Efficacy and safety of different traditional Chinese health exercises in patients with coronary heart disease combined with chronic heart failure: A network meta-analysis.

BACKGROUND: Non-pharmacological treatments, particularly TCM health exercises, have garnered attention for their affordability, ease of access, and potential health advantages. Despite this interest, systematic and direct comparative studies assessing the effectiveness and safety of these therapies in patients with CHD-CHF remain scarce. METHODS: This study aimed to compare the efficacy and safety of conventional treatment, conventional treatment integrated with aerobic endurance training, and various TCM health exercises in treating patients with CHD-CHF using NMA. The analysis was designed to provide a reference for developing treatment plans. To achieve this, literature databases were searched for RCTs on different TCM health exercises for CHD-CHF patients up to December 6, 2022. Major outcomes analyzed included NT-proBNP, LVEF, 6-minute walk test, MLHFQ, clinical effectiveness, and adverse event occurrence. The Cochrane risk of bias tool was employed to assess the risk of bias in the included RCT studies. Systematic review with NMA was conducted using RevMan 5.4 and Stata for cumulative ranking, and comparative adjustment funnel plot analysis. RESULTS: Traditional Chinese medicine gong methods included BaDuanJin (A) and TaiChiQuan (B). The NMA and SUCRA results revealed that: A + D and A + C + D were most likely to be the best interventions to improve NT-proBNP; B + D and A + C + D were most likely to be the best interventions to improve LVEF; A + D and A + C + D were the best interventions to improve 6WMT in CHD-CHF patients; B + C + D had the best effect on shrinking LVESD;A + D and B + C + D was likely the best interventions for contracting LVEDD;B + D and A + D were consistent in their capacity to improve MLHFQ in patients with CHD-CHF, but B + D had better efficacy. Unlike A + C + D, B + C + D was the best intervention to improve MLHFQ. In contrast with interventions, including Dand C + D, B + D was the most clinically effective intervention. Unlike interventions including B + C + D, C + D, and D, A + C + D was the most clinically efficient intervention. CONCLUSION: The findings of this NMA showed that traditional Chinese health exercises integrated with conventional treatment are more effective than conventional treatment (D) alone in patients with CHD-CHF, with A + D, B + D, B + C + D, and A + C + D considered potentially optimal treatment interventions.

[Stable angina pectoris of coronary heart disease treated with different acupuncture and moxibustion therapies: a network Meta-analysis].

To compare the clinical efficacy among different acupuncture and moxibustion therapies on stable angina pectoris (SAP) of coronary heart disease by means of network Meta-analysis. The articles of randomized controlled trial (RCT) for SAP of coronary heart disease treated with acupuncture and moxibustion therapies were searched from PubMed, Web of Science, Cochrane Library, CNKI, Wanfang database and VIP database from May 1, 2002 to May 1, 2022. The quality of them was assessed with the risk of bias assessment tool of Cochrane 5.3, and the network Meta-analysis was undertaken with Stata 13.1 software. A total of 29 articles were included with the acupuncture and moxibustion therapies involved, e.g. acupuncture, acupoint application and moxibustion. In comparison with the simple routine western medication, the effective rate was better on SAP treated with the combined treatments, in which, acupoint application, moxibustion, acupuncture and intradermal needling were combined with routine western medication (P<0.05). Of those combined treatments, the combination of the acupoint application with routine western medication had high probability, suggesting the optimal regimen (area under the curve [SUCRA]=0.711, P<0.05). The effective rate of acupuncture combined with routine western medication for ECG improvement was better than that of routine western medication (P<0.05), and such combined treatment was high in probability, underlying its optimal treatment (SUCRA=0.800, P<0.05). Combined with routine western medication, acupuncture, acupoint application, moxibustion and intradermal needling all improve the clinical efficacy on SAP of coronary heart disease. But, with different outcomes considered, the optimal treatments may be different. It needs more multi-central and large-sample randomized controlled trials to validate these results.

Efficacy and safety of acupuncture combined with Xuefu Zhuyu Decoction on major adverse cardiovascular events after percutaneous coronary intervention: A protocol for systematic review and meta-analysis.

BACKGROUND: Percutaneous coronary intervention (PCI) is an effective treatment for coronary heart disease (CHD). With the merits of small trauma and high success rate, PCI can promote the fast recovery of CHD patients and greatly improve their prognosis and quality of life. However, because PCI does not eliminate the pathogenic factors that lead to atherosclerosis, major adverse cardiovascular events (MACEs) often occur after PCI. These events have become one of the principal factors affecting the long-term outcome of patients after PCI. In China, increasing attention is paid to the use of acupuncture combined with Xuefu Zhuyu Decoction (XFZYD) for the treatment of post-PCI MACEs in clinical practice. Nevertheless, this treatment approach still lacks evidence-based medical evaluation. In this study, a meta-analysis was conducted to evaluate the effectiveness and safety of acupuncture combined with XFZYD in the treatment of MACEs after PCI. METHODS: Randomized controlled trials on the efficacy and safety of acupuncture combined with XFZYD for the treatment of MACEs after PCI were retrieved from CNKI, WanFang, PubMed, Embase, Cochrane Library, Google Scholar and Web of Science databases from the time of database establishment to October 2022. The papers were screened strictly according to the inclusion and exclusion criteria, and the quality of the included studies was assessed using the Risk of Bias 2 (RoB 2) tool. Raw data were extracted from the studies and then a meta-analysis was made using RevMan 5.3 software. RESULTS: The results of this meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION: This study will summarize the latest evidence for the efficacy and safety of acupuncture combined with XFZYD in the treatment of MACEs after PCI.REGISTRATION NUMBER: CRD42022365657.

Intracoronary Ultrasound Imaging Combined with Traditional Chinese Medicine Nursing Applied in the Treatment of Coronary Heart Disease Patients with Phlegm and Blood Stasis Syndrome.

This study was to explore the effect of traditional Chinese medicine (TCM) nursing intervention based on intracoronary ultrasound imaging on patients with coronary heart disease (CHD) and phlegm and blood stasis syndrome (PBSS). 100 hospitalized patients with CHD with Qi deficiency and blood stasis syndrome (QDBSS) were rolled into the experimental (Exp) group (routine nursing intervention) and control (Ctrl) group (TCM nursing intervention, syndrome differentiation nursing), with 50 patients in each group. They underwent the intracoronary ultrasound imaging scanning. The results showed that after intervention, the plaque load (45.08 ± 6.02%), plaque eccentricity index (0.47 ± 0.08%), vascular remodeling index (0.53 ± 0.11%), and vascular external elastic membrane area (8.67 ± 3.06 mm2) of the Exp group were notably inferior to those of the Ctrl group (60.22 ± 5.82%, 0.59 ± 0.08%, 0.71 ± 0.09%, and 10.56 ± 2.31 mm2). The total effective rate in the Exp group (88%) was greatly superior to that of the Ctrl group (68%). In terms of TCM symptom scores, the TCM symptom scores of chest pain, chest tightness, and shortness of breath in the Exp group after intervention (1.07 ± 0.21 points, 0.75 ± 0.27 points, and 0.58 ± 0.12 points) were notably inferior to those in the Ctrl group (1.62 ± 0.28 points, 1.03 ± 0.21 points, and 0.79 ± 0.14 points). In the Exp group, after intervention, the degree of physical activity limitation (67.05 ± 5.08 points), the stable state of angina pectoris (65.28 ± 3.76 points), the frequency of angina pectoris attack (85.92 ± 2.97 points), the degree of treatment satisfaction (75.39 ± 5.94 points), the cognition score of disease (63.56 ± 5.84 points), the levels of triglyceride (1.27 ± 0.41 mmol/L), and total cholesterol (2.24 ± 0.41 mmol/L) were remarkably inferior to the Ctrl group (52.97 ± 4.31 points, 50.77 ± 4.69 points, 71.36 ± 3.77 points, 64.08 ± 5.64 points, 51.77 ± 6.33 points, 2.09 ± 0.57 mmol/L, and 3.06 ± 0.84 mmol/L) (P < 0.05). It suggested that intracoronary ultrasound imaging can clearly display the coronary plaques of patients and accurately evaluate the clinical efficacy of patients with CHD. The TCM nursing program can greatly improve the angina symptoms and quality of life of patients with CHD and PBSS, reduce blood lipid levels, and effectively improve the clinical efficacy of patients.

The Effect of Acupuncture Combined with Aerobic Exercise for Coronary Heart Disease as Cardiac Rehabilitation.

Background: The mortality of coronary heart disease continues to rise. Cardiac rehabilitation intervenes the risk factors of cardiovascular disease, improves cardiopulmonary function, maintains healthy psychology, improves the quality of life of patients, and reduces cardiovascular mortality. Objective: To explore the effect of acupuncture combined with aerobic exercise on cardiopulmonary exercise ability, blood lipid, fatty acid oxidation, and psychology in patients with coronary heart disease. Methods: Sixty patients with coronary heart disease from February 2018 to October 2020 were randomly divided into two groups: the control group and experimental group. The control group was given an exercise prescription, and the experimental group was given acupuncture combined with an exercise prescription. Before and after the intervention, the cardiopulmonary exercise test, blood lipid, carnitine acyltransferase (CACT), the Self-Rating Somatic Symptom Scale (SSS), the Generalized Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9) of the two groups were compared. Results: The PHQ-9 score was better in the experimental group than in the control group. In both groups, after the intervention, the peak oxygen uptake and anaerobic threshold were increased, and blood lipid and PHQ-9 scores were decreased. In the experimental group, the carbon dioxide metabolic equivalent was decreased, CACT was increased, and SSS and GAD-7 scores were decreased, with statistical difference (P < 0.05). Conclusion: Acupuncture combined with aerobic exercise can improve the cardiopulmonary exercise ability, increase fatty acid oxidation, decrease blood lipid, and ameliorate anxiety and depression symptoms of patients with coronary heart disease as cardiac rehabilitation.

Efficacy and safety of acupuncture combined with Chinese herbal medicine in the treatment of angina pectoris of coronary heart disease (CHD): A protocol for systematic review and meta analysis.

BACKGROUND: Coronary heart disease (CHD) angina pectoris is a clinical syndrome in which episodic chest pain or chest discomfort is the main manifestation of temporary ischemia and hypoxia of the myocardium due to coronary atherosclerosis and coronary artery functional changes (spasm). A large amount of clinical evidence confirms that acupuncture combined with Chinese herbal medicine in the treatment of CHD and angina pectoris can relieve the symptoms of angina pectoris and improve the performance of electrocardiograph ischemia; It still has obvious therapeutic effects in regulating the levels of cardiovascular regulatory peptides ET and cGRP. To better evaluate the effectiveness and safety of acupuncture combined with Chinese herbal medicine in the treatment of CHD and angina pectoris, we designed a systematic evaluation program to provide a reliable scientific basis for the future use of this method. METHODS: Search Pubmed database, Embase, Cochrane library, Chinese Biomedical Literature CD-ROM Database (CBMdisk), China Journal Network Full-text Database (CNKI), Wanfang Database, Web of Science (SCI-E), the retrieval time is established from each database Until October 2021, search for relevant eligible randomized controlled trials with keywords or subject terms "acupuncture", "Chinese herbal medicine", and "CHD angina". Outcome indicators were clinical symptoms of CHD and angina pectoris, changes in electrocardiogram, changes in blood lipids, and significant improvement in traditional Chinese medicine syndromes before and after treatment. Two researchers independently carried out data extraction and quality assessment, and use RevMan5.3 software to carry out final data analysis and assessment. RESULTS: This study provides a reliable clinical scientific basis for acupuncture combined with Chinese herbal medicine for the treatment of CHD and angina pectoris. CONCLUSION: Acupuncture combined with Chinese herbal medicine can effectively relieve the clinical symptoms of CHD and angina pectoris and improve the performance of electrocardiograph. At the same time, it can reduce the cardiovascular regulatory peptide ET and increase the level of cGRP in the patient's plasma, thus confirming its effectiveness and safety.

[Effect of transcutaneous electric acupoints stimulation on vascular endothelial function and inflammatory factors after percutaneous coronary intervention].

OBJECTIVE: To observe the effect of transcutaneous electric acupoints stimulation (TEAS) on vascular endothelial function and inflammatory factors after percutaneous coronary intervention (PCI) in patients. METHODS: A total of 94 patients with coronary heart disease and undergoing PCI were randomized into a TEAS group and a sham-TEAS group, 47 cases in each one. In the TEAS group, TEAS started at unilateral Neiguan (PC6) and Ximen (PC4) 30 min before PCI till the end of PCI. In the sham-TEAS group, the procedure and persistent time were same as the TEAS group, but no electric stimulation was performed. Before treatment and at 8 h and 24 h after PCI, the levels of serum endothelin-1 (ET-1), von Willebrand factor (vWF), nitric oxide (NO), blood flow dependent diastolic function (FMD), interleukin-6 (IL-6), inteleukin-10 (IL-10), matrix metalloproteinase-9 (MMP-9) and high-sensitivity C-reactive protein (hs-CRP) were detected in the patients successively. RESULTS: Compared with the levels before PCI, the levels of ET-1 and vWF were all increased at 8 h and 24 h after PCI in the two groups (P<0.05) and the levels in the TEAS group were remarkably lower than those in the sham-TEAS group (P<0.05). Compared with the levels before PCI, the levels of NO and FMD at 8 h and 24 h after PCI were all reduced in the two groups (P<0.05) and the levels in the TEAS group were higher obviously than those in the sham-TEAS group (P<0.05). Compared with the levels before PCI, the levels of hs-CRP, MMP-9, IL-6 and IL-10 were all increased at 8 h and 24 h after PCI in the two groups (P<0.05); Compared with the sham-TEAS group, the levels of hs-CRP, MMP-9 and IL-6 were reduced and the level of IL-10 was increased at 8 h and 24 h after PCI in the TEAS group (P<0.05). CONCLUSION: TEAS effectively improves the vascular endothelial function and reduces serum inflammatory factors after PCI.

Investigating patients´ views on screening for depression in cardiac practice: A qualitative interview study.

OBJECTIVE: Recommendations on screening for depression in patients with coronary heart disease (CHD) are highly debated. While recent research has prioritized efficacy studies, little is known about what is potentially required for screening to be efficacious. Expanding our knowledge of how patients with CHD view screening is likely to pose a first step towards addressing this gap. We aimed to investigate patients ́ views on routine screening for depression in cardiac practice. METHODS: This exploratory, qualitative study was conducted among 12 patients with CHD, who completed semi-structured interviews. We used a purposive sampling strategy to include patients within a range of ages, gender and self-reported depression. Thematic analysis was carried out. RESULTS: We identified four main themes: Acceptance, utility, barriers and expectations. Patients in this sample appeared to be in favor of standardized routine screening for depression in cardiac practice, if the rationale was disclosed. Patients reported that standardized screening addresses holistic care demands, promotes validation of individual symptom burden and legitimizes the display of psychological distress in cardiac practice. Yet, skepticism towards the validity of screening instruments and perceived stigmatization could pose a main barrier to screening efficacy. Patients expected to receive feedback on results and consecutive recommendations. CONCLUSION: We found that depression screening is endorsed by patients with CHD in this study sample. Standardized routine screening procedures could serve as a useful tool to combat stigmatization, and encourage patients to display symptoms of depression towards cardiologists. The efficacy of depression screening could potentially be enhanced by tailoring the screening process towards patients´ needs.

Comparison of efficacy and safety of complementary and alternative therapies for coronary heart disease complicated with anxiety or depression disorder: A protocol for Bayesian network meta-analysis.

BACKGROUND: With the acceleration of the pace of life, the phenomenon of anxiety and depression in patients with coronary heart disease (CHD) is more and more common, and "psycho-cardiology" arises spontaneously. At present, the drug treatments of psycho-cardiology are difficult to achieve satisfactory results, and the side effects are obvious. Complementary and replacement therapies of CHD complicated with anxiety or depression disorder play an increasingly positive role, but there is a lack of comparison among different complementary and alternative therapies. In this study, Bayesian network meta-analysis (NMA) analysis method will be used for the first time to synthesize all the evidences of direct and indirect comparison among a variety of interventions, and rank their effectiveness and safety. METHODS: Two independent researchers will search from the beginning to January 2021 mainly including randomized controlled trials (RCTs) and closely related ongoing RCTs of complementary and alternative therapies for CHD complicated with anxiety or depression disorder. And then identify, select and extract the data. The primary outcome measures are frequency of acute attack angina, severity of angina pectoris; the changed score in the validated scales, which can assess severity of anxiety or depression. Secondary outcomes include total efficacy rate, electrocardiogram improvement, traditional Chinese medicine symptoms score, changes of dosage of nitroglycerin and adverse effects. Using softwares WinBUGS 1.4.3 and STATA 16.0 for pairwise meta-analysis and NMA to comprehensively evaluate various interventions. The quality of evidences will be evaluated through the Grading of Recommendations Assessment, Development and Evaluation. RESULTS: This NMA will comprehensively compare and rank the efficacy and safety of a series of complementary and alternative therapies in the treatment of CHD complicated with anxiety or depression disorder. CONCLUSION: Supplementary and replacement therapies play an essential role in improving CHD complicated with anxiety or depression disorder. We expect that the NMA will provide reliable evidences of evidence-based medicine for treatment of CHD complicated with anxiety or depression disorder. PROTOCOL REGISTRATION NUMBER: INPLASY202120046. ETHICAL APPROVAL: This review does not require ethical approval.

Effects of mind-body exercise on cardiopulmonary function, blood pressure, and quality of life in CHD patients: A protocol for systematic review and meta-analysis.

BACKGROUND: Coronary heart disease (CHD) is one of the highest mortality diseases in the world, which seriously threatens human health and quality of life (QOL). The purpose of this study is to systematically analyze the effects of mind-body exercise on cardiopulmonary function, blood pressure and QOL in CHD patients, and to provide scientific evidence-based exercise prescription for patients with coronary heart disease. METHODS: This research review will include the following electronic databases from its establishment to December 2020: PubMed, EMBASE, Web of Science, Cochrane Library, the Chinese National Knowledge Infrastructure, the Chinese Science and Technology Periodical Database, and Wanfang. Objective to search randomized controlled trials (RCTs) about the effects of mind-body exercise on cardiopulmonary function, blood pressure and QOL in patients with coronary heart disease. CONCLUSION: This systematic review and meta-analysis will provide strong evidence for the efficacy and safety of mind-body exercise in patients with coronary heart disease. SYSTEMATIC REVIEW REGISTRATION: INPLASY202120016. ETHICS AND DISSEMINATION: Ethical approval will not be necessary since this systematic review and meta-analysis will not contain any private information of participants or violate their human rights.

A systematic review of effects of recorded music listening during exercise on physical activity adherence and health outcomes in patients with coronary heart disease.

BACKGROUND: Exercise training is a key facet of cardiac rehabilitation and is associated with irrefutable benefits for individuals with coronary heart disease. However, compliance with and adherence to such interventions are challenging among this population. The incorporation of music into exercise training may be a potential approach to address this issue. OBJECTIVES: This study aimed to evaluate the effects of recorded music listening during exercise on adherence to physical activity and health outcomes in individuals with coronary heart disease. METHODS: A systematic review was conducted by searching 7 English databases for reports of randomized controlled trials and quasi-experimental studies evaluating the effects of recorded music listening during exercise on adherence to physical activity and physical, psychological, and cognitive outcomes in adults with coronary heart disease. Two reviewers independently screened records for eligibility, extracted data, and assessed the quality of reports by using the Effective Public Health Practice Project Quality Assessment Tool tool. RESULTS: We identified 7 studies involving 293 participants (mean age 62.6 to 72 years, men: 57% to 80%). All but one study included relatively small samples (17 to 56). The overall quality was weak for 3 studies, moderate for 2, and strong for 2. Several reviewed studies showed significant effects of music on attendance at exercise-based cardiac rehabilitation (1 of 2 studies), maintenance of physical activity after intervention (1 study), perceived exertion (2 of 3 studies), exercise capacity (1 of 3 studies), heart rate during exercise (1 of 2 studies), male waist circumference (1 of 2 studies), mood (2 of 3 studies), and cognitive function (1 study) as compared with controls. CONCLUSIONS: This review provides relatively limited evidence for the potential benefits of recorded music listening during exercise in individuals with coronary heart disease. The findings should be carefully interpreted and generalised. Further rigorous-designed research addressing the limitations of current literature is needed.

Effects of Yangxinshi tablet on exercise tolerance in patients with coronary heart disease: A protocol of randomized, double-blind, placebo-controlled, and multi-center trial.

BACKGROUND: Exercise intolerance is very common in patients with coronary heart disease (CHD). Although some researches confirming the validation of traditional Chinese medicine (TCM) on CHD treatment, the effect of TCM on improving the exercise tolerance of patients with CHD remains unclear so far. Our trial is to investigate whether the Yangxinshi (YXS) tablet can improve exercise tolerance as well as the quality of life among CHD patients. METHODS: It is a randomized, double-blind, placebo-controlled, multi-center trial. A total of 90 patients with CHD from 3 hospitals in China will be enrolled and randomly assigned to one of 2 groups: YXS group, N = 45; placebo group, N = 45. The 2 groups will simultaneously receive standardized western medicine and exercise-based cardiac rehabilitation program for 12 weeks. The primary outcome measure is the exercise capacity, which will be evaluated by the cardiopulmonary exercise test and 6-minute walking test. The 2nd outcomes include symptom improvement, psychologic issues, laboratory tests, side effects, and adverse events. DISCUSSION: To our knowledge, it is the 1st randomized controlled trial to evaluate the effect of TCM YXS tablet on exercise tolerance in patients with CHD. The results will provide more evidence for future studies in this area. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5752).

Complementary and alternative medicine use in coronary heart disease patients: a cross-sectional study from Palestine.

BACKGROUND: There is a lack of data on the use of complementary and alternative medicine (CAM) in patients with coronary heart disease (CHD). This study examined the use of CAM among patients with CHD, the reasons and factors influencing their use, the types of CAM used, and the relationship between patient's demographics and the use of CAM. METHODS: In order to determine the prevalence and usage of CAM among Palestinian patients with CHD, a cross-sectional descriptive study was performed from three different hospitals. Using a convenient sampling method, a questionnaire was completed in a face-to-face interview with the patients. Descriptive statistics were used for socio-demographic, and clinical variables. Siahpush scale was used to examine the attitude of CHD patients toward CAM use. RESULTS: Of the 150 patients that were interviewed, 128 (85.3%) of the patients completed the questionnaire. The majority of CAM users reported CAM use for health problems other than CHD, while a total of 59 (45.9%) patients have used CAM for their heart problems. On the other hand, it was found that the place of residency and pattern of CHD were significantly associated with CAM use (p = 0.039 and 0.044, respectively). In addition, religious practices were found to be the most common form of CAM used by patients, while body and traditional alternative methods were the least being used. A significant association between the attitudes of patients with CHD and their use of CAM was found (patients' attitudes towards alternative medicine and natural remedies were p = 0.011 and 0.044, respectively). CONCLUSIONS: CAM use among our respondents is common. Despite a lack of evidence-based research supporting its potential benefits and side effects. Understanding the factors that affect CAM use by CHD patients offers healthcare workers and policymakers an opportunity to better understand CAM use and ultimately improve patient-physician interactions.

[Effect of traditional Chinese medicine in attenuating coronary heart disease and main risk factors by regulating gut micro-biota].

Ischemic heart disease has became the world's most common deadly disease, and coronary heart disease(CHD) is the most common type of ischemic heart disease. The pathological mechanism of CHD has not been fully elucidated. In recent years, scientific studies have found that gut micro-biota are closely related to the occurrence and development of CHD, and CHD could be intervened by regulating gut micro-biota because of the correlation between CHD and intermediate metabolite of gut micro-biota. Current intervention strategies mainly include probiotics supplementation, reduction of TMAO and increase of SCFAs, which can achieve the effect of stabilizing plaques, and controlling blood pressure, blood lipids, blood glucose and obesity. Traditional Chinese medicine(TCM) has the multi-component and multi-target effects, which is correlated to its role in the prevention and treatment of CHD. This paper summarizes the domestic and foreign researches on the effect of TCM in attenuating CHD and its main risk factors by regulating gut micro-biota. The article aims to explore the correlation between gut micro-biota and CHD, and propose three main intervention strategies. Furthermore, the research progress of TCM on CHD, hypertension, dyslipidemia, hyperglycemia and obesity is reviewed by the categories of Chinese medicine monomer and compound, in the hope to provide more theoretical basis for TCM therapy on CHD and guidance for further studies in this field.

Network Medicine: A Clinical Approach for Precision Medicine and Personalized Therapy in Coronary Heart Disease.

Early identification of coronary atherosclerotic pathogenic mechanisms is useful for predicting the risk of coronary heart disease (CHD) and future cardiac events. Epigenome changes may clarify a significant fraction of this "missing hereditability", thus offering novel potential biomarkers for prevention and care of CHD. The rapidly growing disciplines of systems biology and network science are now poised to meet the fields of precision medicine and personalized therapy. Network medicine integrates standard clinical recording and non-invasive, advanced cardiac imaging tools with epigenetics into deep learning for in-depth CHD molecular phenotyping. This approach could potentially explore developing novel drugs from natural compounds (i.e. polyphenols, folic acid) and repurposing current drugs, such as statins and metformin. Several clinical trials have exploited epigenetic tags and epigenetic sensitive drugs both in primary and secondary prevention. Due to their stability in plasma and easiness of detection, many ongoing clinical trials are focused on the evaluation of circulating miRNAs (e.g. miR-8059 and miR-320a) in blood, in association with imaging parameters such as coronary calcifications and stenosis degree detected by coronary computed tomography angiography (CCTA), or functional parameters provided by FFR/CT and PET/CT. Although epigenetic modifications have also been prioritized through network based approaches, the whole set of molecular interactions (interactome) in CHD is still under investigation for primary prevention strategies.

Yoga and Cardiovascular Health Trial (YACHT): a UK-based randomised mechanistic study of a yoga intervention plus usual care versus usual care alone following an acute coronary event.

OBJECTIVE: To determine the effects of yoga practice on subclinical cardiovascular measures, risk factors and neuro-endocrine pathways in patients undergoing cardiac rehabilitation (CR) following acute coronary events. DESIGN: 3-month, two-arm (yoga +usual care vs usual care alone) parallel randomised mechanistic study. SETTING: One general hospital and two primary care CR centres in London. Assessments were conducted at Imperial College London. PARTICIPANTS: 80 participants, aged 35-80 years (68% men, 60% South Asian) referred to CR programmes 2012-2014. INTERVENTION: A certified yoga teacher conducted yoga classes which included exercises in stretching, breathing, healing imagery and deep relaxation. It was pre-specified that at least 18 yoga classes were attended for inclusion in analysis. Participants and partners in both groups were invited to attend weekly a 6- to 12-week local standard UK National Health Service CR programme. MAIN OUTCOME MEASURES: (i) Estimated left ventricular filling pressure (E/e'), (ii) distance walked, fatigue and breathlessness in a 6 min walk test, (iii) blood pressure, heart rate and estimated peak VO2 following a 3 min step-test. Effects on the hypothalamus-pituitary-adrenal axis, autonomic function, body fat, blood lipids and glucose, stress and general health were also explored. RESULTS: 25 participants in the yoga + usual care group and 35 participants in the usual care group completed the study. Following the 3-month intervention period, E/e' was not improved by yoga (E/e': between-group difference: yoga minus usual care:-0.40 (-1.38, 0.58). Exercise testing and secondary outcomes also showed no benefits of yoga. CONCLUSIONS: In this small UK-based randomised mechanistic study, with 60 completing participants (of whom 25 were in the yoga + usual care group), we found no discernible improvement associated with the addition of a structured 3-month yoga intervention to usual CR care in key cardiovascular and neuroendocrine measures shown to be responsive to yoga in previous mechanistic studies. TRIAL REGISTRATION NUMBER: NCT01597960; Pre-results.

Cardioprotective effect of transcutaneous electrical acupuncture point stimulation on perioperative elderly patients with coronary heart disease: a prospective, randomized, controlled clinical trial.

PURPOSE: The purpose of this study was to evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) on postoperative autonomic nervous system function and serum biomarkers in the elderly. PATIENTS AND METHODS: A total of 122 American Society of Anesthesiologists class II or III patients with coronary heart disease undergoing spinal surgery were randomly divided into two groups: TEAS (received TEAS at Neiguan [PC6] and Ximen [PC4] for 30 minutes before anesthesia induction until the end of surgery) and control (received electrode plate at the same acupuncture points without any electrical stimulation). Serum was isolated for the measurement of concentration of high-sensitive troponin T (hs-cTnT), CRP, and CK. Heart rate (HR) and heart rate variability (HRV) including: total power (TP), low-frequency (LF) power, high-frequency (HF) power, and LF/HF ratio were used to assess autonomic nervous system function. The primary outcome was to evaluate whether TEAS changed the postoperative serum hs-cTnT. The secondary outcomes were to observe the effects of TEAS on HRV, circulating CK and CRP after surgery. RESULTS: Hs-cTnT, CRP, and CK concentrations were significantly higher on first, third and fifth day after surgery than those before anesthesia induction in both groups. Hs-cTnT concentration was significantly lower on the first and third day after surgery in TEAS group than in control group. Compared with 1 day before surgery, TP, LF, and HF decreased significantly and HR, LF/HF increased significantly on first, third, and fifth day after surgery in control group. Compared with control group, HR was significantly lower on the first, third, and fifth day after surgery, LF/HF decreased and TP, LF, HF were significantly higher on the first day after surgery in TEAS group. CONCLUSION: TEAS at PC6 and PC4 could reduce postoperative serum hs-cTnT concentration and change HRV index to improve autonomic nervous system activity.

Antithrombotic Therapy for Atrial Fibrillation with Stable Coronary Disease.

BACKGROUND: There are limited data from randomized trials evaluating the use of antithrombotic therapy in patients with atrial fibrillation and stable coronary artery disease. METHODS: In a multicenter, open-label trial conducted in Japan, we randomly assigned 2236 patients with atrial fibrillation who had undergone percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG) more than 1 year earlier or who had angiographically confirmed coronary artery disease not requiring revascularization to receive monotherapy with rivaroxaban (a non-vitamin K antagonist oral anticoagulant) or combination therapy with rivaroxaban plus a single antiplatelet agent. The primary efficacy end point was a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death from any cause; this end point was analyzed for noninferiority with a noninferiority margin of 1.46. The primary safety end point was major bleeding, according to the criteria of the International Society on Thrombosis and Hemostasis; this end point was analyzed for superiority. RESULTS: The trial was stopped early because of increased mortality in the combination-therapy group. Rivaroxaban monotherapy was noninferior to combination therapy for the primary efficacy end point, with event rates of 4.14% and 5.75% per patient-year, respectively (hazard ratio, 0.72; 95% confidence interval [CI], 0.55 to 0.95; P<0.001 for noninferiority). Rivaroxaban monotherapy was superior to combination therapy for the primary safety end point, with event rates of 1.62% and 2.76% per patient-year, respectively (hazard ratio, 0.59; 95% CI, 0.39 to 0.89; P = 0.01 for superiority). CONCLUSIONS: As antithrombotic therapy, rivaroxaban monotherapy was noninferior to combination therapy for efficacy and superior for safety in patients with atrial fibrillation and stable coronary artery disease. (Funded by the Japan Cardiovascular Research Foundation; AFIRE UMIN Clinical Trials Registry number, UMIN000016612; and ClinicalTrials.gov number, NCT02642419.).

Model for integrated care for chronic disease in the Australian context: Western Sydney Integrated Care Program.

Objective To describe the implementation of a model of integrated care for chronic disease in Western Sydney. This model was established on the basis of a partnership between the Local Health District and the Primary Health Network. Methods The Western Sydney Integrated Care Program (WSICP) focuses on people with type 2 diabetes, chronic obstructive pulmonary disease and coronary artery disease or congestive cardiac failure. We describe the design of the program, the processes involved and some of the challenges and barriers to integration. Results Early data indicate a high uptake of services, with some evidence of a reduction in hospital admissions and presentations to the emergency department. Conclusion A model of integrated care has been successfully implemented and embedded into local practices. Preliminary data suggest that this is having an impact on the utilisation of hospital services. What is known about the topic? There is evidence that integrated models can improve cost-effectiveness and the quality of clinical care for people with chronic disease. However, most integrated models are small scale, focus on very specific populations and generally do not engage both primary care and acute hospitals. What does this paper add? This paper describes an effective partnership between state-funded hospital services in the WSLHD and the federally funded local Primary Health Network (PHN) of general practitioners. The paper outlines the design of the program and the structural, governance and clinical steps taken to embed integrated care into everyday clinical practice. In addition, preliminary results indicate a reduction in the use of hospital services by people who have received integrated care services. What are the implications for practitioners? Involvement of both primary care and the public hospital system is important for a successful and sustainable integrated care program. This is a long and challenging process, but it can lead to positive effects not just for individuals, but also for the health system as a whole.

[Data-mining-revealed Regularities of Application of Meridian Acupoints for Coronary Heart Disease in Ancient Chinese Medical Literature].

OBJECTIVE: To analyze the regularities of selection of meridian acupoints for coronary heart disease (CHD) recorded in the ancient Chinese medical literature, in order to provide a reference for clinical application of meridian acupoint recipes to treat CHD nowadays. METHODS: Papers were retrieved from 1 156 ancient Chinese medical books collected in "Encyclopedia of Traditional Chinese Medicine" (Fifth Edition) by using key words "Xin Tong"(cardiac pain), "Zhen Xin Tong"(true heart pain), "Jue Xin Tong"(precordial pain with cold limbs), "Xiong Bi" (obstruction of qi in the chest), "Zheng Chong"(severe palpitation), "Xin Ji"(palpitation), followed by establishment of a database. Then, the association analysis data mining technology was used to analyze the characteristics and regularities of application of meridian acupoints in the treatment of CHD. RESULTS: A total of 347 items of ancient document data were collected, containing acupoints of the 12 regular meridians, Conception Vessel and Governor Vessel, with a frequency of usage being 625 times. Among the involved meridians, the Conception Vessel was most frequently used, followed by the Pericardium Meridian. Zhongwan (CV 12) was the most frequently used acupoint, and Rangu (KI 2) and Taixi (KI 3), CV 12 and Shangwan (CV 13), and Quze (PC 3) and Daling (PC 7) were the top 3 frequently used auxiliary acupoint pairs. CONCLUSION: In ancient China, in the treatment of CHD, the main acupoints of the Conception and Pericardium Meridian, and the auxiliary acupoints i．e., five-shu points are most frequently used. PC 3 and PC 7 combination is suitable for the treatment of CHD with negative emotion.