Chin J Integr Med
•1•
EVIDENCE-BASED INTEGRATIVE MEDICINE Ginkgo Biloba Extract for Angina Pectoris: A Systematic Review SUN Tian (孙 天)1,2, WANG Xian (王
显)2,3, and XU Hao (徐
浩)4
Objective : To evaluate the efficacy and safety of Ginkgo Biloba extract for patients with ABSTRACT Objective: Methods:: Electronic databases were searched for all angina pectoris according to the available evidence. Methods of the randomized controlled trials (RCTs) of angina pectoris treatments with Ginkgo Biloba extract, either alone or combined with routine Western medicine (RWM), and controlled by untreated, placebo, Chinese patent medicine, or RWM treatment. The RCTs were retrieved from the following electronic databases: PubMed/MEDLINE, ProQuest Health and Medical Complete, Springer, Elsevier, and ProQuest Dissertations and Theses, Wanfang Data, China National Knowledge Infrastructure (CNKI), VIP database, China Biology Medicine (CBM), Chinese Medical Citation Index (CMCI), from the earliest database records to December 2012. No language restriction was applied. Study selection, data extraction, quality assessment, and data analyses were conducted according to the Cochrane standards. RevMan 5.1.0 provided by Cochrane Results:: A total of 23 RCTs (involving 2,529 patients) were Collaboration The data were analysed by using. Results included and the methodological quality was evaluated as generally low. Ginkgo Biloba extract with RWM was more effective in angina relief and electrocardiogram improvement than RWM alone. Reported adverse Conclusions:: Ginkgo events included epigastric discomfort, nausea, gastrointestinal reaction, and bitter taste. Conclusions Biloba extract may have beneficial effects on patients with angina pectoris, although the low quality of existing trials makes it difficult to draw a satisfactory conclusion. More rigorous, high quality clinical trials are needed to provide conclusive evidence. KEYWORDS Ginkgo Biloba extract, angina pectoris, systematic review, Chinese medicine
Angina pectoris (AP) is characterized by shortlasting squeezing pains and substernal pain in the chest that radiates to the neck, jaw, shoulder, arm, back, and epigastric region. (1) The most common cause of AP is coronary artery atherosclerotic disease, which is the leading cause of mortality and morbidity in the world.(2,3) In the USA and UK, the prevalence of AP has been reported as 6 to 30 per 1,000 men and 4 to 16 per 1,000 women aged 65 to 74.(4,5) In China, AP is a common disease with a high incidence and lethality rate in middle- and old-aged patients.(6)
important active chemical compounds are ginkgo flavone glycosides (24% to 25%) and terpenoids (6%).(9,10) Some studies have indicated that Ginkgo Biloba extract can scavenge oxygen free radicals, antagonize platelet activating factor, inhibit platelet aggregation and arterial thrombosis, and improve hemorheology.(11,12) However, the scientific evidence for the effect of Ginkgo Biloba extract on coronary heart disease has not been systematically reviewed. The following systematic review aims to evaluate the
At present, routine Western medicine (RWM) for the treatment of AP includes antiplatelet agents, beta receptor blockers, angiotensin-converting enzyme inhibitors or angiotensin Ⅱ receptor blockers, calcium antagonists, and nitrates (e.g., nitroglycerin), which have been shown to be clinically effective. However, RWM treatment of AP needs to be improved.(7) Extract of Ginkgo Biloba from the dried leaves of the ginkgo tree has a long history of use as a medical treatment in China. It is also commonly prescribed in France and Germany. (8) The most
The Chinese Journal of Integrated Traditional and Western Medicine Press and Springer-Verlag Berlin Heidelberg 2015 Supported by the Graduate Student Projects of Beijng University of Chinese Medicine (No. 2014-JYBZZ-XS-133) 1. Graduate School, Beijing University of Chinese Medicine, Beijing (100029), China; 2. Cardiovascular Diseases Center, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing (100700), China; 3. Beijing University Cardiology Research Institute of Traditional Chinese Medicine, Beijing (100700), China; 4. Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing (100091), China Correspondence to: Prof. WANG Xian, Tel: 86-10-84015563, E-mail: [email protected] DOI: 10.1007/s11655-015-2070-0
Chin J Integr Med
•2•
efficacy and safety of Ginkgo Biloba extract for the treatment of AP in randomized controlled trials (RCTs).
METHODS Database and Search Strategies Three authors (Sun T, Wang X, and Xu H) independently identified studies through searches of the overseas databases PubMed/MEDLINE, ProQuest Health and Medical Complete, Springer, Elsevier, and ProQuest Dissertations and Theses. These searches were done with free text terms related to ischemic heart disease and the type of ginkgo biloba extract (e.g., "ginkgo biloba extract" OR "ginkgo biloba" OR "EGb" OR "EGb761" OR "LI1370" OR "ginkgo preparation" OR "angina pectoris" OR "angina" OR "coronary heart disease" OR "coronary artery disease"). Wanfang Data, China National Knowledge Infrastructure (CNKI), the VIP database, the Chinese databases China Biology Medicine (CBM), and Chinese Medical Citation Index (CMCI) were also searched using equivalent Chinese terms. A comprehensive and exhaustive search strategy was formulated to identify all relevant studies regardless of language or publication status. The date of search was from the earlist database records to December 2012.
Inclusion Criteria (1) Designation: all published and unpublished RCTs of treatment of angina pectoris with Ginkgo Biloba extract were included. (2) Subject selection: Trials included male or female patients, of any age or ethnic origin, with any stage of AP. (3) Intervention measures: treatments of Ginkgo Biloba extract, either alone or in combination with RWM, and control group interventions of placebos, RWM, or Chinese patent medicine were included. Only treatments lasting at least 1 month were included. (4) Outcome measures: The primary outcome measures were cardiac death and adverse events occurring in at least 6 months of follow-up. Secondary outcome measures included angina relief, electrocardiogram (ECG) improvement, cardiac function improvement, and health-related quality of life.
Exclusion Criteria Studies that did not identify the type of control were excluded, as were duplicate publications involving the same group of patients, and studies with small sample sizes (
•1•
EVIDENCE-BASED INTEGRATIVE MEDICINE Ginkgo Biloba Extract for Angina Pectoris: A Systematic Review SUN Tian (孙 天)1,2, WANG Xian (王
显)2,3, and XU Hao (徐
浩)4
Objective : To evaluate the efficacy and safety of Ginkgo Biloba extract for patients with ABSTRACT Objective: Methods:: Electronic databases were searched for all angina pectoris according to the available evidence. Methods of the randomized controlled trials (RCTs) of angina pectoris treatments with Ginkgo Biloba extract, either alone or combined with routine Western medicine (RWM), and controlled by untreated, placebo, Chinese patent medicine, or RWM treatment. The RCTs were retrieved from the following electronic databases: PubMed/MEDLINE, ProQuest Health and Medical Complete, Springer, Elsevier, and ProQuest Dissertations and Theses, Wanfang Data, China National Knowledge Infrastructure (CNKI), VIP database, China Biology Medicine (CBM), Chinese Medical Citation Index (CMCI), from the earliest database records to December 2012. No language restriction was applied. Study selection, data extraction, quality assessment, and data analyses were conducted according to the Cochrane standards. RevMan 5.1.0 provided by Cochrane Results:: A total of 23 RCTs (involving 2,529 patients) were Collaboration The data were analysed by using. Results included and the methodological quality was evaluated as generally low. Ginkgo Biloba extract with RWM was more effective in angina relief and electrocardiogram improvement than RWM alone. Reported adverse Conclusions:: Ginkgo events included epigastric discomfort, nausea, gastrointestinal reaction, and bitter taste. Conclusions Biloba extract may have beneficial effects on patients with angina pectoris, although the low quality of existing trials makes it difficult to draw a satisfactory conclusion. More rigorous, high quality clinical trials are needed to provide conclusive evidence. KEYWORDS Ginkgo Biloba extract, angina pectoris, systematic review, Chinese medicine
Angina pectoris (AP) is characterized by shortlasting squeezing pains and substernal pain in the chest that radiates to the neck, jaw, shoulder, arm, back, and epigastric region. (1) The most common cause of AP is coronary artery atherosclerotic disease, which is the leading cause of mortality and morbidity in the world.(2,3) In the USA and UK, the prevalence of AP has been reported as 6 to 30 per 1,000 men and 4 to 16 per 1,000 women aged 65 to 74.(4,5) In China, AP is a common disease with a high incidence and lethality rate in middle- and old-aged patients.(6)
important active chemical compounds are ginkgo flavone glycosides (24% to 25%) and terpenoids (6%).(9,10) Some studies have indicated that Ginkgo Biloba extract can scavenge oxygen free radicals, antagonize platelet activating factor, inhibit platelet aggregation and arterial thrombosis, and improve hemorheology.(11,12) However, the scientific evidence for the effect of Ginkgo Biloba extract on coronary heart disease has not been systematically reviewed. The following systematic review aims to evaluate the
At present, routine Western medicine (RWM) for the treatment of AP includes antiplatelet agents, beta receptor blockers, angiotensin-converting enzyme inhibitors or angiotensin Ⅱ receptor blockers, calcium antagonists, and nitrates (e.g., nitroglycerin), which have been shown to be clinically effective. However, RWM treatment of AP needs to be improved.(7) Extract of Ginkgo Biloba from the dried leaves of the ginkgo tree has a long history of use as a medical treatment in China. It is also commonly prescribed in France and Germany. (8) The most
The Chinese Journal of Integrated Traditional and Western Medicine Press and Springer-Verlag Berlin Heidelberg 2015 Supported by the Graduate Student Projects of Beijng University of Chinese Medicine (No. 2014-JYBZZ-XS-133) 1. Graduate School, Beijing University of Chinese Medicine, Beijing (100029), China; 2. Cardiovascular Diseases Center, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing (100700), China; 3. Beijing University Cardiology Research Institute of Traditional Chinese Medicine, Beijing (100700), China; 4. Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing (100091), China Correspondence to: Prof. WANG Xian, Tel: 86-10-84015563, E-mail: [email protected] DOI: 10.1007/s11655-015-2070-0
Chin J Integr Med
•2•
efficacy and safety of Ginkgo Biloba extract for the treatment of AP in randomized controlled trials (RCTs).
METHODS Database and Search Strategies Three authors (Sun T, Wang X, and Xu H) independently identified studies through searches of the overseas databases PubMed/MEDLINE, ProQuest Health and Medical Complete, Springer, Elsevier, and ProQuest Dissertations and Theses. These searches were done with free text terms related to ischemic heart disease and the type of ginkgo biloba extract (e.g., "ginkgo biloba extract" OR "ginkgo biloba" OR "EGb" OR "EGb761" OR "LI1370" OR "ginkgo preparation" OR "angina pectoris" OR "angina" OR "coronary heart disease" OR "coronary artery disease"). Wanfang Data, China National Knowledge Infrastructure (CNKI), the VIP database, the Chinese databases China Biology Medicine (CBM), and Chinese Medical Citation Index (CMCI) were also searched using equivalent Chinese terms. A comprehensive and exhaustive search strategy was formulated to identify all relevant studies regardless of language or publication status. The date of search was from the earlist database records to December 2012.
Inclusion Criteria (1) Designation: all published and unpublished RCTs of treatment of angina pectoris with Ginkgo Biloba extract were included. (2) Subject selection: Trials included male or female patients, of any age or ethnic origin, with any stage of AP. (3) Intervention measures: treatments of Ginkgo Biloba extract, either alone or in combination with RWM, and control group interventions of placebos, RWM, or Chinese patent medicine were included. Only treatments lasting at least 1 month were included. (4) Outcome measures: The primary outcome measures were cardiac death and adverse events occurring in at least 6 months of follow-up. Secondary outcome measures included angina relief, electrocardiogram (ECG) improvement, cardiac function improvement, and health-related quality of life.
Exclusion Criteria Studies that did not identify the type of control were excluded, as were duplicate publications involving the same group of patients, and studies with small sample sizes (
