[Show abstract][Hide abstract] ABSTRACT: To assess the effect (harms and benefits) of nitrates for stable angina.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Randomized controlled trials with both parallel and crossover design were included. The following outcome measures were evaluated: number of angina attacks weekly and nitroglycerin consumption, quality of life, total exercise duration, time to onset of angina and time to 1 mm ST depression.
Fifty-one trials with 3595 patients meeting inclusion criteria were analyzed. Both intermittent and continuous regimens of nitrates lengthened exercise duration significantly by 31 and 53 s respectively. The number of angina attacks was significantly reduced by 2.89 episodes weekly for continuous administration and 1.5 episodes weekly for intermittent administration. With intermittent administration, increased dose provided with 21 s more length of exercise duration. With continuous administration, exercise duration was pronged more in low-dose group. Quality of life was not improved by continuous application of GTN patches and was similar between continuous and intermittent groups. In addition, 51.6% patients receiving nitrates complained with headache.
Long-term administration of nitrates was beneficial for angina prophylaxis and improved exercise performance but might be ineffective for improving quality of life. With continuous regimen, low-dose nitrates were more effective than high-dose ones for improving exercise performance. By contrast, with intermittent regimen, high-dose nitrates were more effective. In addition, intermittent administration could bring zero-hour effect.
International journal of cardiology 01/2011; 146(1):4-12. · 7.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sudden cardiac death (SCD) from cardiac arrest, one of the most common types of cardiac-related death, is most often triggered by ventricular arrhythmia (VA). It has been reported that aldosterone antagonists (AAs) have the benefit of reducing SCD in patients with heart failure (HF). It also has been indicated in animal experiments and clinical trials that AAs may have an antiarrhythmic effect.
AAs have an effect on VA in patients with HF or coronary artery disease.
We searched the Cochrane Central Register of Controlled Trials, PubMed, Current Controlled Trials, and the National Research Register, and identified randomized controlled trials on the effect of AAs on VA.
All together, 7 trials with a total of 8635 patients were identified and extracted. AAs reduced the risk of SCD in patients with HF by 21% (relative risk [RR]: 0.79, 95% confidence interval [CI]: 0.67-0.93). AAs significantly reduced the episodes of ventricular premature complexes (mean difference 705 ± 646 episodes per 24 hours). Risk of ventricular tachycardia was reduced by 72% (RR: 0.28, 95% CI: 0.10-0.77).
The additional administration of AAs in patients with HF or coronary artery disease shows a benefit in reducing the risk of SCD and may also be effective for reducing episodes of ventricular premature complexes and ventricular tachycardia.
[Show abstract][Hide abstract] ABSTRACT: Acute myocardial infarction (AMI) is the most important cause of morbidity from ischaemic heart disease, and is among the leading causes of death in the western world. Danshen, a Chinese herbal medicine, is widely used in China for treatment of several diseases, including AMI.
To assess the effects (both benefits and harms) of danshen preparations for AMI.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (issue 4, 2006), MEDLINE (1966-2006), EMBASE (1980-2006), and the Chinese Biomedical Database (CBM) (1982-2006). We also handsearched 75 Chinese medical journals.
Randomised controlled trials (RCTs) lasting at least 7 days were sought. Since it seemed evident that few RCTs were available, we also considered other controlled studies.
Eligibility and trial quality were assessed by three reviewers.
Six studies comprised of 2368 participants were included. Only one trial was judged to be a genuine RCT and showed no statistically significant difference in reduction of total mortality (Peto OR 0.55, 95% CI 0.23 to 1.32), but a quasi-RCT reported a reduced total mortality (Peto OR 0.42, 95% CI 0.23 to 0.77). Pooling these trials yielded an approximate halving of mortality in those patients treated with danshen preparations plus usual care compared with usual care alone (Peto OR 0.46, 95% CI 0.28 to 0.75).
The evidence to support use of danshen preparations is too weak to make any judgement about its effects. Evidence from RCTs is insufficient and of low quality. The safety of danshen preparations is unproven, although some adverse events have been reported. More evidence from high quality trials is needed to support the clinical use of danshen preparations.
[Show abstract][Hide abstract] ABSTRACT: To assess the effectiveness and safety of Chinese medicinal herbs for treating uncomplicated acute bronchitis.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which includes the Cochrane Acute Respiratory Infections Group's specialized register; The Chinese Cochrane Centre's Controlled Trials Register; MEDLINE; EMBASE; and the Chinese Biomedical Database (CBM).
We only included randomized controlled trials. At least two authors extracted data and assessed trial quality.
Four trials reported the time to improvement of cough, fever, and rales associated with bronchitis and showed that patients treated with Chinese herbs had a shorter duration of signs and symptoms. Two trials reported the proportion of patients with improved signs and symptoms at follow-up and showed that Chinese herbs were beneficial in terms of relief of signs and symptoms. Thirteen (13) trials analyzed the data on physician global assessment of improvement at follow-up. Nine (9) of 13 trials showed that Chinese herbs were superior to routine treatment and the other four trials showed a similar effect to routine treatment. In general, Chinese herbs appeared beneficial. Only one trial reported adverse effects during treatment.
There are insufficient quality data to recommend the routine use of Chinese herbs for acute bronchitis. The benefit found in this systematic review could be due to publication bias and study-design limitations of the individual studies. In addition, the safety of Chinese herbs is unknown due to the lack of toxicological evidence on these Chinese herbs, though adverse events are rarely reported.
The Journal of Alternative and Complementary Medicine 04/2006; 12(2):159-69. · 1.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Tongxinluo capsule is a medicine consisting of traditional Chinese herbs and insects used for cardiovascular diseases in China and some other Asian countries. To date the evidence of its effect has not previously been subject to systematic review, making it difficult to derive robust conclusions about its actual benefits, and indeed, possible harms.
To assess systematically the effects of tongxinluo capsule in people with unstable angina pectoris.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, Issue 4 2004, MEDLINE, EMBASE, Chinese Biomedical Database, China National Knowledge Infrastructure, Japana Centra Revuo Medicina (all 1995 to 2005). We also handsearched the relevant Chinese journals, checked with manufacturers and registers of ongoing studies.
Randomised trials comparing either tongxinluo capsule only or standard treatment plus tongxinluo capsule with standard treatment or other anti-angina pectoris drugs, placebo or no intervention.
Two authors identified relevant studies for the review independently and went on to abstract data, and assess trial quality. Authors of included studies were contacted to obtain further information as required.
18 short term follow-up trials involving 1413 people were included. The studies did not provide strong support of a benefit of tongxinluo for reducing the combined outcome of acute myocardial infarction, angioplasty (PTCA) coronary artery bypass graft (CABG) and sudden death or all-cause mortality (RR 0.42, 95% CI 0.07 to 2.59, P=0.35; RR 0.33, 95% CI 0.01to 7.78, P=0.49, respectively). Tongxinluo reduced the frequency of acute angina attacks (WMD -1.20, 95%CI -1.38 to -1.02, P<0.00001 and RR -2.36, 95%CI -2.53 to -2.18, P<0.00001, respectively), improved ECG (RR 1.31, 95% CI 1.08 to 1.57, P=0.005) and angina symptoms (RR 1.21, 95% CI 1.06 to 1.40; P=0.007).
Tongxinluo in combination with routine angina therapy appears to reduce the risk of subsequent AMI, PTCA or CABG, angina attacks and severity, as well as improving symptoms and ischaemic changes on the electrocardiogram (ECG). Due to the methodological limitations of the studies, the evidence is insufficient to make any conclusive recommendations about the use of this treatment for patients presenting with unstable angina. Large high quality randomised controlled trials are warranted.
[Show abstract][Hide abstract] ABSTRACT: To assess the benefits and harms of artemisinin-type compounds for preventing schistosomiasis.
The quality of included randomised controlled trials with the people at risk of contacting schistosomiasis were evaluated and Meta-analysis was conducted.
We found ten randomised controlled trials relating to our question. Of them, four trials were multi-centre studies, others were single centre studies. Numbers of participants in the trials ranged from 318 to 5,098, total 12,829. The total OR of 0.11 (95% CI 0.06 to 0.21) indicated that those who were administrated artemisinin-type compounds were significantly less infected with Schistosoma japonica than those who were administrated placebo.
Artemisinin-type compounds are effective drug for preventing Schistosomiasis japonica infection. Fifteen days interval schemes of artesunate and artemether be considered preferable to seven days interval scheme and were associated with very few side effects. More high quality controlled trials are required for assessing which scheme is the better. These studies should be large.