Cardiovascular disease is the leading cause of death worldwide. Serious side effects of therapeutic drugs lead to increased awareness of the role of Chinese herbal medicine in the treatment of cardiovascular disease. Chinese herbal medicine has been widely used in many countries, especially China, since ancient times; However, the mechanisms by which herbal medicines can prevent or treat cardiovascular disease are unclear. In this review, we briefly describe the medicinal properties of Chinese herbs in comparison with Western medicine. We then categorized the prescriptions and herbal/natural products used in clinical and animal studies according to cardiovascular risk factors. Importantly, we elaborate on existing research on the mechanisms by which plant compounds act at the cellular level, including vascular smooth muscle cells, endothelial cells, cardiomyocytes, and immune cells. Future research should focus on well-designed clinical trials, in-depth mechanistic studies, and studies of herbal side effects and drug interactions. Research to develop effective and safe new drugs from traditional Chinese medicine is a promising way to prevent and treat cardiovascular diseases.
Key words: Chinese herbal medicine, hypertension, atherosclerosis, dyslipidemia, heart disease, cardiovascular disease
Cardiovascular diseases, especially atherosclerosis, hypertension, cardiac hypertrophy, myocardial infarction, and heart failure, are the leading causes of death worldwide. The increasing number of patients with CVD worldwide highlights the need for more effective prevention and innovative treatment strategies. Currently, Western medicine, CHM and integrative medicine are the three major models of health care around the world. Western medicine is considered the primary treatment method. For example, antithrombotic drugs are widely used in patients with CVD in combination with timely revascularization, coronary artery bypass grafting, or prior coronary heart surgery. Although widespread evidence has shown that these treatment regimens are effective in reducing cardiovascular morbidity, serious adverse effects remain a major challenge. Therefore, this has led to the search for alternative and complementary therapies to better manage CKD. CHM often uses natural herbal products such as nutritional factors or herbal medicines. There is increasing awareness of the role of medicinal plants in the prevention and treatment of CVD (Li et al., 2015). With the more successful use of CHM in hospitals for the prevention and treatment of CVD, the effectiveness of CHM has attracted more attention even in developed countries such as the United States and Australia. In this review, we focus on clinical practice and experimental studies to summarize mechanistic studies on the use and use of herbal products.
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Search strategy
To view all studies that directly described the use of CHM in CVD, we limited the search to the keywords “cardiovascular” and “herbs” in the title and/or abstract. The first search returned 281 results. We then selected the articles based on their objectives. Since there are many formulas widely used in Chinese medicine, guidelines for the diagnosis and treatment of common internal diseases in Chinese medicine are also discussed. A total of 123 articles and 1 Chinese guideline were finally included in the review.
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Comparison of CHM and Western Medicine
Chinese herbal medicine is characterized by “holistic regulation” that considers the organism as a whole. Because they are guided by the balance of the human body, HCW doctors focus more on the sick person than on the disease that afflicts them. Specific Western medicine focuses on specific physiological targets, neglecting the unique characteristics of each patient, and has a strong effect on specific diseases.
“Treatment based on the differentiation of syndromes” is another characteristic of traditional Chinese medicine, in which diagnosis and treatment are based on the general analysis of the disease, and doctors change the prescription in time according to various syndromes and clinical symptoms. Therefore, it is an individualized treatment for different patients, even with the same disease. Western medicine often works against specific disease processes, not the patient.
Many CHMs and foods come from the same source, and the “Drug-Food Similarity” feature suggests that CHMs have fewer adverse effects. Traditionally, certain foods have been preferred over health-preserving medicines, and certain types of plants have been considered food. Hawthorn berries and garlic are such examples. However, because of its strong dependence, Western medicine is bound to have side effects. Although
the efficacy of CHM is not as strong as chemicals on a pathological process of CVDs, the feature of individualized intervention with minimum adverse effects makes CHM would be a good choice and will continue to make great contributions to the health of CVDs patients.
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Application of CHM in CVDs
Many experimental studies indicate that a great many herbs have potential benefits for CVDs. Herbal plant-based formulations or drugs are pivotal to traditional practices and application of plant products as CHM treatment has been widely used in patients with hypertension, atherosclerosis, congestive heart failure, angina pectoris and other cardiovascular risk factors.
Application of Plant Products in Hypertension
Hypertension is a worldwide health problem with high morbidity and a major player in the onset of diseases such as atherosclerosis, stroke, peripheral artery disease, heart failure and coronary artery disease. Hypertension is defined as having a systolic BP of ≥140 mmHg and a diastolic BP of ≥90 mmHg. Every 20/10 (systolic BP/diastolic BP) mmHg increase indicates a higher risk stage of hypertension, stage 1 (140–159/90–99 mmHg) and stage 2 (≥160/100 mmHg) with the latter stage requiring immediate medical attention attention.
Notably, there are some formulas, many well-known herbal products and their extracts or secondary metabolites of the herbs and spices exhibit antihypertensive effects. Interestingly, in a population-based database enrolling 984 CHM users and 2434 non-CHM users with hypertension among type 2 diabetes patients, the CHM users were characterized with slightly longer duration time from diabetes to hypertension, suggesting that CHM may restrain hypertension pathogenesis among type 2 diabetes. 2 diabetes patients (Lin et al., 2015). Here, we present the most commonly used formulas and a comprehensive alphabetical list of plant products with evidence suggesting beneficial in hypertension therapy.
Formulae Yiqi Huaju Formula and Bushen Qinggan Formula are regularly applied in clinical practice for treating hypertension. Yiqi Huaju Formula consists of Gastrodia elata, Uncaria, Eucommia bark, radix Scutellariae, and bitter butyl tea. In a study with 43 hypertensive patients coupled with metabolic syndrome, 12 weeks of additional use of Yiqi Huaju Formula (together with anti-hypertensive drugs) significantly decreased systolic BP and 24-h BP variability compared with the control group (anti-hypertensive drugs plus placebo), indicating that Yiqi Huaju treatment may be better than antihypertensive drugs alone (Chen et al., 2013). Bushen Qinggan Formula consists of Astragali Mongholici, Rhizoma Coptidis, Pollen Typhae, Rhizoma Alismatis, and Artemisiae Capillaries. A favorable effect of Bushen Qinggan Formula was observed on control of BP variability level after 8 weeks of treatment in a randomized controlled pilot clinical trial (150 patients with hypertension). This was accompanied by decreased endothelin and elevated nitric oxide (NO)/endothelin in circulation, indicating improved endothelial function (Wu et al., 2014). In addition, according to the Guidelines for Diagnosis and Treatment of Common Internal Diseases in Chinese Medicine, there are some frequently used formulas for hypertension in the clinic which are based on syndrome differentiation (China Association of Chinese Medicine, 2008). The formulas are listed in Table