and mushrooms. Nat Rev Endocrinol 2017;13:149–60.
Chang CJ, Lin CS, Lu CC, et al. Ganoderma lucidum reduces obesity in mice by modulating the composition of the gut microbiota. Nat Commun 2015;6:7489.
Li X, Zhang J, Huang J, et al. A multicenter, randomized, double-blind, parallel-group, placebo-controlled study of the effects of qili qiangxin capsules in patients with chronic heart failure. J Am Coll Cardiol 2013;62:1065–72.
Normile D. Asian medicine. The new face of traditional Chinese medicine. Science 2003;299:188–90.
Efferth T, Kaina B. Toxicities by herbal medicines with emphasis to traditional Chinese medicine. Curr Drug Metab 2011;12:989–96.
Wu X, Tang J, Mao C, Yuan JQ, Qin Y, Chung VCH. Systematic reviews and meta-analyses of traditional Chinese medicine must search Chinese databases to reduce language bias. Evid Based Complement Alternat Med 2013;2013:812179.
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:01–12.
Review Manager (RevMan) Computer program. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Pedersen F, Butrymovich V, Kelbæk H, et al. Short- and long-term cause of death in patients treated with primary PCI for STEMI. J Am Coll Cardiol 2014;64:2101–8.
Pfeffer MA, Braunwald E. Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications. Circulation 1990;81:1161–72.
Hirt MN, Hansen A, Eschenhagen T. Cardiac tissue engineering: state of the art. Circ Res 2014;114:354–67.
Bahit MC, Kochar A, Granger CB. Post-myocardial infarction heart failure. JACC Heart Fail 2018;6:179–86.
Guo M, Liu Y, Shi D. Cardiovascular actions and therapeutic potential of tetramethylpyrazine (active component isolated from Rhizoma Chuanxiong): roles and mechanisms. Biomed Res Int 2016;2016:2430329.
Wang L, Zhang J, Hong Y, Feng Y, Chen M, Wang Y. Phytochemical and pharmacological review of da chuanxiong formula: a famous herb pair composed of Chuanxiong Rhizoma and gastrodiae rhizoma for headache. Evid Based Complement Alternat Med 2013;2013:425369.
Adesso S, Russo R, Quaroni A, Autore G, Marzocco S. Astragalus membranaceus extract attenuates inflammation and oxidative stress in intestinal epithelial cells via NF-κB activation and Nrf2 response. Int J Mol Sci 2018;19:800.
Liu P, Zhao H, Luo Y. Anti-aging implications of Astragalus membranaceu s (Huangqi): a well-known Chinese tonic. Aging Dis 2017;8:868–86.
Shan H, Zheng X, Li M. The effects of Astragalus membranaceu s active extracts on autophagy-related diseases. Int J Mol Sci 2019;20:1904.
Mu F, Duan J, Bian H, et al. Cardioprotective effects and mechanism of Radix Salviae miltiorrhizae and Lignum Dalbergiae odoriferae on rat myocardial ischemia/reperfusion injury. Mol Med Rep 2017;16:1759–70.
Li GH, Li YR, Jiao P, et al. Therapeutic Potential of Salviae Miltiorrhizae Radix et Rhizoma against human diseases based on activation of Nrf2-mediated antioxidant defense system: bioactive constituents and mechanism of action. Oxid Med Cell Longev 2018;2018:7309073.
Xie P, Cui L, Shan Y, Kang WY. Antithrombotic effect and mechanism of radix paeoniae rubra. Biomed Res Int 2017;2017:9475074.
Ke Z, Wang G, Yang L, et al. Crude terpene glycoside component from Radix paeoniae rubra protects against isoproterenol-induced myocardial ischemic injury via activation of the PI3K/AKT/mTOR signaling pathway. J Ethnopharmacol 2017;206:160–9.
Zhou D, Qu Z, Wang H, et al. The effect of hydroxy safflower yellow A on coronary heart disease through Bcl-2/Bax and PPAR-γ. Exp Ther Med 2018;15:520–6.
Yao D, Wang Z, Miao L, Wang L. Effects of extracts and isolated compounds from safflower on some index of promoting blood circulation and regulating menstruation. J Ethnopharmacol 2016;191:264–72.
Wang L, Zhao X, Mao S, et al. Efficacy of danlou tablet in patients with non-ST elevation acute coronary syndrome undergoing percutaneous coronary intervention: results from a multicentre, placebo-controlled, randomized trial. Evid Based Complement Alternat Med 2016;2016:7960503.
Hao D, Danbin W, Maojuan G, et al. Ethanol extracts of danlou tablet attenuate atherosclerosis via inhibiting inflammation and promoting lipid effluent. Pharmacol Res 2019;146:104306.
Qi JY, Wang L, Gu DS, Guo LH, Zhu W, Zhang MZ. Protective effects of danlou tablet against murine myocardial ischemia and reperfusion injury in vivo. Chin J Integr Med 2018;24:613–20.
Li Z, Yang L, Liu Y, et al. Anti-inflammatory and antioxidative effects of danlou tablets in the treatment of coronary heart disease revealed by metabolomics integrated with molecular mechanism studies. J Ethnopharmacol 2019;240:111911.
Xu J, Li X, Zhang F, et al. Integrated UPLC-Q/TOF-MS technique and MALDI-MS to study of the efficacy of YiXinshu capsules against heart failure in a rat model. Front Pharmacol 2019;10:1474.
Zhang M, Wu H, Guo F, et al. Identification of active components in Yixinshu capsule with protective effects against myocardial dysfunction on human induced pluripotent stem cell-derived cardiomyocytes by an integrative approach. Mol Biosyst 2017;13:1469–80.
Wei J, Guo F, Zhang M, et al. Signature-oriented investigation of the efficacy of multicomponent drugs against heart failure. FASEB J 2019;33:2187–98.
Zhang J, Geng Y, Guo F, et al. Screening and identification of critical transcription factors involved in the protection of cardiomyocytes against hydrogen peroxide-induced damage by Yixin-shu. Sci Rep 2017;7:13867.
Zhao Y, Xu L, Qiao Z, et al. YiXin-Shu, a ShengMai-San-based traditional Chinese medicine formula, attenuates myocardial ischemia/reperfusion injury by suppressing mitochondrial mediated apoptosis and upregulating liver-X-receptor α. Sci Rep 2016;6:23025.
Feng X, Li Y, Wang Y, et al. Danhong injection in cardiovascular and cerebrovascular diseases: pharmacological actions, molecular mechanisms, and therapeutic potential. Pharmacol Res 2019;139:62–75.
Hu Z, Wang H, Fan G, et al. Danhong injection mobilizes endothelial progenitor cells to repair vascular endothelium injury via upregulating the expression of Akt, eNOS and MMP-9. Phytomedicine 2019;61:152850.
Ye LF, Zheng YR, Wang LH. Effects of Shenmai injection and its bioactive components following ischemia/reperfusion in cardiomyocytes. Exp Ther Med 2015;10:1348–54.
Yu J, Li Y, Liu X, et al. Mitochondrial dynamics modulation as a critical contribution for Shenmai injection in attenuating hypoxia/reoxygenation injury. J Ethnopharmacol 2019;237:09–19.
Ma J, Qiao L, Meng L, et al. Tongxinluo may stabilize atherosclerotic plaque via multiple mechanisms scanning by genechip. Biomed Pharmacother 2019;113:108767.
Li Q, Cui HH, Yang YJ, et al. Quantitative proteomics analysis of ischemia/reperfusion injury-modulated proteins in cardiac microvascular endothelial cells and the protective role of tongxinluo. Cell Physiol Biochem 2017;41:1503–18.
Guan Q, Liu M, Liu R, et al. Tongxinluo induces nNOS expression through ERK activation: possible contribution to the effects of tongxinluo to attenuate vasoconstriction. J Cardiovasc Pharmacol 2015;66:09–15.
Yin Y, Zhang Q, Zhao Q, et al. Tongxinluo attenuates myocardiac fibrosis after acute myocardial infarction in rats via inhibition of endothelial-to-mesenchymal transition. Biomed Res Int 2019;2019:6595437.
Qi K, Li X, Geng Y, et al. Tongxinluo attenuates reperfusion injury in diabetic hearts by angiopoietin-like 4-mediated protection of endothelial barrier integrity via PPAR-α pathway. PLoS One 2018;13:e0198403.
Xu RX, Zhang Y, Guo YL, et al. Novel findings in relation to multiple anti-atherosclerotic effects of XueZhiKang in humans. Chronic Dis Transl Med 2017;4:117–26.
Feng Y, Xu H, Chen K. Natural polypill Xuezhikang: its clinical benefit and potential multicomponent synergistic mechanisms of action in cardiovascular disease and other chronic conditions. J Altern Complement Med 2012;18:318–28.
Liang L, Shao W, Shu T, et al. Xuezhikang improves the outcomes of cardiopulmonary resuscitation in rats by suppressing the inflammation response through TLR4/NF-κB pathway. Biomed Pharmacother 2019;114:108817.
Shen L, Sun Z, Chu S, et al. Xuezhikang, an extract from red yeast rice, attenuates vulnerable plaque progression by suppressing endoplasmic reticulum stress-mediated apoptosis and inflammation. PLoS One 2017;12:e0188841.
Jia Y, Huang F, Zhang S, Leung SW. Is danshen ( Salvia miltiorrhiza ) dripping pill more effective than isosorbide dinitrate in treating angina pectoris? A systematic review of randomized controlled trials. Int J Cardiol 2012;157:330–40.
Zhang Y, Xie Y, Liao X, Jia Q, Chai Y. A Chinese patent medicine Salvia miltiorrhiza depside salts for infusion combined with conventional treatment for patients with angina pectoris: a systematic review and meta-analysis of randomized controlled trials. Phytomedicine 2017;25:100–17.
Chen R, Xiao Y, Chen M, et al. A traditional Chinese medicine therapy for coronary heart disease after percutaneous coronary intervention: a meta-analysis of randomized, double-blind, placebo-controlled trials. Biosci Rep 38D 2018:BSR20180973.
Liao P, Wang L, Guo L, Zeng R, Huang J, Zhang M. Danhong injection (a traditional Chinese patent medicine) for acute myocardial infarction: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2015;2015:646530.
Maggioni AP, Dahlström U, Filippatos G, et al. EURObservational research programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail 2013;15:808–17.