Some traditional Chinese medicine may provide benefits in cardiovascular conditions

Some traditional Chinese medications might be used as a complementary and alternative approach for primary and secondary prevention of cardiovascular disease, but further long-term study is needed.

Traditional Chinese medicine might be effective as a complement or alternative to traditional Western medicine for primary and secondary prevention of heart disease, according to a review.

Researchers reviewed randomized controlled trials from the past 10 years that assessed the efficacy or safety of traditional Chinese medicine for patients with hypertension, dyslipidemia, diabetes/prediabetes, atherosclerotic cardiovascular disease, or chronic heart failure.

The review was published by the Journal of the American College of Cardiology on June 12.

For essential hypertension, eight randomized controlled trials were included. The sample sizes ranged from 102 to 480 participants, and mean follow-up ranged from 4 to 52 weeks. The methodological quality of the included studies was, in general, high. According to the review, herbs that have been found to be effective in lowering blood pressure include Ramulus Uncariae cum Uncis, milkvetch root, Achyranthes bidentata Bl., Ligusticum wallichii, tall gastrodia tuber, Radix Rehmanniae, and glossy privet fruit.

In the six eligible randomized controlled trials that examined dyslipidemia, several formulations were compared with placebo: Xiaoyujiangzhi capsule, Propolis and ginkgo extract, glossy ganoderma and sea cucumber extract, Jiangzhitongluo capsule, and Salvia miltiorrhiza and Pueraria lobata capsule. Zhibitai capsule was compared with atorvastatin. The sample sizes ranged from 106 to 288 patients, and the mean follow-up duration was 6 to 52 weeks. The methodological quality of the included studies was, in general, low. In one trial of 138 patients randomized to Jiangzhitongluo or placebo in addition to atorvastatin, eight weeks of Jiangzhitongluo treatment significantly lowered serum triglyceride levels (P<0.05) but did not change serum levels of total cholesterol or low- or high-density lipoprotein cholesterol (all P>0.05) compared with placebo.

Traditional Chinese medicine treatment was compared with placebo in seven randomized controlled trials and with Western medications in three randomized controlled trials. The sample sizes ranged from 108 to 800 patients, and mean follow-up ranged from 4 to 78 weeks. The review authors found data to suggest that some traditional compounds such as Xiaoke, Tangminling, Jinlida, and Jianyutangkang have a potent therapeutic effect on glycemic control and/or beta-cell function in patients with type 2 diabetes and that some others, such as Tangzhiping and Tianqi, might prevent the progression of prediabetes to diabetes.

For atherosclerotic cardiovascular disease, 13 randomized controlled trials were included, with sample sizes ranging from 100 to 4,870 patients and follow-up ranging from 4 weeks to 4.5 years. Red sage root, Ligusticum wallichii, safflower, and curcuma root were found to be effective in improving angina symptoms and clinical outcomes, according to the review authors. They concluded that treatment with some traditional compounds might be effective in alleviating angina symptoms, myocardial perfusion abnormalities, or neurological deficit in patients with coronary artery disease or ischemic stroke, and Xuezhikang might reduce cardiovascular events in patients after myocardial infarction.

Nine randomized controlled trials enrolled 100 to 512 patients with heart failure and had mean follow-up ranging from 4 to 52 weeks. Compounds included the Qiliqiangxin capsule, Nuanxin capsule, Shencaotongmai granule, and Yangxinkang tablet, which were proven efficacious in improving hard and/or surrogate endpoints, the authors wrote. Medications such as Qiliqiangxin, Nuanxin, Shencaotongmai, and Yangxinkang might be effective in improving cardiac remodeling and function in patients with chronic heart failure and had a good safety profile, the authors noted.

For each disease state, the authors stressed that long-term positive cardiovascular outcomes would have to be determined by long-term trials. In addition, they pointed out that traditional Chinese medicine medications are usually prescribed as complex formulae that are often further manipulated by the practitioner.

“The pharmacological effects and the underlying mechanisms of some active ingredients of TCM [traditional Chinese medicine] medications have been elucidated,” they wrote. “Thus, some TCM medications might be used as a complementary and alternative approach for primary and secondary prevention of cardiovascular disease.”