2023-10-25 06:30:15
In capsule form, tongxinluo is a product from traditional Chinese medicine whose name means “to open (tong) the network (luo) of the heart (xin)”. It is composed of powders and extracts of several plants and insects.
Although its active substance(s) and mechanisms of action are still uncertain, it may have some cardioprotective effect. In humans, a first study was carried out on around 200 patients who had an acute ST-segment elevation infarction, but the results needed to be confirmed in a larger randomized trial, write Yuejin Yang of Fuwai Hospital in Beijing and his colleagues in the introduction to their study.
Thus, 3,777 STEMI patients were randomized the day following the appearance of symptoms between tongxinluo (2.08 g at the start, then 1.04 g three times a day) and a placebo, in addition to standard STEMI treatments.
The majority of patients were men (77%) with an average age of 61. Almost all patients received aspirin, P2Y12 inhibitors, and statins. Less than two-thirds received beta-blockers and, for half, angiotensin II receptor antagonists (AIARs) and angiotensin-converting enzyme inhibitors (ACEIs).
The primary endpoint of the study was the 30-day incidence of major adverse cardiac and cerebral events (MACCE), including cardiac mortality, re-infarction, stroke, and revascularization. coronary.
Tongxinluo was thus associated with a benefit at one month, with incidences of MACCE of 3.4 cases per 100 patients on tongxinluo (64 cases) and 5.2 cases per 100 control patients (99 cases). This corresponds to a significant reduction in the risk of MACCE of 36% over the first month post-STEMI.
Concerning the criteria taken individually, a significant reduction in the risk of cardiac death of 30% was also observed at 30 days, and of 65% for recurrence of infarction – even if there were very few cases observed for this. last criterion (0 under tongxinluo, 9 under placebo). There was no significant difference in stroke risk at one month.
At one year, patients treated with Tongxinluo still had a reduced risk of MACCE (-36%), cardiac death (-27%) and recurrent heart attack (-74%) compared to patients taking placebo, but also stroke (-56%).
Traditional treatment was also associated with a one-year reduction in the risk of new hospitalization for heart failure by 52%. However, it had no effect on all-cause mortality at one year.
Concerning safety, tongxinluo was not associated with any particular signal compared to placebo.
As traditional Chinese medicine is often discredited due to a lack of modern scientific basis and quantitative evaluations, this study can serve as a model for future clinical trials aimed at evaluating the safety and effectiveness of other treatments of this type, say the authors in conclusion.
Further research will also be needed to understand the mechanism of action of tongxinluo in STEMI. The authors explain that the compound has previously been shown to “promote myocardial microvascular perfusion and reduce ischemia-reperfusion injury” and “may also stabilize vulnerable coronary plaques.”
(JAMA, online publication of October 24)
Source: APMnews
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