Abstract
Depressive symptoms have been found to be highly prevalent among patients with coronary heart disease (CHD) and seriously affect the patients' quality of life. However, most psychotropic drugs have warnings about potential side effects. Accordingly, safer effective alternatives are urgently demanded. Angina pectoris of CHD is considered as “chest stuffiness and heartache syndrome” in traditional Chinese medicine, with the major syndrome type named Qi stagnation and blood stasis. Qi-regulating and blood circulation-promoting therapy has increasingly shown unique advantages in CHD patients. This study investigated the efficacy of Xuefu Zhuyu decoction, a representative prescription of Qi-regulating and blood circulation-promoting therapy, on angina pectoris patients with depressive symptoms. Depressive symptoms were stratified at baseline in 30 patients with stable angina pectoris who participated in both baseline and 12-week follow-up studies. After performing a stratified analysis, the angina pectoris-specific health status and traditional Chinese medicine “chest stuffiness and heartache syndrome” were evaluated by self-reports using the associated questionnaire scales, respectively. We measured serum concentrations of serotonin, brain-derived neurotrophic factor, and ATP, which are associated with the development of depression. We found that the Xuefu Zhuyu granule significantly improved the angina pectoris-specific health status in patients after 12 weeks of treatment; specifically, it had a better curative effect on patients with depressive symptoms. Xuefu Zhuyu granule also significantly improved the chest stuffiness and heartache syndrome in patients with depressive symptoms (efficacy index is 61.24%, P < 0.05 versus baseline). Interestingly, Xuefu Zhuyu granule has been found to be more susceptible to improving ATP levels in patients with depressive symptoms, indicating that the improvement in serum ATP levels might account for the better efficacy of Xuefu Zhuyu granule in patients with depressive symptoms. Our data provide prospective evidence that Xuefu Zhuyu granule improves angina pectoris-specific health status through regulating Qi and promoting blood circulation. This trial is registered with ChiCTR-IOR-15006989.
Highlights
Coronary heart disease (CHD) refers to the heart disease caused by coronary atherosclerosis or spasms, resulting in vascular stenosis or obstruction, leading to myocardial ischemia, hypoxia, and necrosis
In traditional Chinese medicine, angina pectoris of CHD belongs to the categories of “heartache” and “chest stuffiness.” e most common syndrome type of “chest stuffiness and heartache” syndrome is “Qi stagnation and blood stasis,” which is the stagnation of blood circulation caused by impaired Qi. e major symptoms of “Qi stagnation and blood stasis” include chest pain, chest tightness, and palpitation, while the concurrent symptom is emotional discomfort. e fact that traditional Chinese medicine has noticed that cardiovascular diseases are often combined with psychological diseases has some common points with the psychocardiology recognized by modern Western medicine
A blood stasis animal model prepared by ligation of the coronary artery or injection of pituitrin for 7–28 days showed obvious myocardial ischemia, hypoxia, and energy remodelling, accompanied by behavioural characteristics such as retardation and decreased responsiveness, suggesting that the energy metabolism disorder caused by hypoxia may be an important mechanism for the comorbidity of cardiovascular diseases and depressive symptoms [32]
Summary
Coronary heart disease (CHD) refers to the heart disease caused by coronary atherosclerosis or spasms, resulting in vascular stenosis or obstruction, leading to myocardial ischemia, hypoxia, and necrosis. Depression and depressive symptoms have been shown to worsen morbidity and mortality across CHD patients and independently predict adverse cardiovascular events [2]. Ree important clinical intervention trials for CHD patients with depression, SADHART [6, 7], ENRICHD [8, 9], and CRATE [10], showed that antidepressants treatment improved the psychiatric symptoms of patients with depression to a certain extent; there are adverse reactions to psychotropic drugs. Many psychotropic drugs lead to a deterioration in the quality of life of CHD patients due to their associated adverse reactions. Many antidepressants show no significant improvements in the endpoints, such as death, in the combined treatment of cardiovascular diseases and depression [11, 12]. Many antidepressants show no significant improvements in the endpoints, such as death, in the combined treatment of cardiovascular diseases and depression [11, 12]. erefore, it is necessary to find more suitable alternatives or candidates for the treatment of CHD patients with depressive disorders
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