Sodium Tanshinone II A Sulfonate Injection as Adjuvant Treatment for Unstable Angina Pectoris: A Meta-Analysis of 17 Randomized Controlled Trials.

OBJECTIVE: To systematically evaluate the effectiveness and safety of Sodium Tanshinone II A Sulfonate Injection (STS) as one adjuvant therapy for treating unstable angina pectoris (UAP). METHODS: Randomized controlled trials (RCTs) of UAP treated by STS were searched in the China National Knowledge Infrastructure Database (CNKI), VIP Database for Chinese Technical Periodicals (VIP), Wanfang Database, the Chinese Biomedical Literature Database (CBM), Web of Science, the Cochrane Library, Embase, and PubMed, which from inception to January, 2016. The Cochrane Risk Assessment Tool was used to evaluate the methodological quality of the RCTs. The Review Manager 5.3 software was used to conduct the metaanalysis. RESULTS: The results showed that 17 RCTs involving 1,372 patients were included. The meta-analysis indicated that the combined use of STS and Western medicine (WM) in the treatment of UAP can obviously improve the total effective rate [risk ratio (RR)=1.31, 95% confidence interval (CI) (1.24,1.39), P<0.0001], and the total effective rate of electrocardiogram [RR=1.43, 95% CI (1.30,1.56), P<0.0001], decrease the level of CRP [mean difference (MD)=-3.06, 95%CI (-3.85,-2.27), P<0.00001], fibrinogen [MD=-1.03, 95% CI (-1.16,-0.89), P<0.00001], and whole blood high shear viscosity [MD=-0.70, 95% CI (-0.92,-0.49), P<0.00001]. Additionally, the occurrence of adverse drug reaction of the experimental group was significantly higher than that of the control group [RR=3.57, 95% CI (1.28, 9.94), P<0.05]. CONCLUSIONS: Compared with WM, the combined use of STS was more effective.

Biomarkers of unstable angina pectoris and yangxin decoction intervention: An exploratory metabonomics study of blood plasma.

BACKGROUND: This study aimed to explore the related metabolic biomarkers and to observe the effects of Yangxin Decoction (YXD) on plasma metabolism of patients with unstable angina (UA). METHODS: In total, 10 patients with UA (intervention group) and 10 healthy participants (control group) were recruited for this study from January 2009 to December 2010. Plasma samples from both groups were analyzed using liquid chromatography mass spectrometry (LC-MS). Principle component analysis (PCA) and partial least squares (PLS) were used to explore the correlations between metabolic markers in patients with UA. RESULTS: The LC-MS results indicated that the serum levels of 5 potential metabolic markers, namely, ceramide, glycocholic acid, allocholic acid, lithocholic acid, and leukotriene (LT) B4, were significantly higher in the intervention group than those in the control group. CONCLUSION: The results of this study demonstrated potential metabolic markers that can be used to distinguish and diagnose patients with UA.

Danshen injection as adjuvant treatment for unstable angina pectoris: A systematic review and meta-analysis.

OBJECTIVE: To systematically evaluate the clinical effectiveness and safety of Danshen Injection (, DS) as one adjuvant treatment for conventional therapy with Western medicine (WM) for unstable angina pectoris (UAP). METHODS: Using literature databases, a thorough and systematic retrieval of randomized controlled trials (RCTs) comparing DS plus WM with WM was conducted from inception to April 2015. The extracted data from included studies was analyzed by Review Manager 5.2 software. The Cochrane risk of bias tool was used to assess the quality of included studies, and Begg's and Egger's tests conducted by Stata 12.0 were used to evaluate the potential presence of publication bias. RESULTS: A total of 17 RCTs, which involving 1,433 participants, were identified and reviewed. The meta-analysis indicated that the combined use of DS and WM was significantly superior to WM alone for UAP in terms of the total effectiveness rate of angina pectoris [risk ratio (RR) =1.23, 95% confidence interval (CI): 1.17, 1.29, P<0.01] and the total effectiveness rate of electrocardiogram (ECG) [RR=1.18, 95%CI: 1.06, 1.30, P=0.001]. Additionally, DS could also further reduce the content of fibrinogen, adjust blood lipid level, correct T wave inversion, and so on. Fifteen adverse drug reactions were reported in two studies, Four of which appeared in the experimental group. CONCLUSION: Based on the systematic review, the combined use of DS and WM was more effective than WM alone, it can be further widely used in clinic, however, there was no exact conclusion for its safety.

Effects of atorvastatin combined with trimetazidine on myocardial injury and inflammatory mediator in unstable angina patients during perioperative of percutaneous coronary intervention.

OBJECTIVE: To investigate the effects of atorvastatin combined with trimetazidine on periprocedural myocardial injury and serum inflammatory mediators in unstable angina pectoris (UAP) patients following percutaneous coronary intervention (PCI) treatment. PATIENTS AND METHODS: 90 patients with UAP treated with conventional medications and PCI were recruited and were randomly divided into the control group and the experimental group. The control group had 42 patients were treated with atorvastatin alone, while the experimental group had 48 cases treated with atorvastatin combined with trimetazidine. All the patients were checked the preoperative 24h and postoperative 24h PCI concentrations of cardiac troponin I (cTnI), hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), serum interferon-γ (IFN-γ) and interlukin-10 (IL-10). RESULTS: At the pre-PCI stage, every serum factors was no significant difference. 24 hours after the PCI intervention, the occurence of abnormal cTnI level in the experimental group was remarkable reduced than the control group. In the experimental group, the serum levels of TNF-α and IFN-γ significantly decreased (p < 0.05); while IL-10 was increased. In the control group, all the mediators were increased significantly except the hs-CRP (p < 0.05). CONCLUSIONS: No unexpected symptom was found in patients with large dose atorvastatin combined with large dose trimetazidine. The administration of conventional medications together with the atorvastatin plus trimetazidine were able to reduce the prevalence of postoperative myocardial injury.

NLRP3 inflammasome in peripheral blood monocytes of acute coronary syndrome patients and its relationship with statins.

OBJECTIVES: Despite recent advances in the understanding of the role of NLRP3 inflammasomes in coronary atherosclerosis, further work on their activation and clinical implications remains to be performed. In this study, we aimed to evaluate the effect of the dose of rosuvastatin on NLRP3 and cathepsin-B expression in peripheral blood monocytes in patients with acute coronary syndrome. METHODS: A total of 123 participants were enrolled in this study; these included acute myocardial infarction (AMI) patients (n=53), unstable angina patients (UA, n=40), and normal controls (n=30). AMI and UA patients were divided into high-dose rosuvastatin (20 mg) and low-dose rosuvastatin (5 mg) groups. NLRP3, cathepsin-B, and downstream cytokine expressions were appropriately evaluated using real-time PCR, flow cytometry, western blotting and enzyme-linked immunosorbent assay. The concentrations of serum inflammatory markers were also evaluated for correlation with NLRP3 levels. RESULTS: AMI and UA patients had higher NLRP3, cathepsin-B, interleukin-18 (IL-18), pro-IL-18, IL-1ß, and pro-IL-1ß expressions as compared with the control group (P<0.05). This corresponded with higher levels of serum total cholesterol, serum low-density lipoprotein cholesterol, and oxidized low-density lipoprotein in UA and AMI patients (P<0.05). Rosuvastatin at a concentration of 20 mg led to a significant decrease (P<0.05) in the expressions of NLRP3, cathepsin-B, and their downstream cytokines as compared with 5 mg rosuvastatin (P>0.05) from baseline to 4 weeks. This study also showed a positive correlation between NLRP3, cathepsin-B, and downstream inflammatory mediators. CONCLUSION: NLRP3 is involved in inflammation that leads to atherosclerosis. A high dose of rosuvastatin can modulate the inflammatory process of atherosclerosis by downregulating the expression of NLRP3, cathepsin-B, and their downstream mediators. These findings provide insight into the pathogenesis and management of acute coronary syndrome, with NLRP3 as the potential target.

[Effects of yangxin decoction on metabolomics of patients with unstable angina].

OBJECTIVE: To primarily seek for unstable angina (UA) correlated metabolic markers and to observe the effects of Yangxin Decoction on the plasma metabolism of UA patients. METHODS: Ten UA patients from clinics of No. 2 Circulation Department, First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from November 2009 to December 2010 were recruited as the treatment group. Another 10 healthy volunteers were recruited as the control group (Group D). The changes of plasma metabolic components were observed in UA patients after they took Yangxin Decoction for 28 days, using liquid chromatography mass spectrometry (LC-MS). Analysis was conducted using principle component analysis (PCA) and partial least squares (PLS) to seek for UA correlated metabolic markers. RESULTS: Results of PCA among Group D (the healthy group), Group M (UA group before medication), and Group G (UA group after medication): all samples of the three groups were centrally distributed in the four score plot of the oval regions (95% confidence interval). In Group M, the relative dispersion of the sample 8, 9, and 10 was near to Group D. The samples of the three groups could be separated. The samples of Group M (before medication) and Group G (after medication) could be basically separated. Comparison of metabolic end products between Group D and Group M: In the metabolites of UA group, ceramide, glycocholic acid, allocholic acid, lithocholic acid, leukotriene B4 obviously increased. CONCLUSIONS: Ceramide, glycocholic acid, allocholic acid, lithocholic acid, leukotriene B4 might be metabolic markers of UA. Yangxin Decoction might have effects on some plasma metabolites or metabolic pathways of UA patients.

[Effects of different statins, ezetimibe/simvastatin combination on hsCRP levels in unstable angina pectoris and non-ST elevation myocardial infarction patients: a randomized trial]. / Kararsiz anjina pektoris ve ST-elevasyonsuz miyokart enfarktüslü hastalarda degisik statinlerin, ezetimib/simvastatin kombinasyonunun hsCRP düzeyleri üzerine etkileri: randomize bir çalisma.

OBJECTIVE: The aim of our study was to evaluate the effects of two different statins and a statin/ezetimibe combination on high sensitive C-reactive protein (hsCRP) values, which were given at high doses in the early period of acute coronary syndromes. METHODS: A total of 150 patients with non-ST elevation myocardial infarction and unstable angina pectoris were enrolled to our prospective, randomized, single-blind study. Patients were divided into three groups by block randomization method. One group received 20 mg/day atorvastatin, one group received 10 mg/day rosuvastatin and the other group received 10 mg/day ezetimibe/simvastatin combination therapy, which was initiated within the first 24 hours of admission. Follow-up duration was 2 months . Biochemical investigations and hsCRP levels (by nephelometric method) were performed with 138 patients evaluated at baseline, 10th and 60th days of therapy. Decreases of hsCRP levels were analyzed with one-way MANOVA and repeated measures of ANOVA methods. Post-hoc Tukey HSD test was performed for finding the different group, when the difference was detected between the groups. RESULTS: Tenth day hsCRP levels in ezetimibe/simvastatin group was significantly lower than the other groups (p<0.001). Further, after 60 days of follow-up a significant reduction was seen in hsCRP levels in ezetimib/simvastatin group (in ezetimibe/simvastatin group the mean hsCRP was reduced from 38.4±15.0 mg/L to 2.4±1.3 mg/L, in atorvastatin group the mean hsCRP was reduced from 27.3±11.7 mg/L to 4.1±2.4 mg/L and in rosuvastatin group the mean hsCRP was reduced from 22.0±6.9 mg/L to 3.6±1.7 mg/L (F (1.1, 148.2) = 746.9, p<0.01 and the difference between drugs; F (2.2, 148.2) = 32.1, p<0.01). No side effects related to drugs were seen during follow-up in all three treatment groups. CONCLUSION: This study showed that ezetimibe/simvastatin 10 mg/day combination treatment was superior to atorvastatin 20 mg/day and rosuvastatin 10 mg/day treatment in reducing the inflammatory markers when high dose statins was started in the early period of unstable angina and non ST elevation myocardial infarction.

[Effect of danshen chuanxiongqin injection on the myocardial damage of unstable angina patients undergoing percutaneous coronary intervention].

OBJECTIVE: To observe the effect of Danshen Chuanxiongqin Injection (DCI) on the myocardial damage of unstable angina (UA) patients undergoing percutaneous coronary intervention (PCI). METHODS: 76 UA patients were randomly assigned to the test group (39 cases) and the control group (37 cases). Routine treatment of Western medicine and PCI were given to all patients. But 10 mL DCI was intravenously dripped to patients in the test group by adding in 250 mL normal saline three to five days before PCI, once daily, lasting for 7 to 10 days. Changes of platelet P-selectin positive expressions before and after medication, the thrombolysis in myocardial infarction (TIMI), myocardial perfusion (TMP) score, levels of creatine kinase-myocardial band (CK-MB) and troponin I (TnI) after PCI were observed in the two groups. RESULTS: After medication the P-selectin positive expressions was lower in the test group than in the control group (2.45% +/- 1.42% vs 4.43% +/- 1.79%, P<0.05). After PCI the incidence of TMP 0/1, the levels of CK-MB and TnI were lower in the test group than in the control group at the same phase, showing statistical difference (P<0.05). No cardiac event occurred in the two groups during the hospital stay. CONCLUSION: Administration of DCI before PCI could effectively inhibit the activation of platelets, improve post-operative myocardial blood perfusion, and lower the incidence of the myocardial damage.

Effects of loading dose of atorvastatin before percutaneous coronary intervention on periprocedural myocardial injury.

OBJECTIVES: To investigate the effects of loading dose of atorvastatin on periprocedural myocardial injury and inflammatory reaction in patients with non-ST segment elevation (NSTE) acute coronary syndromes (unstable angina or NSTE acute myocardial infarction). METHODS: A total of 81 patients with NSTE-acute coronary syndromes were randomly divided into the pretreatment with atorvastatin group [80 mg 12 h before percutaneous coronary intervention (PCI), with a further 40 mg preprocedure dose] (n=41) or the placebo group (n=40). The main end point was a 30-day incidence of major adverse cardiac events (cardiac death, nonfatal acute myocardial infarction, or revascularization with either PCI or coronary artery bypass grafting). Creatine kinase-MB, cardiac troponin I, and high-sensitivity C-reactive protein levels were measured at the baseline and at 8 and 24 h after the procedure. RESULTS: Major adverse cardiac events occurred in 2.4% of patients in the atorvastatin group and 22.5% of those in the placebo group (P=0.0161). This difference was mostly because of reduction in the incidence of myocardial infarction (2.4 vs. 20.0%; P=0.0307). Markers of the two groups were elevated after PCI; however, the higher values of creatine kinase-MB, cardiac troponin I, and high-sensitivity C-reactive protein in the atorvastatin treatment group were significantly lower than those in the placebo group (P<0.01). CONCLUSION: Short-term pretreatment with a high dose of atorvastatin significantly reduces procedural myocardial injury in early PCI.

[Gel electrophoresis analysis on plasma differential protein in patients with unstable angina of blood-stasis pattern].

OBJECTIVE: To seek the plasma differential proteins in patients with unstable angina of blood-stasis pattern (UA-BSS) for exploring the proteomic specialty in them by way of two-dimensional difference gel electrophoresis (DIGE) detection on plasma of patients and healthy persons. METHODS: Using DIGE and tandem mass spectrometry, comparative proteomic study was conducted on the plasma of 12 UA patients of qi-deficiency and blood-stasis pattern (UA-QBS), 12 UA patients of phlegm-stasis cross-blocking pattern (UA-PSS) and 12 healthy volunteers. RESULTS: Preliminary results showed that Haptoglobin beta chain, DBP, HBB, HBA, Transthyretin, ApoA- I, ApoA-IV were significantly differentially expressed in both patterns, while Haptoglobin alpha1 chain, alpha-1-acid glycoprotein, ApoC-III, ApoA-II, ApoC-II, ApoJ, and Haptoglobin alpha 2 chain were only seen differentially expressed in the UA-PSS patients, alpha1-antitrypsin, Fibrinogen gamma chain, and Fibrin beta were only seen differentially expressed in UA-QBS patients. CONCLUSION: The common proteomics characteristics of patients of QBS and PSS patterns may be correlated with inflammatory reaction and metabolic disturbance (including blood lipid and blood oxygen).

[A randomized double-blinded controlled trial of Xuefu Zhuyu Capsule on short-term quality of life in unstable anginal patients with blood-stasis syndrome after percutaneous coronary intervention].

BACKGROUND: With the wide application of percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD), it is a popularly concerned problem within clinical doctors to promote the patients' early recovery and improve their health related quality of life (HR-QoL). OBJECTIVE: To evaluate the efficacy and safety of Xuefu Zhuyu (XFZY) Capsule, a compound traditional Chinese herbal medicine for activating blood circulation, in improving HR-QoL in unstable angina (UA) patients with blood-stasis syndrome after PCI, and to make a comparison with Shengmai (SM) Capsule. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: The study was performed at Rescue Center of Emergency, Beijing Anzhen Hospital, China Capital University of Medical Science from March 2008 to February 2009. Using a randomized, double-blinded, double-dummy and placebo controlled study design, ninety patients diagnosed as UA and concomitant blood stasis syndrome after successful PCI therapy were enrolled and randomized into three groups: XFZY group, SM group and placebo group, and the patients were administered with the corresponding medications for 4 weeks. MAIN OUTCOME MEASURES: The Short-Form 36 (SF-36) and Seattle Angina Questionnaire (SAQ) were applied to assess the HR-QoL in each group before and after the treatment. RESULTS: A total of 90 patients were recruited and 4 cases of them withdrew from the study during the treatment period indicating a 4.4% of dropping rate. After the treatment, several domains of scores in SF-36 and SAQ were significantly increased in three groups (P<0.05, P<0.01). The efficacy of XFZY Capsule in improving body pain (BP), general health (GH), vitality (VT), social function (SF), role emotional (RE), angina stability (AS), angina frequency (AF), as well as treatment satisfaction (TS) was better than that of placebo (P<0.05, P<0.01). Meanwhile, the dimensions of BP, GH, SF, AS, AF, TS were improved as compared with those in the SM group (P<0.05). No obvious adverse reaction was found during and after the treatment with the exception of one case in XFZY group reporting of discomfort in the stomach. CONCLUSION: Compared with SM Capsule, a short-term treatment of XFZY Capsule exhibits better efficacy in improving HR-QoL in UA patients with blood-stasis syndrome after PCI. However, its long-term efficacy and safety needs further investigation. TRIAL REGISTRATION: ClinicalTrials.gov Identifier, NCT00817024.

Efficacy and safety of atorvastatin during early hospitalization in elderly patients with unstable angina.

1. Previous studies have demonstrated that early statin therapy after acute coronary syndrome decreases inflammation and mortality rates. The dose-response relationship for atorvastatin in elderly patients with unstable angina (UA) during early hospitalization in terms of lowering inflammatory factors, improving vascular endothelium function and safety is unclear. 2. In the present study, 166 consecutive patients with UA who were >/= 60 years of age were randomly assigned, in a double-blind manner, to receive 80 or 20 mg/day atorvastatin. High-sensitivity C-reactive protein, interleukin-6, tumour necrosis factor-alpha, fibrinogen and lipid levels were measured at admission and 1, 2 and 8 weeks later. Vascular endothelial function was measured and the safety of the drug was monitored. 3. Levels of inflammatory factors were significantly lower in patients on 80 mg atorvastatin than in those on 20 mg atorvastatin at 2 and 8 weeks. Atorvastatin 80 mg not only resulted in a significant improvement in vascular endothelial function during early hospitalization for UA over that seen in patients on 20 mg atorvastatin, but also reduced lipid levels to a greater extent. At 8 weeks, almost all patients showed good tolerance of 80 mg/day atorvastatin. 4. The results of the present study indicate that intensive statin therapy with high-dose (80 mg/day) atorvastatin is more efficacious than and as safe as 20 mg/day atorvastatin when administered to elderly patients during early hospitalization for UA.

[Study on proteomic specificity of unstable angina with qi deficiency and blood stasis syndrome].

OBJECTIVE: To seek the special plasma molecule in unstable angina (UA) patients of qi deficiency and blood stasis syndrome (QDBS) and method for explore the proteomic specificity of the disease. METHODS: LC-MS(E) analysis was performed in UA patients of QDBS or non-QDBS and in healthy persons after the 6 proteins with optimal abundance in plasma being removed by polyclonal antibody affinity column (product of Agilent Co. USA). RESULTS: Actin were found only expressed, and FN, ApoH and ANXA6 were found highly expressed in plasma of patients with UA-QDBS, suggesting they might be the special molecules for the disease. Moreover, as compared with health persons, SAA, CP, MYH11 and C6 showed high expression, and the 6 proteins, e.g. A1BG, ApoA4, GSN, HBB, HBD and TF, showed low expression in the plasma of UA-QDBS patients. CONCLUSION: UA-QDBS might belong to a kind inflammatory reaction. There are simultaneous existence of myocardial injury, blood coagulation factor abnormality, lipid metabolic disorder and oxygen transport obstacle in patients of UA-QDBS, they influence and interact mutually. The newly discovered differential proteins might provide clues for studying or discovering new protein targets of angina relieving drugs. The new technique of label free quantitative proteomics is an efficient method for bio-marker research of diseases and syndromes.

Influence of folic acid on plasma homocysteine levels & arterial endothelial function in patients with unstable angina.

BACKGROUND & OBJECTIVE: High plasma homocysteine (Hcy) levels are known to be associated with coronary artery disease, but the precise level associated with an increased risk is yet controversial. Whether the beneficial effects of folic acid on arterial endothelial function persist over longer periods is not known. This study was carried out to assess whether folic acid supplementation could produce improvements in Hcy levels and arterial endothelial function in the patients with unstable angina (UA) and hyperhomocysteinaemia. METHODS: The plasma Hcy levels of 52 cases with UA and 30 control subjects were measured by using high-performance liquid chromatography (HPLC) with fluorescence detection, plasma folic acid and vitamin B(12) levels were also measured. The patients with hyperhomocysteinaemia were treated with 5 mg of folic acid for 8 wk, and then rechecked the plasma levels of Hcy, folic acid and vitamin B(12) at the end of 4(th) and 8(th) wk. Arterial endothelial function was measured as flow-mediated dilation of the brachial artery using high-resolution B-mode ultrasound in 22 cases with UA and hyperhomocysteinaemia before and after folic acid treatment. RESULTS: The plasma Hcy level was significant higher in the patients with UA than in the controls (19.2 +/- 4.9 vs 10.7 +/- 5.3 micromol/l, P<0.01). The plasma levels of folic acid and vitamin B12 were significant lower in the patients with UA than in the controls. There were 22(42.3%) patients with hyperhomocysteinaemia in UA group. After 4 and 8 wk of administration of folic acid, the Hcy level reduced by 20.3 and 55.3 per cent in the UA patients with hyperhomocysteinaemia, respectively. Flow-mediated dilation also improved significantly, from 6.4 +/- 1.9 to 9.0 +/- 1.2 per cent (P<0.05) after 8 wk treatment with folic acid. INTERPRETATION & CONCLUSION: Plasma Hcy level was elevated in patients with UA. Folic acid can reduce the plasma Hcy levels and improve arterial endothelial function in the UA patients with hyperhomocysteinaemia.

[Clinical effect and mechanismn of xuefu zhuyu capsule in treating unstable angina pectoris].

OBJECTIVE: To observe the clinical effect of Xuefu Zhuyu Capsule (XFZYC) in treating unstable angina pectoris (UAP) and to investigate its mechanism of protection on vascular endothelia. METHODS: Sixty UAP patients were randomly assigned to two groups, the 30 in the treated group were treated by conventional therapy plus XFZYC, and the 30 in the control group treated by conventional therapy alone. The frequency and persistent time of angina pectois, dosage of nitroglycerin used, changes of electrocardiogram (ECG) were observed, and the plasma levels of endothelin (ET), nitric oxide (NO), von Willebrand factor (vWF), soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecule-1 (sICAM-1) were tested before and after the two-month therapeutic course. RESULTS: (1) The clinical symptoms as frequency and persistent time of angina pectoris in the treated group were bettered significantly after treatment and the dosage of nitroglycerin used decreased (all P < 0.01), showing significant difference when compared with those in the control group (P < 0.05). (2) The effective rates on UAP symptoms and ECG in the treated group were 86.7% and 76.7% respectively, which were significantly higher than those in the control group (70.0% and 63.3%, P < 0.05). (3) Laboratory examination showed in the control group, changes only displayed in the decrease of vWF and ET and increase of NO (all P < 0.05), while in the treated group, plasma levels of vWF, ET, sVCAM-1 and sICAM-1 after treatment significantly decreased and were lower than those in the control group (P < 0.01), but NO elevated significantly and was higher than that in the control group (P < 0.01). CONCLUSIONS: XFZYC is an effective Chinese patent medicine for treatment of UAP. It displays its effect on protecting vascular endothelia and anti-angina pectoris partially by decreasing the plasma levels of ET, vWF, sVCAM-1 and sICAM-1 and elevating the level of NO.

Sulfotanshinone Sodium Injection could decrease fibrinogen level and improve clinical outcomes in patients with unstable angina pectoris.

We randomly divided 100 unstable angina pectoris (UAP) patients into two groups: the trial group received Sulfotanshinone Sodium Injection (SSI) 60 mg combined with a loading dose of 300 mg aspirin and a maintenance dose of 100 mg of aspirin plus baseline therapy, and the control group received the same doses of aspirin and baseline therapy. 94 patients completed treatment. After 4 weeks' medication, the severity of angina pectoris improved in both groups, with a significant improvement in total effective rate in the trial group but no difference in the total effective rate of improvement seen on ECG. Compared with baseline level, FIB level after treatment decreased significantly in both groups but to a greater extent in the trial group. Similar changes in DD levels were observed in both groups. With a background of aspirin and baseline therapy, SSI can significantly attenuate angina pectoris attacks in patients with UAP which may be associated with the decreased level of FIB.

Acute coronary syndrome patients with depression have low blood cell membrane omega-3 fatty acid levels.

OBJECTIVE: To determine the extent to which levels of membrane eicosapentaenoic (EPA)+docosahexaenoic acids (DHA) (the omega-3 index) were associated with depression in patients with acute coronary syndrome (ACS). Depression is associated with worse cardiovascular (CV) outcomes in patients with ACS. Reduced levels of blood cell membrane omega-3 (n-3) fatty acids (FAs), an emerging risk factor for both CV disease and depression, may help to explain the link between depression and adverse CV outcomes. METHODS: We measured membrane FA composition in 759 patients with confirmed ACS. The analysis included not only EPA and DHA but also the n-6 FAs linoleic and arachidonic acids (LA and AA). Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ). Multivariable linear regression was used to adjust for demographic and clinical characteristics. RESULTS: There was a significant inverse relationship between the n-3 index and depressive symptoms (PHQ) in the fully adjusted model (p = .034). For every 4.54% point rise in the n-3 index, there was a 1-point decline in depressive symptoms. In contrast to the n-3 FAs, membrane levels of the n-6 FAs LA and AA were not different between depressed and nondepressed ACS patients. CONCLUSION: We found an inverse relationship between the n-3 index and the prevalence of depressive symptoms in patients with ACS. Therefore, this study supports the hypothesis that reduced n-3 FA tissue levels are a common and potentially modifiable link between depression and adverse CV outcomes.

Compound Salvia droplet pill, a traditional Chinese medicine, for the treatment of unstable angina pectoris: a systematic review.

Compound Salvia droplet pill (CSDP) has been frequently used for patients with angina pectoris in China. However, the efficacy and safety of CSDP for unstable angina pectoris (UA) have not been systematically evaluated. The aim was to assess the efficacy and safety of CSDP for UA and provide information for current practice or future research. An extensive search was performed in Jan 2007 which included MEDLINE, EMBASE, Chinese Biomedical Database (CBM), and the Cochrane Center Controlled Trials Register. Randomized controlled trials (RCTs) about CSDP for UA were included irrespective of language. The main comparisons was CSDP plus current western drugs compared with western drugs alone. The quality of each trial was assessed according to criteria from the Cochrane Reviewers' Handbook. Statistical software (RevMan 4.2) provided by the Cochrane Collaboration was applied. Seventeen RCTs were included in this review. The quality of the trials was low. Statistical analysis of the results showed that CSDP plus western routine drugs compared with routine drugs alone had significant effect on relieving angina symptoms (P<0.00001, pooled RR=1.23, 95%CI: 1.16-1.30) and improving ECG (P<0.00001, pooled RR=1.34, 95%CI: 1.23-1.46). Some trials' data suggest that CSDP can also improve hemorheology and blood lipid level. CSDP had a significant effect for treatment of UA with few adverse events. However, the evidence is not reliable enough because of the low quality of the methodology of the included trials. To produce good evidence, high-quality clinical trials are needed.

[Study on effect of promoting blood circulation drugs components in treating unstable angina in patients with blood stasis inflammatory levels].

OBJECTIVE: To discussion the effects of Huoxue components of effective drug in treating unstable angina in patients with blood stasis WBC (WBC), C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha). METHOD: one hundred and twenty cases of unstable angina were randomly divided into the conventional therapy group, component compatibility group, Pieces group and Xuesaitong group 4 groups, each with 30 cases. Observation of patients before and after treatment of clinical efficacy, blood lipid indicators and the indicators changes. RESULT: Component compatibility group after treatment clinical marked improvement in conditions, and the WBC, CRP, IL-6 and TNF-alpha, TC, TG levels lower than before treatment, there were significant differences (P < 0.05), and lower than the other three groups After treatment (P < 0.05). And HDL-C after treatment than before treatment increased, there were significant differences (P < 0. 05). CONCLUSION: Huoxue-effective component compatibility can be effective treatment of unstable angina blood stasis, and could inhibit the inflammatory level.

[Platelet function after a high dose bolus of tirofiban immediately after coronary angioplasty]. / Etude de la fonction plaquettaire après bolus de tirofiban a haute dose au décours immédiat de I'angioplastie coronaire.

In the TARGET trial, the lower incidence of cardiac events at one month with abciximab compared with tirofiban was attributed to a lack of efficacy in the first hour because of suboptimal dosage. The object of this study was to confirm that high dose tirofibal is associated with over 90% platelet inhibition during the first hour and to analyse the effect of this new dosage on platelet activation. Thirty-three patients treated with clopidogrel and aspirin for an acute coronary syndrome without ST elevation were given before angioplasty a bolus of 25 microg/Kg of tirofiban injected in 3 minutes, followed by an infusion of 0.15 microg/kg/min. Blood samples were taken before the treatment (TO) and at the 45th minute (T1) to measure platelet aggregation induced by ADP, the expression of P-selection, the quantification of circulating monocyte-platelet aggregates and the phospholyration of VASP protein. The results showed that all patients had over 90% (100%) inhibition of platelet aggregation at T1. The expression of P-selection was significantly reduced (T0: 0.195 +/- 0.057 MFI; T1: 0.186 +/- 0.055 MFI, p = 0.03). There was no significant difference in the number of monocyte-platelet aggregates or in the phosphorylation of VASP. In conclusion, a bolus of 25 microg/Kg/3 min of tirofiban provides over 90% inhibition of platelet aggregation in the first hour. The initial platelet proactivator effect at this dosage was shown to have disappeared with an inhibition of platelet activation.