Objective To evaluate prognostic impact of treatment with Continuous Positive Airway Pressure (CPAP) or upper airway surgery on the patients with obstructive sleep apnea (OSA) and coronary heart disease (CHD). Methods Database search in The Cochrane Library, PubMed, OVID and CBM (from establishment dates to October 2009) were conducted. Cohort studies and randomized controlled trials of OSA with CPAP or upper airway surgery in CHD patients were identified. We assessed the quality of the included trials and extracted the relevant data. Statistical analysis was performed using RevMan 4.3.2 software. Results A total of 4 cohort studies involving 945 participants were included. The results of meta-analysis were as follows: a) there were no significant differences in the rate of late lumen loss and 10-year mortality between CHD patients with OSA treated by CPAP and those without OSA (RR=1.84, 95%CI 0.73 to 4.68, P=0.20; RR=0.80, 95%CI 0.24 to 2.64, P=0.71). b) CPAP or uvulopalatopharyngoplasty used in the treatment of OSA on CHD patients after PCI had a significant decrease in the rate of 5-year cardiac death when compared with those untreated OSA patients (RR=0.34, 95%CI 0.14 to 0.82, P=0.02). But there were no differences in the rate of 5-year all-cause mortality, major adverse cardiac events (MACE) between the two groups respectively (RR=0.66, 95%CI 0.39 to 1.10, P=0.11; RR=0.97, 95%CI 0.81 to 1.15, P=0.69). c) CPAP or upper airway surgery in treating OSA significantly reduced the risk of MACE occurrence during the 86.5±39 months follow-up period (RR=0.22, 95%CI 0.07 to 0.72, P=0.01). Conclusion Current evidence indicates that treating OSA with CPAP or upper airway surgery in CHD patients might be associated with a decrease in the risk of cardiac death. But more studies are necessary to evaluate prognostic impact of treatment with CPAP or upper airway surgery on the patients with OSA and CHD. However, due to the limited quantity and quality of the included studies, more high-quality studies are need.
ObjectivesTo systematically review the efficacy of folic acid supplementation in the primary prevention of stroke among patients with H-Type hypertension.MethodsPubMed, EMbase, The Cochrane Library, WanFang Data, CNKI, VIP and Sinomed databases were electronically searched to collect randomized controlled trials (RCTs) of folic acid supplementation in the primary prevention of stroke among patients with H-Type hypertension from inception to April, 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software and Stata 12.0 software.ResultsA total of 12 RCTs involving 18 170 participants were included. The results of meta-analysis showed that H-Type hypertensive patients who received folic acid and antihypertensive had a significant low risk of stroke (RR=0.34, 95%CI 0.21 to 0.55, P<0.000 1) compared with patients who received antihypertensive alone. In the stratified analyses, folic acid >2 mg/d (RR=0.27, 95%CI 0.14 to 0.51, P<0.000 1) and ≤2 mg/d (RR=0.36, 95%CI 0.20 to 0.65, P=0.000 8) both could reduce the risk of stroke. Enalapril folic acid tablets (RR=0.35, 95%CI 0.16 to 0.77, P=0.009) and free combinations of folic acid and antihypertensive drugs (RR=0.29, 95%CI 0.18 to 0.47, P<0.000 01) could lower the incidence of stroke.ConclusionsCurrent evidence shows that the folic acid supplementation significantly reduce the risk of stroke among patients with H-Type hypertension. Enalapril folic acid tablets and free combinations of folic acid with antihypertensive drugs both play an important role in stroke prevention. There is no significant dose-response relationship between dosage of folic acid and prevention of stroke. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
The theoretical innovation and new drug research on the prevention and treatment of cardiovascular diseases by activating blood circulation has been one of the most active and outstanding achievements in the field of integrated Chinese and western medicine for the past 60 years. Research on blood stasis syndrome (BSS) and activating blood circulation (ABC) was the first to be awarded the first prize of National Award for Science and Technology Progress in Chinese Medicine since the founding of the People's Republic of China. The research team headed by prof. Keji CHEN has obtained abundant research achievements. Taking coronary heart disease, a major clinical cardiovascular disease as the entry point, the team explored the development of the diagnostic criteria for the combination of BSS, the interpretation of the modern connotation of ABC, the development of a series of new drugs for ABC, clinical efficacy evaluation and mechanism of its action. It promotes the standardization and internationalization of traditional Chinese medicine and forms high-quality evidence for clinical transformation. It has also made outstanding contributions to the prevention and treatment of cardiovascular diseases with original features. In this paper, the history of prevention and treatment of cardiovascular diseases by ABC after the founding of the People's Republic of China was reviewed. The representative research findings of several domestic academic teams, including prof. Keji CHEN's team, over the past 60 years were expounded emphatically so as to provide reference for promoting and innovating research in activating blood circulation and removing blood stasis.