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Forest plot of stenocardia based on the time point of intervention and the effect of Liqihuoxue or Yiqihuoxue.
Source publication
Introduction:
TCMI with the effect of Liqihuoxue and Yiqihuoxue has been applied as complementary therapies during the perioperative period of PCI for patients with ACS, while the recommended time points and plans of TCMI are still short of the support of evidence-based medicine.
Methods:
A systematic review and meta-analysis was conducted to ev...
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Background:
It was a meta-analysis on the efficacy of statins in the treatment of atherosclerosis.
Methods:
The PubMed, Medline, Embase, Web of Sciences, and other Chinese and English databases were used to retrieve literature on randomized controlled trials (RCTs) of statins in the treatment of atherosclerosis, published from January 2000 to Ja...
Citations
... Acute coronary syndrome (ACS) accounts for more than 1 million deaths worldwide each year [1]. The incidence of ACS in China is increasing annually and is predicted to reach 22.6 million patients by 2030 [2]. ACS commonly arises from the rupture or erosion of atherosclerotic plaques in the coronary arteries that supply blood to the heart, resulting in arterial thrombosis and subsequent myocardial ischemia. ...
Background
MicroRNA (miRNA) plays a critical function in the progression of acute coronary syndrome (ACS) and is associated with major adverse cardiovascular events (MACEs) after undergoing percutaneous coronary intervention (PCI). This research was designed to probe the diagnostic accuracy of miR-483-5p in patients with ACS and its predictive value of MACEs.
Methods
118 patients with ACS (40 with unstable angina pectoris [UAP] and 78 with acute myocardial infarction [AMI]) and 75 healthy controls were enrolled. Serum miR-483-5p was detected in the subjects by reverse transcription-quantitative real-time PCR (RT-qPCR). ROC curve and logistic regression models were employed to estimate the diagnosis. Patients were monitored for 6 months after PCI to document the occurrence of MACEs. Kaplan-Meier survival was conducted to explore the predictive significance of miR-483-5p for the MACEs.
Results
Serum miR-483-5p levels were higher in ACS patients and associated with SYNTAX score and Gensini score. miR-483-5p was effective in identifying ACS patients from healthy individuals (AUC = 0.919) and AMI patients from ACS patients (AUC = 0.867), demonstrating a high diagnostic value, proven by logistic regression (OR = 9.664, 95%CI = 4.462–20.928, P < 0.001). The prevalence of MACEs during follow-up were 24.58%, and a higher prevalence of MACEs were observed in patients with elevated miR-483-5p (P = 0.01). miR-483-5p was also an effective predictor of MACE occurrence (HR = 5.955, 95%CI = 1.928–18.389, P = 0.002).
Conclusion
Expression of serum miR-483-5p can be utilized as a non-invasive marker for diagnosing ACS and predicting the onset of MACE after PCI.
... Further studies have confirmed that its mechanism is related to the downregulation of P2Y12 response units and C-reactive protein levels [92]. A metaanalysis of 68 randomized controlled trials involving 6,043 patients showed that the combination of traditional Chinese medicine injection and conventional drugs, including aspirin and clopidogrel, is better than conventional drugs alone in terms of clinical efficacy and incidence of myocardial infarction [93]. ...
Ischemic heart disease is a significant risk factor that threatens human health, and antiplatelet drugs are routinely used to treat cases in clinical settings. Chinese medicine for promoting blood circulation and removing blood stasis (PBCRBSCM) can often be combined with antiplatelet drugs to treat ischemic heart disease. PBCRBSCM can inhibit platelet adhesion, activation, and aggregation; moreover, PBCRBSCM in combination with antiplatelet drugs exerts antiplatelet effects. The mechanism is related to several factors, including the inhibition of platelet activation and aggregation, improvement of the hemodynamic status and coagulation function, and correction of metabolism and inflammation. PBCRBSCM can also regulate the absorption and metabolism of conventional antiplatelet drugs and protect the gastric mucosal epithelial cells against damage induced by conventional antiplatelet drugs. Randomized controlled trials have confirmed that PBCRBSCM preparations and the active ingredients in these preparations can reduce resistance to aspirin and clopidogrel so that the combination of these drugs can exert their antiplatelet effects. In the perioperative treatment of patients with stable angina pectoris, unstable angina pectoris, and acute coronary syndrome undergoing percutaneous coronary intervention therapy, preparations of the active ingredients of PBCRBSCM combined with antiplatelet drugs and other conventional Western medicine treatments have been proven effective. The efficacy and safety of such combinations have also been extensively verified. Considerable progress has been made to understand the antiplatelet mechanism of PBCRBSCM. However, most clinical studies had problems, such as limited sample size and inappropriate research design, which has limited the translational use of PBCRBSCM in antiplatelet therapy. A large-scale, multicenter, randomized controlled study with cardiovascular events as the endpoint is still to be conducted to provide evidence for the combined application of PBCRBSCM and antiplatelet drugs in the prevention and treatment of ischemic heart disease.
Traditional Chinese herbal medicine (CHM) has been extensively used in cardiovascular disease in modern clinical practice, alone or in combination with conventional treatment. However, its efficacy has not been assessed extensively. From inception until August 2023, we systematically searched five public literature databases to conduct the umbrella review. The inclusion criterion is systematic reviews of randomized controlled trials investigating the effect of CHM in the contemporary management of cardiovascular diseases. The quality of the included systematic reviews, the certainty of the evidence, and the potential risk of bias were assessed. Five hundred and thirty-nine systematic reviews, including 346 studies in Chinese and 193 in English, were selected before the quantitative synthesis. The methodological quality was generally moderate, with a median value of 11. The favorable efficacy of CHM was primarily presented on five main conditions, coronary artery disease, hypertension, heart failure, restenosis, and angina pectoris. CHM, with or without conventional treatment, showed a consistent beneficial effect in various cardiovascular diseases. Nevertheless, the magnitude of the effect requires further investigation as the lack of relevant research and the complexity of the clinical practice of CHM.
Aims
We assessed the efficacy of the traditional Chinese medicine formulation Jia-Wei-Si-Miao-Yong-An decoction (HJ11) in the treatment of acute coronary syndrome and evaluated its impact on the intestinal microbiota and their metabolites.
Methods
An acute coronary syndrome model was established in rats, which were randomly assigned to the model, HJ11 treatment, and atorvastatin treatment groups. Rats were then administered saline solution (model and sham operation control groups) or drugs by oral gavage for 28 d. Echocardiography was performed and serum creatine kinase-MB and cardiac troponin I levels were monitored to examine the cardiac function. Inflammation was evaluated using hematoxylin and eosin staining of heart tissue, and serum interleukin-2, interleukin-6, tumor necrosis factor alpha, and high-sensitivity C-reactive protein measurements. Gut microbiota composition was analyzed via 16S rRNA gene sequencing. Metabolomics was used to determine fecal metabolites and elucidate the modes of action of HJ11 in acute coronary syndrome treatment.
Results
HJ11 improved cardiac function and attenuated inflammation in rats with acute coronary syndrome. Relative to the untreated model group, the HJ11-treated group presented normalized Firmicutes/Bacteroidetes ratio and reduced abundances of the bacterial genera norank_f__Ruminococcaceae, Desulfovibrio, Clostridium_sensu_stricto_1, Adlercreutzia, Staphylococcus, Bacteroides, Prevotella, Rikenellaceae_RC9_gut_group, unclassified_o__Bacteroidales , and Ruminococcus_gauvreauii_group . We found 23 differentially expressed intestinal metabolites, and the enriched metabolic pathways were mainly related to amino acid metabolism. We also discovered that asymmetric dimethylarginine levels were strongly associated with cardiovascular disease. Correlation analyses revealed strong associations among intestinal microflora, their metabolites, proinflammatory factors, and cardiac function. Hence, the therapeutic effects of HJ11 on acute coronary syndrome are related to specific alterations in gut microbiota and their metabolites.
Conclusion
This work demonstrated that HJ11 effectively treats acute coronary syndrome. HJ11 seems to increase the abundance of beneficial bacterial taxa ( Bacteroides and Rikenellaceae_RC9_gut _group), mitigate the risk factors associated with cardiovascular disease, alter bacterial metabolites, lower asymmetric dimethylarginine levels, and effectively treat acute coronary syndrome.
A intervenção coronariana percutânea (ICP) é um tratamento minimamente invasivo relacionado a desobstrução das artérias coronárias com o objetivo de aumentar o fluxo sanguíneo ao coração e, para sua realização é necessária uma abordagem perioperatória para balancear corretamente os riscos das complicações por agregação plaquetária e os riscos de sangramentos. Dentro desse contexto, a questão norteadora para esse estudo foi definida como: Qual a assistência perioperatória adequada para pacientes que serão submetidos a Intervenção coronariana percutânea? Este estudo tem como objetivo geral identificar a assistência perioperatória adequada para pacientes que serão submetidos a Intervenção Coronariana Percutânea. A metodologia utilizada tratou-se de uma revisão bibliográfica do tipo integrativa de objetivo descritivo. Nessa perspectiva, foram selecionados 19 artigos, os quais passaram por um processo criterioso de triagem, para compor a revisão. Os principais resultados enfatizaram a terapia com fármacos inibidores do receptor P2Y12 como estratégia de escolha para prevenção de complicações perioperatórias da ICP, como o infarto do miocárdio, acidente vascular cerebral, trombose de stent e sangramentos. Ainda foi recomendado o uso da terapia antiplaquetária dupla, a qual garante uma inibição plaquetária eficaz e precoce, porém apresenta riscos de sangramentos. Ademais, os estudos evidenciaram a importância da anticoagulação parenteral durante a ICP, com a utilização do cangrelor, sendo considerado a assistência perioperatória mais eficaz na prevenção de eventos trombóticos. Portanto, pode-se concluir que os pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST o uso do inibidor da proteína P2Y12 foi a principal escolha, no âmbito hospitalar, para prevenção de complicações perioperatórias da ICP diminuindo a morbimortalidade, e ainda, associado ao ácido acetilsalicílico, foi potencializado sua ação antiagregante. Para mais, novos anticoagulantes orais surgiram como alternativa para redução dos riscos de sangramentos. Portanto, é necessário o conhecimento das alternativas farmacológicas durante todo perioperatório da ICP a fim de escolher o tratamento mais adequado para o paciente.
