Chinese herbal medicine suxiao jiuxin wan for angina pectoris

Duan X, Zhou L, Wu T, Liu GJ, Qiao J, Wei J, Ni J, Zheng J, Chen XY, Wang Q

Published Online:

October 7, 2009

Angina pectoris is pain or discomfort within the chest, typically provoked by exertion or anxiety. Angina is a sign that someone is at increased risk of heart attack, cardiac arrest or sudden cardiac death. The aim of treatment for angina is to control the symptoms and prevent a cardiovascular event such as a heart attack. In western medicine, treatment is usually with beta blockers, calcium channel blockers and nitrates (nitroglycerin). Suxiao jiuxin wan is widely used in China in conjunction with these western treatments. This review found weak evidence to suggest suxiao jiuxin wan alone or in combination with other anti-anginal drugs reduces the symptoms of angina. However, because of the quality of the research, the role of suxiao jiuxin wan is uncertain and more high quality trials are required to assess the effects of suxiao jiuxin wan in the long term.

Abstract (click to read)

Background:

Suxiao jiuxin wan is widely used in China for angina pectoris.

Objectives:

The objective of this review is to determine the effects (benefits and harms) of suxiao jiuxin wan in the treatment of angina pectoris.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials on The Cochrane Library (issue 4 2005), Medline (1995 to 2005), EMBASE (1995 to 2005), the Register of Chinese trials developed by the Chinese Cochrane Centre (to 2006), and the Chinese Biomedical Database (1995 to 2005), and handsearched 83 Chinese journals. We also searched reference lists, databases of ongoing trials and the Internet. Date of last search: November 2005.

Selection criteria:

Randomised controlled trials of suxiao jiuxin wan compared to standard treatment in people with angina. Studies with a treatment duration > 4 weeks were included.

Data collection and analysis:

Two reviewers independently applied the inclusion criteria, assessed trial quality and extracted the data.

Main results:

Fifteen trials involving 1776 people were included. There was weak evidence that suxiao jiuxin wan compared with nitroglyerin (xiaoxintong) improved ECG measurements (RR 1.16, 95% CI 1.05 to 1.27), reduced symptoms (RR 1.09, 95% CI 1.04 to 1.13), reduced the frequency of acute attacks of angina (difference in means -0.70, 95% CI -0.90 to -0.50), reduced diastolic pressure (difference in means -3mmHg, 95% CI -5.73 to -0.27) and reduced the need for supplementary nitroglycerin (difference in means of -0.60, 95% CI -0.94 to -0.26). There was also weak evidence that suxiao jiuxin wan compared with Salvia miltiorrhiza (danshen) reduced symptoms (RR 1.21, 95% CI 1.11 to 1.31) and improved ECG measurements (RR 1.55, 95% CI 1.30 to 1.84). There was no significant difference when comparing suxiao jiuxin wan with isosorbide dinitrate (xiaosuanyishanlizhi) both for ECG improvement (RR 1.34, 95% CI 0.91 to 1.98) and for symptom improvement (RR 1.11, 95% CI 0.86 to 1.43).

Authors' conclusions:

Suxiao jiuxin wan appears to be effective in the treatment of angina pectoris and no serious side effects were identified. However, the evidence remains weak due to poor methodological quality of including studies.

This record should be cited as:

Duan X, Zhou L, Wu T, Liu GJ, Qiao J, Wei J, Ni J, Zheng J, Chen XY, Wang Q. Chinese herbal medicine suxiao jiuxin wan for angina pectoris. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004473. DOI: 10.1002/14651858.CD004473.pub2

Assessed as up to date:

November 13, 2007

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Primary Review Group:

Heart Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective is the Chinese herbal medicine suxiao jiuxin wan in the treatment of angina pectoris?

Bottom line:

Suxiao jiuxin wan alone or in combination with other anti-anginal drugs showed weak evidence of a reduction in symptoms of angina and an improvement in ECG measurements. No serious side effects were identified.

Caveat:

Methodological concerns included lack of concealment of allocation, lack of blinding, lack of statistical power, lack of information on hazards of treatment, and lack of other clinically relevant outcomes. Only a small number of studies were included in the review, and all of these were conducted in China.

Context:

In western medicine, angina is usually treated with beta blockers, nitrates and calcium channel blockers. Suxiao jiuxin wan is a new drug on the national essential drug list of China for the treatment of cardiocerebral vascular disease. It has been reported to cause remission of angina, improve anginal symptoms, and reduce the use of nitrates. It may be used on its own or in conjunction with conventional anti-anginal treatments.

Cochrane Systematic Review:

Duan X et al. Chinese herbal medicine suxiao jiuxin wan for angina pectoris. Cochrane Reviews 2008, Issue 1. Art. No.: CD004473. DOI: 10.1002/14651858.CD004473.pub2. This review contains 15 trials involving 1,776 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Heart & circulation > Myocardial ischemia/coronary disease > Angina

Complementary & alternative medicine > Heart & circulation > Myocardial ischemia/coronary disease

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Chinese herbal medicine suxiao jiuxin wan for angina pectoris

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