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      Traditional Chinese Medicine Is Widely Used for Cardiovascular Disease

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            Abstract

            A review article by Hao et al. (J Am Coll Cardiol 2017;69(24):2952–66) has had huge repercussions among those familiar with traditional Chinese medicine (TCM) in the international academic community. It evaluated the efficacy and safety of TCM for cardiovascular disease and the pharmacological effect of active TCM ingredients on the cardiovascular system and potential mechanisms. We have several comments: Firstly, we give a brief summary addressing nonpharmacotherapy in TCM, including acupuncture, moxibustion, Qigong, and Tai Chi. Secondly, we have added traditional antiarrhythmic drug–related randomized controlled trials to make the coverage more comprehensive. Lastly, we support the concept that research into, development of, and application of active ingredients is part of modern TCM.

            Main article text

            A review article by Hao et al. [1] has attracted great attention among those familiar with traditional Chinese medicine (TCM) owing to a clinical evidence–based approach to this topic. It systematically and elegantly evaluated the efficacy and safety of TCM for cardiovascular disease, as well as the pharmacological effects and potential mechanisms of active TCM ingredients on the cardiovascular system [1]. We sincerely congratulate the authors since the article has had huge repercussions in the international academic community, and it will promote the application of TCM to the world. Meanwhile, we believe this article could have been more comprehensive if the following points had been addressed.

            Firstly, there is no summary of nonpharmacotherapy in TCM, including acupuncture, moxibustion, Qigong, and Tai Chi. Recently, for instance, several large-scale randomized controlled trials (RCTs) of acupuncture proved its clinical effect on migraine [2], constipation [3], polycystic ovary syndrome [4], and urinary incontinence [5]. In the cardiovascular field, acupuncture has shown its efficacy and safety in the treatment of heart failure, hyperlipidemia, and hypertension [610]. We performed a meta-analysis to evaluate acupuncture for the treatment of arrhythmia compared with existing antiarrhythmic drugs [9]. In 13 trials with 797 patients enrolled, acupuncture, with or without use of an antiarrhythmic drug, displayed a clear benefit in treating ventricular premature beat and sinus tachycardia.

            Secondly, arrhythmia-related RCTs were not included. In cardiac electrophysiology, several herbal components, such as Shenmai, acacetin, Shensong Yanxin, and Wenxin Keli, have been proposed as antiarrhythmic drugs. Similar to amiodarone, the latter two have been verified to have effects on multiple ion channels and to modulate cardiac autonomic nervous function. In 49 RCTs with 4610 patients enrolled, Wenxin Keli was shown to be more effective than other available treatments of arrhythmia, angina, and heart failure [10]. We selected Wenxin Keli for the treatment of ventricular premature beats. The characteristics of RCTs of Wenxin Keli are shown in Table 1 [1119]. Shensong Yanxin is another well-known compound, first described in the 16th century, and recommended by two Chinese experts’ consensuses [20, 21]. In a meta-analysis of 22 trials involving 2347 paroxysmal atrial fibrillation patients, it appeared to be beneficial [22]. Another study showed that in 465 study participants, Shensong Yanxin had the benefits of ventricular premature beat suppression and cardiac function improvement with good adherence on a background of standard treatment for heart failure [23]. Shensong Yanxin also significantly increased the heart rate in patients with bradycardia without severe side effects [24].

            Table 1

            Characteristics of Randomized Controlled Trials of Wenxin Keli for Treatment of Ventricular Premature Beats (VBP).

            StudySample sizeIntervention
            Course (weeks)Outcome measureMain result
            Experimental groupControl group
            Yu [11]44/40Wenxin Keli 9 g, tidMexiletine 150 mg, tid4VPBThe total effective rate in the experimental group for VPB was greater than that in the control group
            Yang et al. [12]30/30Wenxin Keli 9 g
            +amiodarone 0.2 g, tid
            Amiodarone 0.2 g, tid4VPBThe clinical efficacy of the combination of Wenxin Keli and amiodarone for the treatment of VPB in coronary heart disease was greater than that of amiodarone alone
            Zhang et al. [13]60/30Wenxin Keli 9 g, tidPropafenone 100 mg, tid4VPBThere was no significant difference in the total effective rate for Wenxin Keli in elderly patients with or without cardiovascular disease on 24 h ECG for VPB
            Sun and Zhang [14]126/83Wenxin Keli 9–18 g, tidPropafenone 100 mg, tid4VPBThe relief of clinical symptoms in the experimental group was obviously greater than that in the control group. There was no significant difference in improvement in the two groups on 24 h ECG for VPB
            Jiang et al. [15]66/65Wenxin Keli 9 g, tidMetoprolol 12.5–25 mg, bid4VPBThe effect of Wenxin Keli was similar to that of metoprolol in treating VPB, but Wenxin Keli had a greater effect in relieving clinical symptoms than metoprolol. The incidence of adverse reactions was lower than with metoprolol
            He [16]41/40Wenxin Keli 9 g, tidMetoprolol 25 mg, bid4VPBThe effect of Wenxin Keli was similar to that of metoprolol in the treatment of senile VPB, but the effect of Wenxin Keli in relieving conscious symptoms was more obvious
            Lu et al. [17]42/44Wenxin Keli 5 g, tidPlacebo 5 g, tid2VPBThe effective rate in the experimental group for VPB was greater than that in the control group
            Liang and Wang [18]90/90Wenxin Keli 9 g
            +amiodarone 0.2 g, tid
            Amiodarone 0.2 g, tid4VPBThe clinical effect in the experimental group for VPB was greater than that in the control group
            Hua et al. [19]565/552Wenxin Keli 9 g, tidPlacebo 9 g, tid4VPBThe experimental group demonstrated a significantly greater reduction in the frequency of VBP than the control group

            In addition, it is controversial that the active ingredients of TCM have been confined to TCM in recent decades. Many people believe that TCM should contain only Chinese herbal compounds and should be guided by the theory of syndrome differentiation, since TCM is usually prescribed as a complex formula by the practitioner on a personalized basis. With the development of modern biomedical technology, the pharmacological effects and the underlying mechanisms of some active ingredients of TCM have been elucidated or assessed. For instance, after reviewing 19 natural drug therapies for antiarrhythmic effects, we summarized 18 active ingredient therapies, such as alkaloids, flavonoids, saponins, quinones, and terpenes [25]. This gives us new concepts and challenges in the use of natural drug agents. Thus we support the view that the active ingredients of TCM are an intrinsic part of TCM, which will help to enrich and develop the practice of TCM in the future [1].

            Conflict of Interest

            The authors declare that they have no conflicts of interest.

            References

            1. HaoP, JiangF, ChengJ, MaL, ZhangY, ZhaoY. Traditional Chinese medicine for cardiovascular disease: evidence and potential mechanisms. J Am Coll Cardiol 2017;69(24):295266.

            2. ZhaoL, ChenJ, LiY, SunX, ChangX, ZhengH, et al. The long-term effect of acupuncture for migraine prophylaxis: a randomized clinical trial. JAMA Intern Med 2017;177(4):50815.

            3. LiuZ, YanS, WuJ, HeL, LiN, DongG, et al. Acupuncture for chronic severe functional constipation: a randomized trial. Ann Intern Med 2016;165(11):7619.

            4. WuXK, Stener-VictorinE, KuangHY, MaHL, GaoJS, XieLZ, et al. Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome: a randomized clinical trial. JAMA 2017;317(24):250214.

            5. LiuZ, LiuY, XuH, HeL, ChenY, FuL, et al. Effect of electroacupuncture on urinary leakage among women with stress urinary incontinence: a randomized clinical trial. JAMA 2017;317(24):2493501.

            6. NiYM, FrishmanWH. Acupuncture and cardiovascular disease: focus on heart failure. Cardiol Rev 2018;26(2):938.

            7. YuanM, LiuZ, XuB, LuS. Effects of acupuncture on 1528 patients with obesity complicated with hyperlipidemia in different obesity levels. Zhongguo Zhen Jiu 2016;36(8):80711.

            8. TerentevaN, ChernykhO, Sanchez-GonzalezMA, WongA. Acupuncture therapy improves vascular hemodynamics and stiffness in middle-age hypertensive individuals. Complement Ther Clin Pract 2018;30:148.

            9. LiY, Barajas-MartinezH, LiB, GaoY, ZhangZ, ShangH, et al. Comparative effectiveness of acupuncture and antiarrhythmic drugs for the prevention of cardiac arrhythmias: a systematic review and meta-analysis of randomized controlled trials. Front Physiol 2017;8:358.

            10. WangX, WangY, FengXi, LuY, ZhangY, WangW, et al. Systematic review and meta-analysis of randomized controlled trials on Wenxin Keli. Drug Des Devel Ther 2016;10:372536.

            11. YuSY. Clinical efficacy of Wenxin Keli on premature beats. Chin J Clin 2004;32(6):62.

            12. YangJ, HeJS, YangXY. Clinical observation of Wenxin Keli plus amiodarone combination therapy on coronary heart disease complicated by ventricular premature beats. J Guangxi Tradit Chin Med Univ 2005;8(3):1820.

            13. ZhangXJ, GeN, HuangXL, WuJH, ZhangYL, WangS, et al. The effect of Wenxin Keli on arrhythmia of cardiovascular disease in elderly. West China Med J 2005;20(4):2634.

            14. SunG, ZhangB. Clinical observation of Wenxin Keli in treating 126 cases with ventricular premature beats. Chin J Basic Med Tradit Chin Med 2005;11(10):7934.

            15. JiangQL, YangCL, WeiX, LuX, WuQA. A comparison of Wenxin Keli tometoprolol in treatment of ventricular premature beats. Pract Clin J Integr Tradit Chin West Med 2007;7(4):123.

            16. HeCF. A comparison of Wenxin Keli to metoprolol in treatment of symptoms of ventricular premature beats. Chin J Integr Med CardioCerebrovasc Dis 2008;6(1):989.

            17. LuZH, WuXB, LiuL, LiXP, QiuXL, LinYZ, et al. The effect of Wenxin Keli on acute coronary syndrome complicated by arrhythmias: a multi-center clinical trial. J Clin Med Pract 2010;14(1):5962.

            18. LiangT, WangXM. Clinical observation of Wenxin Keli in treating 90 cases with ventricular premature beats. Guangxi Med J 2013;34(6):7956.

            19. HuaW, GaoRL, ZhaoBC, WangJ, ChenXH, CaiC, et al. The efficacy and safety of Wenxin Keli in patients with frequent premature ventricular contractions: a randomized, double-blind, placebo-controlled, parallel-group, multicenter trial. Chin Med J 2015;128(19):255764.

            20. CaoKJ, ChenKP, ChenML, DongJZ, HuaW, HuangCX, et al. Current knowledge and management recommendations of atrial fibrillation – 2015. Chin J Card Arrhythm 2015;19(5):32184.

            21. ChaoKJ, ChenML, JiangML, JiangH, YaoY, WangZL, et al. Chinese expert consensus on ventricular arrhythmias. Chin J Card Arrhythm 2016;20(4):279326.

            22. ChenG, WeiB, WangJ, FengB, LiZ, ZhangZ, et al. Shensong yangxin capsules for paroxysmal atrial fibrillation: a systematic review of randomized clinical trials. PLoS One 2016;11(3):e0151880.

            23. WangX, HuD, DangS, HuangH, HuangCX, YuanMJ, et al. Effects of traditional Chinese medicine Shensong Yangxin capsules on heart rhythm and function in congestive heart failure patients with frequent ventricular premature complexes: a randomized, double-blind, multicenter clinical trial. Chin Med J (Engl) 2017;130(14):163947.

            24. LiuY, LiN, JiaZ, LuF, PuJ. Chinese medicine shensongyangxin is effective for patients with bradycardia: results of a randomized, double-blind, placebo-controlled multicenter trial. Evid Based Complementary Altern Med 2014;2014:605714.

            25. LiJ, HuD, SongX, HanT, GaoY, XingY. The role of biologically active ingredients from natural drug treatments for arrhythmias in different mechanisms. Biomed Res Int 2017;2017:4615727.

            Author and article information

            Journal
            CVIA
            Cardiovascular Innovations and Applications
            CVIA
            Compuscript (Ireland )
            2009-8782
            2009-8618
            May 2018
            May 2018
            : 3
            : 1
            : 123-126
            Affiliations
            [1] 1Guang’ Anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100053, China
            [2] 2Global Genetics Corporation, Ventura, CA 93003, USA
            [3] 3Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan 430060, China
            [4] 4Hubei Key Laboratory of Cardiology, Wuhan 430060, China
            Author notes
            Correspondence: Dan Hu, MD, PhD, Professor, FAHA, FACC, FHRS, FAPHRS, Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan 430060, China, Tel.: +86-27-88041911, Fax: +86-27-88042293, E-mail: hudan0716@ 123456hotmail.com
            Article
            cvia20170054
            10.15212/CVIA.2017.0054
            60bb38a8-d81b-4f4f-899a-f19604046c2b
            Copyright © 2018 Cardiovascular Innovations and Applications

            This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

            History
            : 15 January 2018
            : 31 March 2018
            : 17 April 2018
            Categories
            Letter to the Editor

            General medicine,Medicine,Geriatric medicine,Transplantation,Cardiovascular Medicine,Anesthesiology & Pain management
            traditional Chinese medicine,cardiovascular disease,arrhythmia-related randomized controlled trials,wide use,nonpharmacotherapy

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