Comprehensive effects of traditional Chinese medicine treatment on heart failure and changes in B-type natriuretic peptide levels: A meta-analysis

BACKGROUND Heart failure(HF),a common cardiovascular condition,is characterized by significant morbidity and mortality.While traditional Chinese medicine(TCM)is often used as a complementary approach in HF management,systematic evalua-tions of its impact on clinical outcomes,TCM syndrome scores,and B-type natriuretic peptide(BNP)levels are lacking.This study fills this gap through a comprehensive analysis of randomized controlled trials(RCTs)focusing on TCM for HF treatment.It encompasses an assessment of methodological quality,a meta-analysis,and an evaluation of evidence quality based on established standards.The results offer crucial insights into the potential advantages and constraints of TCM in HF management.RCTs on TCM for HF treatment published since the establishment of the database were searched in four Chinese and English databases,including China National Knowledge Infrastructure,Wanfang,VIP Information Chinese Science and Technology Journal,and PubMed.Methodological quality was assessed for the included studies with the Cochrane risk-of-bias assessment tool,and the meta-analysis and publication bias assessment was performed with the RevMan5.3 software.Finally,the quality of evidence was rated according to the GRADE criteria.RESULTS A total of 1098 RCTs were initially retrieved.After screening,16 RCTs were finally included in our study,which were published between 2020 and 2023.These RCTs involved 1660 HF patients,including 832 in the TCM group[TCM combined with conventional Western medicine(CMW)treatment]and 828 in the CWM group(CWM treatment).The course of treatments varied from 1 wk to 3 months.TCM syndrome differentiation was analyzed in 11 of the included RCTs.In all included RCTs,outcome indicators included comprehensive clinical outcomes,TCM syndrome scores,and BNP levels.The meta-analysis results showed significant differences between the TCM and CWM groups in terms of comprehensive clinical outcomes[risk ratio=-0.54;95%confidence interval(CI)=-0.61,-0.47;P<0.00001],TCM syndrome scores[weighted mean difference(WMD)=-142.07;95%CI=-147.56,-136.57;P<0.00001],and BNP levels(WMD=-142.07;95%CI=-147.56,-136.57;P<0.00001).According to the GRADE criteria,RCTs where"TCM improves clinical comprehensive outcomes"were rated as low-quality evidence,and RCTs where"TCM reduces TCM syndrome scores"or"TCM decreases BNP levels"were rated as medium-quality evidence.CONCLUSION TCM combined with CWM treatment effectively improves comprehensive clinical outcomes and diminishes TCM syndrome scores and BNP levels in HF patients.Given the low and medium quality of the included RCTs,the application of these results should be cautious.

Rheumatic valvular heart disease treated with traditional Chinese medicine:A case report

BACKGROUND Rheumatic heart disease(RHD)is an autoimmune disease that leads to irreversible valve damage and heart failure.Surgery is an effective treatment;however,it is invasive and carries risks,restricting its broad application.Therefore,it is essential to find alternative nonsurgical treatments for RHD.CASE SUMMARY A 57-year-old woman was assessed with cardiac color Doppler ultrasound,left heart function tests,and tissue Doppler imaging evaluation at Zhongshan Hospital of Fudan University.The results showed mild mitral valve stenosis with mild to moderate mitral and aortic regurgitation,confirming a diagnosis of rheumatic valve disease.After her symptoms became severe,with frequent ventricular tachycardia and supraventricular tachycardia>200 beats per minute,her physicians recommended surgery.During a 10-day preoperative waiting period,the patient asked to be treated with traditional Chinese medicine.After 1 week of this treatment,her symptoms improved significantly,including resolution of the ventricular tachycardia,and the surgery was postponed pending further follow-up.At 3-month follow-up,color Doppler ultrasound showed mild mitral valve stenosis with mild mitral and aortic regurgitation.Therefore,it was determined that no surgical treatment was required.CONCLUSION Traditional Chinese medicine treatment effectively relieves symptoms of RHD,particularly mitral valve stenosis and mitral and aortic regurgitation.

Meta-analysis of Traditional Chinese Medicine combined with Ivabradine in the Treatment of Chronic Heart Failure

Objective:To systemically evaluate clinical efficacy and safety of traditional Chinese medicine(TCM)combined with ivabradine(IVA)in the treatment of chronic heart failure(CHF).Method:We searched China National Knowledge Infrastructure(CNKI)datebase,Wanfang datebase,Chinese Scientifific Journal Database(VIP)datebase,PubMed,Conchrane Library and EMbase database to enroll the random control trials(RCTs)of TCM combined with IVA treating CHF.Meta-analysis was performed by Review Manager 5.3 software.Results:A total of 10 RCTs involving 960 patients were included.The results of Meta-analysis showed that compared with control group,the experimental group could improve the efficiency of cardiac function improvement[RR=1.19,95%CI(1.12,1.27),P<0.00001],increase left ventricular ejection fraction[MD=4.36,95%CI(2.88,5.83),P<0.0001]and reduce heart rate[MD=-8.21,95%CI(-12.08,-4.34),P<0.00001],the incidence of adverse reactions was similar between two groups[RR=1.00,95%CI(0.62,1.61),P=1.00].Conclusion:Traditional Chinese medicine combined with ivabradine has significant efficacy and good safety in improving cardiac function,improving left ventricular ejection fraction and reducing heart rate in the treatment of chronic heart failure.

Research progress of related signal pathways in the prevention and treatment of heart failure with traditional Chinese medicine

Heart failure(HF)is a kind of continuous development syndrome of cardiac insufficiency caused by various heart diseases.Not only does the prevalence continue to rise,but the mortality rate and readmission rate remain high.Heart failure is also the end-stage of cardiovascular disease and the main cause of death of patients,which seriously affects the health and quality of life of people all over the world.Ventricular remodeling plays a key role in the occurrence and development of heart failure.Therefore,by improving ventricular remodeling,it is of important research value to explore the intervention of traditional Chinese medicine in the development of heart failure.Studies have shown that the mediation of multiple signaling pathways can lead to progressive aggravation of ventricular remodeling,and experimental studies often confirm the therapeutic effects of traditional Chinese medicine.Traditional Chinese medicine usually achieves the therapeutic effect of heart failure through multiple targets and multiple approaches.In recent years,there have been more and more researches on the role and mechanism of Chinese medicine intervention in heart failure.However,it is concluded that Chinese medicine intervention has less influence on heart failure signal pathways.This article summarizes the understanding of Chinese medicine on heart failure and the five signal pathways related to Chinese medicine intervention in heart failure.The 5 signaling pathways in the world,namely transforming growth factor-β1(TGF-β1)/signal transduction protein(Smads)signaling pathway,Toll-like receptor(TLR)/nuclear transcription factor-κB(NF-κB)inflammation signaling pathway,Renin-angiotensinaldosterone(RAAS)system,phosphoinositide 3-kinase(PI3K)-serine/threonine protein kinase(AKT)signaling pathway and mitogen-activated protein kinase(MAPK)dependent signaling pathway.

Efficacy and safety of oral Chinese patent medicine combined with sacubitril/valsartan in the treatment of chronic heart failure:A Metaanalysis

Objective:To systematically evaluate the clinical efficacy of oral Chinese patent medicine combined with sacubitril/valsartan in treating chronic heart failure(CHF).Methods:CNKI,CSPD,CCD,CBM,PubMed,Web of Science,Cochrane Library and EMbase were retrieved to screen out randomized controlled trials Chinese patent medicine and Western medicine in treating CHF.Manual retrieval was also applied as a supplement.The Cochrane Reviewers Handbook 5.1.0 was used to evaluate the bias risk of the included studies and RevMan 5.4 software was used for Meta-analysis.Results:A total of 1301 patients enrolled in the 13 RCTs were included.According to the results of Meta-analysis,a combination of oral Chinese patent medicine and sacubitril/valsartan could further improve total effectiveness rate(RR=1.23,95%CI[1.16,1.30],P<0.001),increase 6 minutes’walk distance(MD=53.04,95%CI[33.43,72.64],P<0.001),improve left ventricular ejection fraction(MD=6.67,95%CI[5.15,8.19],P<0.001)and stroke volume(MD=7.56,95%CI[3.94,11.18],P<0.001),reduce left ventricular end-diastolic dimension(MD=-3.68,95%CI[-4.57,-2.78],P<0.001)and N terminal pro B type natriuretic peptide(MD=-434.08,95%CI[-518.95,-349.22],P<0.001)and no statistically significant difference in drug safety was found between the sacubitril/valsartan-only group and the combined treatment group(RR=0.73,95%CI[0.32,1.65],P=0.45).Conclusion:It’s indicated that a combination of traditional Chinese patent medicine and sacubitril/valsartan had a good clinical efficacy in the treatment of CHF,which had certain guiding significance for clinical practice.

Model informed precision medicine of Chinese herbal medicines formulas-A multi-scale mechanistic intelligent model

Recent trends suggest that Chinese herbal medicine formulas(CHM formulas)are promising treatments for complex diseases.To characterize the precise syndromes,precise diseases and precise targets of the precise targets between complex diseases and CHM formulas,we developed an artificial intelligence-based quantitative predictive algorithm(DeepTCM).DeepTCM has gone through multilevel model calibration and validation against a comprehensive set of herb and disease data so that it accurately captures the complex cellular signaling,molecular and theoretical levels of traditional Chinese medicine(TCM).As an example,our model simulated the optimal CHM formulas for the treatment of coronary heart disease(CHD)with depression,and through model sensitivity analysis,we calculated the balanced scoring of the formulas.Furthermore,we constructed a biological knowledge graph representing interactions by associating herb-target and gene-disease interactions.Finally,we experimentally confirmed the therapeutic effect and pharmacological mechanism of a novel model-predicted intervention in humans and mice.This novel multiscale model opened up a new avenue to combine“disease syndrome”and“macro micro”system modeling to facilitate translational research in CHM formulas.

The potential of herbal drugs to treat heart failure:The roles of Sirt1/AMPK

Heart failure(HF)is a highly morbid syndrome that seriously affects the physical and mental health of patients and generates an enormous socio-economic burden.In addition to cardiac myocyte oxidative stress and apoptosis,which are considered mechanisms for the development of HF,alterations in cardiac energy metabolism and pathological autophagy also contribute to cardiac abnormalities and ultimately HF.Silent information regulator 1(Sirt1)and adenosine monophosphate-activated protein kinase(AMPK)are nicotinamide adenine dinucleotide(NAD+)-dependent deacetylases and phosphorylated kinases,respectively.They play similar roles in regulating some pathological processes of the heart through regulating targets such as peroxisome proliferator-activated receptorγcoactivator 1α(PGC-1α),protein 38 mitogen-activated protein kinase(p38 MAPK),peroxisome proliferator-activated receptors(PPARs),and mammalian target of rapamycin(mTOR).We summarized the synergistic effects of Sirt1 and AMPK in the heart,and listed the traditional Chinese medicine(TCM)that exhibit cardioprotective properties by modulating the Sirt1/AMPK pathway,to provide a basis for the development of Sirt1/AMPK activators or inhibitors for the treatment of HF and other cardiovascular diseases(CVDs).

Network pharmacology-based exploration of molecular mechanisms underlying therapeutic effects of Jianpi Huatan Quyu recipe on chronic heart failure with spleen Qi deficiency syndrome

BACKGROUND Chronic heart failure is a complex clinical syndrome.The Chinese herbal compound preparation Jianpi Huatan Quyu recipe has been used to treat chronic heart failure;however,the underlying molecular mechanism is still not clear.AIM To identify the effective active ingredients of Jianpi Huatan Quyu recipe and explore its molecular mechanism in the treatment of chronic heart failure.METHODS The effective active ingredients of eight herbs composing Jianpi Huatan Quyu recipe were identified using the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform.The target genes of chronic heart failure were searched in the Genecards database.The target proteins of active ingredients were mapped to chronic heart failure target genes to obtain the common drugdisease targets,which were then used to construct a key chemical componenttarget network using Cytoscape 3.7.2 software.The protein-protein interaction network was constructed using the String database.Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed through the Metascape database.Finally,our previously published relevant articles were searched to verify the results obtained via network pharmacology.RESULTS A total of 227 effective active ingredients for Jianpi Huatan Quyu recipe were identified,of which quercetin,kaempferol,7-methoxy-2-methyl isoflavone,formononetin,and isorhamnetin may be key active ingredients and involved in the therapeutic effects of TCM by acting on STAT3,MAPK3,AKT1,JUN,MAPK1,TP53,TNF,HSP90AA1,p65,MAPK8,MAPK14,IL6,EGFR,EDN1,FOS,and other proteins.The pathways identified by KEGG enrichment analysis include pathways in cancer,IL-17 signaling pathway,PI3K-Akt signaling pathway,HIF-1 signaling pathway,calcium signaling pathway,cAMP signaling pathway,NF-kappaB signaling pathway,AMPK signaling pathway,etc.Previous studies on Jianpi Huatan Quyu recipe suggested that this Chinese compound preparation can regulate the TNF-α,IL-6,MAPK,cAMP,and AMPK pathways to affect the mitochondrial structure of myocardial cells,oxidative stress,and energy metabolism,thus achieving the therapeutic effects on chronic heart failure.CONCLUSION The Chinese medicine compound preparation Jianpi Huatan Quyu recipe exerts therapeutic effects on chronic heart failure possibly by influencing the mitochondrial structure of cardiomyocytes,oxidative stress,energy metabolism,and other processes.Future studies are warranted to investigate the role of the IL-17 signaling pathway,PI3K-Akt signaling pathway,HIF-1 signaling pathway,and other pathways in mediating the therapeutic effects of Jianpi Huatan Quyu recipe on chronic heart failure.

Treatment of Coronary Heart Disease from the Perspective of Liver Controlling Dispersion

The liver is in charge of distributing and regulating the movement of qi throughout the whole body,coordinating the transportation and transformation of the internal organs in the middle part of the body,promoting the biochemical circulation of qi,blood,and body fluids,and regulating emotions.Liver dysfunction can disrupt the transportation and transformation of qi,blood,and body fluids,causing phlegm turbidity,blood stasis,and other unwanted symptoms.Poor regulation of emotion further aggravates the accumulation of pathological substances,resulting in the obstruction of heart vessels,and ultimately coronary heart disease(CHD).Through regulating lipid metabolism,inflammatory reaction,vasoactive substances,platelet function,neuroendocrine,and other factors,liver controlling dispersing qi plays a comprehensive role in the prognosis of atherosclerosis,the primary cause of CHD.Therefore,it is recommended to treat CHD from the perspective of liver-controlling dispersion.

Assessing inflammation in Chinese subjects with subtypes of heart failure: an observational study of the Chinese PLA Hospital Heart Failure Registry

Background Inflammation is an important element of the pathophysiological process of heart failure (HF) and is correlated with subtypes of HF. The association between multiple biomarkers of inflammation and HF subtypes in Chinese subjects remains unclear. This study aimed to compare the differences in inflammation biomarkers among Chinese patients with different subtypes of HF who have been identified to date. Methods We included 413 consecutive patients with HF,including 262 with preserved ejection fraction (HFpEF),55 with middle-ranged ejection fraction (HFmrEF) and 96 with reduced ejection fraction (HFrEF). Ten inflammation biomarkers were analyzed and compared according to the HF subtypes. One hundred contemporary non-HF subjects were also recruited as the control group. Moreover,the correlations between the inflammatory biomarkers and left ventricular ejection fraction of the HF subtypes were assessed. Results The mean age of the HF patients was 65.0 ± 12.0 years,65.8% were male. Distinct subtypes of HF demonstrated different inflammation biomarker panels. IL-6,PTX-3,ANGPTL-4 and TNF-α were correlated with HFrEF;IL-1β and PTX-3 were correlated with HFmrEF;and IL-1β and IL-6 were correlated with HFpEF. The multivariable logistic regression showed that IL-1β[relative ratio (RR)= 1.08,95% CI: 1.02–1.15,P = 0.010],IL-6 (RR = 1.03,95% CI: 1.01–1.06,P = 0.016),PTX-3 (RR = 1.31,95% CI: 1.11–1.55,P = 0.001),and ANGPTL-4 (RR = 1.05,95% CI: 1.02–1.07,P < 0.001) were independently associated with HF,while IL-6 (RR = 1.03,95% CI: 1.01–1.04,P = 0.019),PTX-3 (RR = 1.23,95% CI: 1.06–1.43,P = 0.007),and ANGPTL-4 (RR = 1.03,95% CI: 1.01–1.06,P = 0.005) were independently associated with the HF subtype. Conclusions Diverse inflammation biomarkers have multifaceted presentations according to the subtype of HF,which may illustrate the diverse mechanisms of inflammation in Chinese HF patients. IL-6,PTX-3,and ANGPTL-4 were independent inflammation factors associated with HFrEF and HF.

Use of Traditional Chinese Medicine in Chinese Patients with Coronary Heart Disease

Objective To study the use of traditional Chinese medicine （TCM） or both TCM and guideline-recommended Western medicine （WM） in Chinese patients with coronary heart disease （CHD）. Methods A cross-sectional nationwide survey of 2803 CHD outpatients was completed by collecting information, including general demographic data, disease history, and use of drugs （including TCM and WM）. Results Of the 2712 CHD outpatients with complete drug treatment data, only 3.1% received TCM without any WM for CHD, 30.0% received both TCM and WM recommended by current CHD guidelines, and 66.9% received only WM. Patients with a longer history of CHD or with a history of stroke, were more likely to use TCM. However, 90.6% of CHD patients who used TCM also used certain WM. Furthermore, patients who used more types of TCM tended to use much less WM recommended by current guidelines. Conclusion A substantial proportion of Chinese CHD outpatients use both TCM and WM for secondary prevention of CHD. It is important to assess the effect of combined TCM and WM on major clinical outcomes in Chinese CHD patients.

Effects of SNPs at Newly Identified Lipids Loci on Blood Lipid Levels and Risk of Coronary Heart Disease in Chinese Han Population:A Case Control Study

Associations between ＂lipid-related＂ candidate genes,blood lipid concentrations and coronary artery disease（CHD） risk are not clear.We aimed to investigate the effect of three newly identified lipids loci from genome-wide association studies on CHD and blood lipid levels in Chinese Han population.The genotypes of SNPs at three newly identified lipid loci and blood lipids concentrations were examined in 1360 CHD patients and 1360 age-and sex-frequency matched controls from an unrelated Chinese Han population.Allele T of rs16996148 occurred less frequently in CHD patients with the odds ratio（OR） being 0.64（95% CI 0.50 to 0.81）,after adjusting for conventional risk factors and was associated with a 33% decreased CHD risk（P0.01） comparing with the major allele G.Individuals with GT genotype had the lowest CHD risk.No associations were found between the polymorphisms of other two loci with CHD risk and all three SNPs had no effect on lipid profile in this population.SNP rs16996148 on chromosome 19p13 is significantly associated with lower risk for CHD in Chinese Han population.However,it remains unresolved why these lipid-related loci had significantly less effects than the correspondingly expected effects on blood lipids levels in this population.

Validation of Veterans Specific Activity Questionnaire to assess exercise tolerance of Chinese elderly with coronary heart disease

Objective The Veterans Specific Activity Questionnaire （VSAQ） has been used to assess exercise tolerance. Nevertheless, there is no val- idated Chinese version. The aim of this study is to determine whether a questionnaire-based method using the Chinese version of VSAQ （the modified VSAQ） is a practical tool to assess exercise tolerance of Chinese elderly with coronary heart disease. Methods One hundred thirty consecutive elderly patients who were diagnosed with coronary heart disease （CHD） （mean age 68.9 -4- 6.0 years） referred for treadmill exercise testing （TET） for clinical reasons were included in the study. They were asked to complete a questionnaire for clinical characteristics information on age, sex, history, exercise habits, medications, the original VSAQ and the modified VSAQ. We investigated the relationship between exer- cise tolerance in metabolic equivalents （METs） estimated by VSAQ and that obtained by TET. Results The METs by the original VSAQ and the modified VSAQ did not difference significantly （P = 0.528）. The modified VSAQ scores were significantly correlated with the METs oh- mined by TET （r = 0.819, 95% CI： 0.7534）.873, P 〈 0.01）, and the scores of original VSAQ also correlated with the METs by TET （r = 0.804, 95% CI： 0.7454）.854, P 〈 0.01）. The Bland-Altman graph analysis showed few values outside the limits of agrcement, suggesting good precision between the METs estimated by questionnaire and the METs obtained by TET. Conclusions The Chinese version of the VSAQ confirmed its validity and equivalence to the original version, especially when evaluating individuals with coronary heart disease and older adults. The results showed that the VSAQ is a valuable tool to assess the exercise tolerance.

Optimization of evidence-based research in the prevention and treatment of coronary heart disease with traditional Chinese medicine:A comprehensive review

Coronary heart disease(CHD) has severely impacted the lives and health of patients for ages. Although the modern methods used for the prevention and treatment of CHD have been increasingly perfected,clinical problems remain that require solutions. In the prevention and treatment of CHD with traditional Chinese medicine(TCM), great therapeutic advantages have been demonstrated. However, the expression of its advantages relies on scientific evidence-based research and evaluation, which require further optimization and improvement. Therefore, this review aims to comprehensively emphasize our understanding of the current deficiencies in TCM evidence-based studies and the necessity of adopting scientific evidence-based optimization methods for use in research. In this process, evidence should be produced in a standard manner, and the advantages of TCM patterns should be accurately stated because these factors contribute to efficient transformation and proper verification of the obtained evidence.Additionally, focusing on patient-oriented medicine and doctor-patient relationships is also essential.These methods are of great significance to prove the clinical efficacy of TCM and promote its development.

Clinical evidence of traditional Chinese medicine for the prevention and treatment of chronic heart failure

Objective: To summarize clinical evidence of traditional Chinese medicine for the prevention and treatment of chronic heart failure systematically and comprehensively. Method:By retrieving in the database of VIP, WanFang, CNKI, PubMed, Cochrane Library, the qualifying results obtained in the databases above are summarized into the grading evidence including systematic reviews, randomized controlled trials, observational studies, case studies, basic research these five levels. Results: The numbers of the articles included are 12 systematic reviews, 413 randomized controlled trials, 68 observational studies, 15 case reports and 187 fundamental researches. Conclusion: It is concluded that basing on the clinical evidence of different levels, traditional Chinese medicine has prominent ability of preventing and treatment chronic heart failure.

Plasma metabolomics combined with personalized diagnosis guided by Chinese medicine reveals subtypes of chronic heart failure

Background:Chronic heart failure(CHF)is characterized by insufficient blood supply from heart to meet the body’s metabolic demands.Integrating Western and traditional Chinese medicine to treat CHF has proved a validated therapeutic approach.In recent years,metabolomics has been regarded as a potential platform to provide biomarkers for diseasesubtypes.Objective:To examine 38 patients,combined NMR plasma metabolomics and traditional Chinese medicine diagnosis in order to identify diagnostic biomarkers for two CHF syndrome subtypes.Methods:After processing the spectra,orthogonal partial least square discriminant analysis was performed,and the contributing NMR signals were analyzed using Y-scrambling statistical validation with good reliability.Results:Plasma metabolic patterns of yin deficiency and yang deficiency patients were clearly discriminated.The yin-deficiency group had increased level of lactate,glycoprotein,lipoprotein and lower levels of glucose,valine and proline.The yang-deficiency group had higher levels of lactate,glycoprotein and pyruvic acid,and lower levels of glucose and lipoprotein.Potential biomarkers of CHF based on the two traditional Chinese medicine syndromes indicated alternative modes of metabolites and metabolic pathways in the disease,e.g.dysfunction of energy utilization and disturbance in fatty acids,amino acids.Conclusion:This study suggests that combining metabolomics with traditional Chinese medicine diagnosis can reveal metabolic signatures for CHF syndrome subtypes.The plasma metabolites identified might be of special clinical relevance for subtypes of CHF,which could lead to further understanding of mechanisms involved and an improvement in personalized treatment for CHF.

Chinese herbal medicine for chronic heart failure:a multicenter,randomized,double-blind,placebo-controlled trial

Objective:The purpose of this study was to assess the efficacy and safety of Chinese herbal medicine(CHM)in the treatment of chronic heart failure(CHF)patients according to syndrome differentiation.Methods:In this multicenter,randomized,double-blind,placebo-controlled clinical trial,a total of 220 CHF patients were assigned to receive CHM or placebo granules without decoction according to syndrome differentiation in addition to their standard western treatment for 4 weeks.The change in the left ventricular ejection fraction(LVEF)was the primary outcome,and the changes in the TCM syndrome scores(TCM-SS)and New York Heart Association functional classification(NYHA-FC)were the secondary outcomes.

Self-care among older Chinese people with chronic heart failure： the roles of cognitive and psychosocial characteristics

Chronic heart failure （CHF） is a complex clinical syndrome resulting from inefficient myocardial pumping, and is characterised by a typical progressively deteriorating trajectory punctuated by serious episodes of acute disease decompensation.High prevalence of hospital admission has been reported.[2] However, around 40% of hospital admissions was avoidable if patients demonstrate consistent self-care.

Efficacy and safety of traditional Chinese medicine in the treatment of coronary heart disease complicated with anxiety and/or depression after PCI:A systematic review and meta-analysis

Objective:The clinical efficacy and safety of traditional Chinese medicine in the treatment of anxiety and/or depression after PCI for coronary heart disease were systematically evaluated.Methods:The databases of CNKI,Wanfang,VIP,CMB,PubMed,Web of Science,PubMed,Web of Science and Cochrane Library were searched by computer,and the Chinese and English randomized controlled trials(RCTs)of traditional Chinese medicine in the treatment of anxiety and/or depression after PCI of coronary heart disease published from the database to November 2020 were included.The Cochrane bias risk tool and the modified Jadad scale were used to evaluate the quality of the included literature,and the RevMan 5.3 and Stata 16.0 software were used for Meta-analysis.Results:A total of 23 RCTs were included,including 1837 subjects,including 917 cases in the treatment group of traditional Chinese medicine,920 cases in the control group,the baseline situation between groups was consistent,comparable.Meta-analysis results show that TCM treatment improves the total clinical effective rate[OR=2.34,95%CI(1.61,3.40),P<0.00001],and the efficacy of TCM syndrome[OR=5.19,95%CI(2.74,9.86),P<0.00001],reduce Hamilton anxiety scale HAMA score[SMD=-0.96,95%CI(-1.78,-0.14),P=0.02],Hamilton Depression Scale HAMD score[SMD=-1.10,95%CI(-1.79,-0.41),P=0.002],SAS self-rating scale score[SMD=-1.20,95%CI(-1.75,-0.65),P<0.0001],SDS self-rating scale score[SMD=-1.14,95%CI(-1.62,-0.65),P<0.00001]and other indicators are better than the control group,and the difference is statistically significant(P<0.05).Conclusion:The combination of traditional Chinese medicine intervention and conventional western medicine treatment after PCI can further improve the clinical efficacy of patients with anxiety and/or depression after PCI of coronary heart disease and has good safety.Due to the general quality of the literature included in this study,the above conclusions need to be further confirmed by high-quality randomized controlled double-blind clinical trials.

Network Pharmacology-based Analysis on the Molecular Biological Mechanisms of Xin Hui Tong Formula in Coronary Heart Disease Treatment

Objective To investigate the potential molecular mechanism of Xin Hui Tong Formula (XHTF) in the treatment of coronary heart disease (CHD) by using network pharmacology and bioinformatics. Methods The targets network of CHD was constructed through Therapeutic Targets Database (TTD) and Drugbank database;The XHTF pharmacodynamic molecule-targets network and the XHTF pharmacodynamic molecule-CHD targets network were explored by the traditional Chinese medicine systems pharmacology database and analysis platform (TCMSP). And the multi-targets mechanism and molecular regulation network of XHTF in the treatment of CHD were explored from multiple perspectives by Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) database pathway enrichment analysis. Results A total of 88 CHD targets were screened out through the Therapeutic Targets and the Drugbank database. 393 compounds and corresponding 205 drug targets of XHTF were retrieved from TCMSP. A total of 13 known targets directly related to the development of CHD were retrieved from the disease-related databases: TP53, MAPK14, NFKB1, HSPA5, PLG, PTGS2, ADRB1, NOS2, CYP3A4, GRIA2, CYP2A6, GRIA1, PTGS1. XHTF also contained 118 drug targets that directly interact with CHD targets. GO enrichment analysis showed that the biological processes of 13 direct targets proteins were found to be mainly enriched in response to drug, cellular response to biotic stimulus, long-chain fatty acid metabolic process, fatty acid metabolic process and regulation of blood pressure. KEGG pathway enrichment analysis found that XHTF participated in the CHD pathological process mainly through retrograde endocannabinoid signaling, regulation of lipolysis in adipocytes, cAMP signaling pathway, chemical carcinogenesis and other pathways. Conclusions XHTF plays a role in the treatment of CHD through multiple targets and multiple pathways, and provides a scientific basis for the theory of "virtual standard" in the treatment of CHD.