New Findings on Traditional Chinese Medicine from Academician Zhang Yun's Research Team Draw International Attention-Shandong University

A state-of-the-art paper titled "Traditional Chinese Medicine for Cardiovascular Disease: Evidence and Potential Mechanisms" was published online in June, 2017 in theJournal of the American College of Cardiology(J Am Coll Cardiol 2017, 69(24):2952-2966; 2016 IF 19.896; Top 1 in the field of cardiac & cardiovascular systems). Meanwhile, this latest news was released to the public and other press by American College of Cardiology, which was widely reported.

This work was finished by Academician of the CAE Zhang Yun's research team in the Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China. Dr. Hao Panpan is the first author of this paper, and Professors Zhao Yuxia and Zhang Yun served as the co-corresponding authors.

In the paper, investigators selected 56 high-quality double-blinded randomized controlled trials (RCTs) from almost 1,000 studies published from 2006 to 2016, according to strict international criteria. Traditional Chinese medicine (TCM) interventions for hypertension, dyslipidemia, diabetes/pre-diabetes, atherosclerotic cardiovascular disease and chronic heart failure were classified into 2 groups: group A, with evidence from 1 or 2 RCTs that assessed the same compound for the same endpoint with a high-quality design (Jadad score: 5); and group B, with evidence from only 1 RCT that had a moderate-quality design (Jadad score: 3 or 4). Data summaries for the high-quality RCTs of TCM interventions for these conditions were listed in 4 figures. Detailed characteristics of the 56 RCTs were listed in 5 online tables. Thereafter, authors systematically analyzed the pharmacological effects of TCM ingredients, including various polyphenols (baicalein/baicalin and curcumin), terpenoids (tanshinones), saponins (ginsenosides and astragaloside) and alkaloids (berberine and matrine/oxymatrine), on cardiovascular disease, potential mechanisms and experimental models used. Additionally, the corresponding herbs and bioactive ingredients in the TCM formulations were listed in one online table. Results indicate that TCM might be used as a complementary and alternative approach to the primary and secondary prevention of cardiovascular disease. However, further rigorously designed RCTs are warranted to assess the impact of TCM on long-term hard endpoints in patients with cardiovascular disease.

In recent years,Journal of the American College of Cardiologyinvited some famous specialists to review the latest progress in certain fields using the manuscript type "The Present and Future: State-of-the-Art Review". On February 26, 2016, Prof. Zhao Yuxia in the Department of Traditional Chinese Medicine, Shandong University Qilu Hospital received an email from Prof. Valentin Fuster, Editor-in-Chief of Journal of the American College of Cardiology, who invited Yuxia Zhao to examine the recent literature in a comprehensive manner-from basic to clinical to population health perspectives and write a state-of-the-art paper on "Traditional Chinese Medicine for Cardiovascular Disease". With the guidance and help from Profs. Zhao Yuxia and Zhang Yun, 4 other researchers in this team, Hao Panpan, Jiang Fan, Cheng Jing and Ma Lianyue, worked together for more than one year to search for and select literature, analyze data, write and revise the manuscript.

ACC news stated: "Traditional Chinese medicine might be effective as a complement or alternative to traditional Western medicine for primary and secondary prevention of cardiovascular disease, according to a state-of-the-art review paper published June 12 in theJournal of the American College of Cardiology. Western scientists often reject Chinese medicine for specific reasons: the formula consists of dozens of ingredients with many chemical molecules, making it hard to clarify the therapeutic mechanism; the medications available in China do not undergo the same rigorous approval process as Western drugs to guarantee efficacy and safety; and most trials were conducted in China by traditional Chinese medicine physicians with medications largely unavailable in the United States. Panpan Hao, MD, PhD, et al., looked at studies published over the past 10 years on randomized controlled trials of traditional Chinese medicine used for patients with hypertension, dyslipidemia, diabetes/pre-diabetes, atherosclerotic cardiovascular disease and chronic heart failure to assess the efficacy and safety of traditional Chinese medicine. Overall, certain Chinese medications showed suggested benefits for each of the cardiovascular health conditions studied. For example, researchers looked at eight randomized controlled trials on traditional Chinese medicine and hypertension. The evidence indicated that Tiankuijiangya, Zhongfujiangya, Qiqilian, Jiangya and Jiangyabao have antihypertensive effects and a good safety profile, making them a potential good alternative for patients intolerant of or who cannot afford Western medications."

"Of note, one should bear in mind that traditional Chinese medicine medications are usually prescribed as complex formulae, which are often further manipulated by the practitioner on a personalized basis," said Zhao Yuxia, MD, senior author of the study. "The pharmacological effects and the underlying mechanisms of some active ingredients of traditional Chinese medications have been elucidated. Thus, some medications might be used as a complementary and alternative approach for primary and secondary prevention of cardiovascular disease."

Some media websites, including ACC News, World News, Daily Mail Online, HealthDay News, EurekAlert, Practice Update, Physicians Weekly, Montreal Gazette, Doctorslounge, MedicalXpress, Pri-Med, eHealth News, TCTMD, Telegiz, MedSci, and so on, released this news to the public. Prof. Valentin Fuster recorded a 17-min audio summary and uploaded it to the ACC homepage. And HealthDay TV reported this finding by way of video.

Under the leadership of Zhang Yun, some achievements focusing on the basic and clinical research on TCM have been made by the Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital. One previous paper (Am J Physiol Heart Circ Physiol2009, 297: H2004–H2014) reported that Tongxinluo dose-dependently enhanced the stability of vulnerable plaques and prevented plaques from rupture. It was the first high-quality paper focusing on effects of TCM formulations on animal models of cardiovascular disease. Other findings from this lab on TCM for atherosclerosis, heart failure and chronic renal disease were published inJ Am Coll Cardiol, Oncotarget, J Cell Mol Med, PLoS One, J Ethnopharmacol, Evid Based Complement Alternat Med,and so on. Most noteworthy, one invited review on TCM for cardiovascular disease was published inNature Reviews Cardiologyin 2015 (Hao PP, et al. Nat Rev Cardiol, 2015,12:115-122; 2016 IF 14.299). These achievements made TCM research to be one highlight of this lab and promoted TCM to be re-considered and accepted around the world.

Web link of the paper:

http://www.onlinejacc.org/content/69/24/2952?download=true&sso=1&sso_redirect_count=2&access_token=

Web links of the news:

http://www.acc.org/latest-in-cardiology/articles/2017/06/12/16/42/traditional-chinese-medicine-may-benefit-some-cvd-patients

https://www.newsoneplace.com/11644621701/traditional-chinese-medicine-cardiac-diseases

http://www.dailymail.co.uk/health/article-4599854/Chinese-medicine-prevent-heart-disease-diabetes.html

https://consumer.healthday.com/tv/alternative-medicine-information-3/mis-alternative-medicine-news-19/traditional-chinese-medicine-723617.html

https://www.eurekalert.org/pub_releases/2017-06/acoc-tc060817.php

http://www.practiceupdate.com/content/traditional-chinese-medicine-may-benefit-some-cvd-patients/54581/7/2/2

http://www.physiciansweekly.com/traditional-chinese-medicine-may-benefit-some-cvd-patients/

http://montrealgazette.com/health/traditional-chinese-medicine-could-help-treat-cardiac-diseases-study

https://www.doctorslounge.com/index.php/news/pb/72966