Compound Danshen (Salvia miltiorrhiza) dripping pill for coronary heart disease: an overview of systematic reviews.

Compound Danshen dripping pill (CDDP) is commonly used to treat coronary heart disease (CHD) in China. However, clinical practice has not been informed by evidence from relevant systematic reviews (SRs). This overview aims at summarizing evidence from SRs on CDDP for the treatment of CHD. We included SRs of randomized controlled trials (RCTs) on CDDP in treating CHD until March 2014 by searching the Cochrane Library, PubMed, EMBASE and four Chinese databases. Data were extracted according to a pre-designed form. We assessed the quality of SRs according to AMSTAR and graded the quality of evidence in the included SRs using the GRADE approach. All data analyses were descriptive. About 13 SRs involving a total of 34,071 participants with angina or acute myocardial infarction (AMI) were included. Few SRs assessed endpoints (5/13, 38.5%) and quality of life (QOL) (4/13, 30.8%). Most of the SRs suggested that CDDP had potential benefits for patients with CHD, such as improving symptoms and electrocardiogram (ECG) results, with few adverse reactions, while benefits in endpoints were unproved. Moreover, the overall quality of evidence in the SRs was poor, ranging from "very low" to "moderate", and most of the included SRs were of "low" (3/13, 23.1%) or "moderate" (9/13, 69.2%) quality with many serious flaws. Current SRs suggested potential benefits of CDDP for the treatment of CHD. However, high-quality evidence is warranted to support the application of CDDP in treating CHD.

[1]  Yan V. Sun,et al.  Coronary heart disease mortality in China: age, gender, and urban-rural gaps during epidemiological transition. , 2012, Revista panamericana de salud publica = Pan American journal of public health.

[2]  W. Duan,et al.  Effects of purified herbal extract of Salvia miltiorrhiza on ischemic rat myocardium after acute myocardial infarction. , 2005, Life sciences.

[3]  G. Guyatt,et al.  Grading quality of evidence and strength of recommendations , 2004, BMJ : British Medical Journal.

[4]  Yazhou Wu,et al.  Systematic review and meta-analysis of traditional Chinese medicine in the treatment of migraines. , 2013, The American journal of Chinese medicine.

[5]  Gao Xiumei,et al.  Compound Salvia droplet pill, a traditional Chinese medicine, for the treatment of unstable angina pectoris: a systematic review. , 2008 .

[6]  Ke-Ji Chen,et al.  Systematic Review of Compound Danshen Dropping Pill: A Chinese Patent Medicine for Acute Myocardial Infarction , 2013, Evidence-based complementary and alternative medicine : eCAM.

[7]  Yanli Wang,et al.  Compound Danshen dripping pills for stable angina: Meta-analysis of randomized controlled trials , 2011 .

[8]  Yang Chu,et al.  The effect of Compound Danshen Dripping Pills, a Chinese herb medicine, on the pharmacokinetics and pharmacodynamics of warfarin in rats. , 2011, Journal of ethnopharmacology.

[9]  P. Komesaroff,et al.  A Chinese Herbal Preparation Containing Radix Salviae Miltiorrhizae, Radix Notoginseng and Borneolum Syntheticum Reduces Circulating Adhesion Molecules , 2011, Evidence-based complementary and alternative medicine : eCAM.

[10]  B. Tan,et al.  Comparison of cardioprotective effects using ramipril and DanShen for the treatment of acute myocardial infarction in rats. , 2003, Life sciences.

[11]  Ke-Ji Chen,et al.  Traditional Chinese medicine injection for angina pectoris: an overview of systematic reviews. , 2014, The American Journal of Chinese Medicine.

[12]  Wei Wang,et al.  Energy metabolism disorder and myocardial injury in chronic myocardial ischemia with Qi deficiency and blood stasis syndrome based on 2-DE proteomics , 2013, Chinese Journal of Integrative Medicine.

[13]  S. Yusuf,et al.  Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. , 2001, Circulation.

[14]  A. Zhang,et al.  Quality and risk of bias in Panax ginseng randomized controlled trials: a review. , 2013, The American journal of Chinese medicine.

[15]  N. Chen,et al.  Systematic review of traditional chinese medicine for depression in Parkinson's disease. , 2014, The American journal of Chinese medicine.

[16]  W. Cho,et al.  A systematic review on natural medicines for the prevention and treatment of Alzheimer's disease with meta-analyses of intervention effect of ginkgo. , 2014, The American journal of Chinese medicine.

[17]  Y. Bao,et al.  Cardio-protection by Ginkgo biloba extract 50 in rats with acute myocardial infarction is related to Na⁺-Ca²⁺ exchanger. , 2013, The American journal of Chinese medicine.

[18]  B. Luo,et al.  Ginkgo biloba on focal cerebral ischemia: a systematic review and meta-analysis. , 2014, The American journal of Chinese medicine.

[19]  Jie Wang,et al.  Blood stasis syndrome of coronary heart disease: A perspective of modern medicine , 2014, Chinese Journal of Integrative Medicine.

[20]  Shu-guang Gao,et al.  Acupuncture for chronic low back pain in long-term follow-up: a meta-analysis of 13 randomized controlled trials. , 2013, The American journal of Chinese medicine.

[21]  S. Leung,et al.  Is danshen (Salvia miltiorrhiza) dripping pill more effective than isosorbide dinitrate in treating angina pectoris? A systematic review of randomized controlled trials. , 2012, International journal of cardiology.

[22]  Guiqing Yu,et al.  Biomedical mechanisms of blood stasis syndrome of coronary heart disease by systems biology approaches , 2014, Chinese Journal of Integrative Medicine.

[23]  Yixiao Xu,et al.  Notoginsenoside R1 attenuates hypoxia and hypercapnia-induced vasoconstriction in isolated rat pulmonary arterial rings by reducing the expression of ERK. , 2014, The American journal of Chinese medicine.

[24]  Jeremy M. Grimshaw,et al.  Increasing the demand for childhood vaccination in developing countries: a systematic review , 2009, BMC international health and human rights.

[25]  S. Achenbach,et al.  Anti-inflammatory effects of danshen on human vascular endothelial cells in culture. , 2013, The American journal of Chinese medicine.

[26]  Mark D. Huffman,et al.  Heart disease and stroke statistics--2013 update: a report from the American Heart Association. , 2013, Circulation.

[27]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement , 2009, BMJ : British Medical Journal.

[28]  David Moher,et al.  Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews , 2007, BMC medical research methodology.

[29]  D. Young Policymakers, experts review evidence-based medicine. , 2005, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[30]  M. O. Sharif,et al.  An AMSTAR assessment of the methodological quality of systematic reviews of oral healthcare interventions published in the Journal of Applied Oral Science (JAOS) , 2011, Journal of applied oral science : revista FOB.

[31]  A. Vickers,et al.  Do certain countries produce only positive results? A systematic review of controlled trials. , 1998, Controlled clinical trials.

[32]  G. Wang,et al.  Compound salvia pellet, a traditional Chinese medicine, for the treatment of chronic stable angina pectoris compared with nitrates: a meta-analysis. , 2005, Medical science monitor : international medical journal of experimental and clinical research.