Traditional Chinese interventions for stable angina.
Zheng Jie, Li Jin, Liu Guanjian, Chen Xiaoyan, Wang Qin, Ni Juan, Wei Jiafu, Duan Xin, Zhou Likun
Background: Traditional Chinese medicines have been used by more and more physicians for its anti-angina properties. But their anti-angina properties and adverse effects should be systematically reviewed.
Objectives: To assess the effect (harms and benefits) of traditional Chinese medicines for stable angina. Specific comparisons will be made between traditional Chinese medicine and current standard treatment regimen.
Methods: We hand-searched about 60 kinds of Chinese traditional medicine journals, and also searched the Cochrane Heart Review Group trials register, the Cochrane Controlled Trials Register, MEDILINE (1995 to 2003), EMBASE (1995 TO 2003), CBM (Chinese biomedical database, 1995 to 2003), Chinese Cochrane Centre Controlled Trials Register (to 2003), and Cochrane Library (to 2003). We also searched databases of undergoing trials in Current Controlled Trials (
www.controlled-trials.com), and The National Research Register (
www.update-software.com/National/nrr-frame.html). Still we contacted manufacturers and researchers in this field.
Randomised and quasi-randomised controlled trials comparing traditional Chinese medicine with other anti-angina drugs, placebo or no intervention, and comparison among different doses or routes of administrations of traditional Chinese medicine, and any adverse effects are included in our review.
Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. Results: Twenty-one trials involving 1772 people were included in out review. (1)Symptom relief: Six trials involving 562 people compared traditional Chinese medicine (TCM) with routine therapy. Compared with routine therapy, TCM can significantly relieve the angina symptom (total odds ratio 5.90, 95% confidence interval 3.29 to 10.57). (2)ECG improvement: It was documented in twelve trials involving 1147 people, showing that TCM improve the ECG measurement better than routine therapy (total odds ratio 2.89, 95% confidence interval 2.24 to 3.72). (3)We particularly assessed effectiveness of composite Dansheng droplet pills: As one of the most common used TCM, composite Dansheng droplet pills and its effects and adverse reactions were also reviewed. Five trials involving 575 people, comparing composite Dansheng droplet pills with routine therapy and other TCM, showed that it could relieve the angina symptom (odds ratio 5.52, 95% confidence interval 3.07 to 9.90). Seven trials showed that Composite Dansheng droplet pills had significantly less adverse reactions caused by vasodilatation (e.g. headache, flush) (odds ratio 0.03, 95% confidence interval 0.01 to 0.09). However, based on four trials involving 475 people, the slight gastrointestinal reactions were more common with Composite Dansheng droplet pills than other routine therapies (odds ratio 5.62, 95% confidence interval 1.24 to 25.38).
Conclusions: Traditional Chinese interventions appear to be more effective than routine therapies in both reliving the angina symptoms and improving ECG measurements of angina patients. As to the adverse reactions, TCM seems have much less headache and flush caused by vasodilatation.
Acknowledgements: We thank Dr. Theresa Moore, Dr. Katherine Wornell and Prof. Taixiang Wu, for advice in writing this protocol.
http://www.cochrane.org/colloquia/abstr ... /P-064.htm
