Impact Of Formulated Traditional Chinese Medicine On The Endothelial Function In Patients With Unstable Angina

Background: Cardiovascular risk factors, such as dyslipidemia and diabetes mellitus, all contribute to endothelial dysfunction, oxidative stress platelet aggregation and inflammation, which ultimately conspire to accelerate the development and progression of cardiovascular disease. Therefore, to improve impaired endothelial function, inhibit activated platelet and lower elevated blood lipid level is an important and effective way to stop the above vicious circle. Therefore, the present study was designed to explore the effect of formulated traditional Chinese medicine on the endothelial and platelet function in patients with unstable angina using the integration of traditional and western medicine.Methods: A total of 120 patients with unstable angina (Qi-xu Xue-yu sign) were enrolled and divided into two groups according to their primary treatment: conservative treatment group (n=60) and percutaneous coronary intervention (PCI) group (n=60). Patients in these two groups, then, were randomly divided into two groups, respectively: formulated traditional Chinese medicine group (FTCM group) and control group. Patients in control group received standard western medication treatment, while patients in FTCM group received additional formulated traditional Chinese medicine for 1 month besides standard western medication treatment. Fasting venous blood samples were collected for the determination of blood routine, hepatorenal function, blood lipid, platelet adhesion ratio (Pad T), platelet aggregate ratio (Pag T), thromboxane B2 (TXB2), nitric oxide (NO), endothelin 1 (ET1) and brain natriuretic peptide (BNP) in the morning 1 day before and 1 month after the FTCM treatment, respectively. Meanwhile, echocardiography was performed, and the FTCM tolerance was recorded for every patient. The clinical follow-up data at 3 months were collected in these patients.Results:1. Results of conservative group: Endothelial function: The blood level of NO significantly increased while ET1 significantly decreased in both FTCM group and control group after the 1-month treatment (P <0.05). The blood level of NO and ET1 were similar between FTCM group and control group before the treatment. But the blood level of NO was significantly higher and ET1 was significantly lower in FTCM group than in control group after 1 -month treatment.Platelet function: The Pad T, Pag T, and blood level of TXB2 significantly decreased in both FTCM group and control group after the 1-month treatment (P <0.05), while the platelet count did not differ significantly between before and after treatment (P >0.05). The Pad T, Pag T, blood level of TXB2 and platelet count did not differ significantly between FTCM group and control group before the treatment. However, The Pad T and Pag T were significantly lower in FTCM group than in control group after 1-month treatment. While, the blood level of TXB2 and platelet count were still similar between these two groups.2. Results of PCI group:Endothelial function and platelet function: The blood level of NO significantly increased while ET1 , Pad T, Pag T, and blood level of TXB2 significantly decreased in both FTCM group and control group after the 1-month treatment (P <0.05), while the platelet count did not differ significantly between before and after treatment (P >0.05).The blood level of NO, ET1, Pad T, Pag T, TXB2 and platelet count did not differ significantly between FTCM group and control group both before and after the 1-month treatment.BNP and echocardiographic results: The blood level of BNP and echocardiographic results including left atrial dimension (LAD), left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) did not differ significantly between FTCM group and control group both before and after the treatment.Tolerance: The patient's tolerance parameters including gastrointestinal symptoms, and incidences of fecal occult blood and melena did not differ significantly between FTCM group and control group both before and after the treatment.Adverse cardiovascular events: The incidences of adverse cardiovascular events including recurrent angina, acute myocardial infarction, cardiac death and revascularization were similar between FTCM group and control group up to 3 months.Conclusions: FCTM treatment significantly improved the endothelial function and inhibited activated platelet function in patients with unstable angina receiving conservative treatment. However, the FCTM treatment did not significantly show these effects in patient receiving PCI. The FCTM treatment with good tolerance did not significantly improve the clinical outcomes after 3-month follow-up. Further study with long-term follow up and larger study population is needed to get definite conclusions.