Special Issue "10th Anniversary of JCM—Evidence-Based Medicine, Research and Education in Integrative and Personalized Medicine for Cardiovascular Medicine Section"

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 31 December 2022 | Viewed by 3299

Special Issue Editor

Prof. Dr. Nandu Goswami
E-Mail Website
Guest Editor
Division of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Auenbruggerpl. 2, 8036 Graz, Austria
Interests: cardiovascular system; heart rate variability; gravitational adaptation
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Special Issue Information

Dear Colleagues,  

Introduction—Changing demands in Global Health

Created in 1948, the WHO laid an emphasis on treatment and cure of diseases. However, it was not until the Alma Ata declaration in 1978 that a health promotion and disease prevention narrative and primary health care were emphasized. The recently concluded Global Conference on Primary Health Care in Astana, Kazakhstan (25–26 October) saw a coming together of health leaders from around the world to celebrate the 40th anniversary of the declaration and to renew a commitment to primary healthcare and to achieve universal health coverage and the Sustainable Development Goals. The Alma Ata declaration is particularly significant for the future of global healthcare at a time when attempts to contain chronic diseases of epidemic proportions are failing. Many of these conditions are preventable—for instance, up to 70% of cardiovascular diseases and similar proportions of food-, diet-, and lifestyle-related conditions.

Evidence for China’s Traditional Chinese Medicine (TCM) and India’s AYUSH (Ayurveda, Yoga, Unaani, Siddha and Homeopathy) Systems and Further Needs to Address Global Health Challenges:

TCM and AYUSH practices such as acupuncture, Yoga, and meditation are health-promoting practices which have a centuries-long history in China and India, not just in the places where they were conceived, where they evolved and where they were systematized, but throughout both countries. Well-established institutions for higher education are now in place in almost all parts of both these countries. Large nation-wide programs for diabetes management and prevention and research programs for management for mental health issues are now running in China and India, and hospitals and practitioners for all these modalities can be found even in the most rural locations. Many other large programs for health promotion and disease prevention are now being managed by the respective governments in China and India. The beneficial effects of these programs mean that many more of their facets for improving public health are also being implemented.

While TCM, Ayurveda, Yoga, and meditation are part of daily life in China and India, they are not particularly positively perceived and, therefore, still not well-received in the western world. There are many pre-conceptions and much skepticism in the minds of western medical practitioners, and this makes it difficult for them to even consider “alternative” forms of medical therapy that differ from the standard allopathic approaches to which they were exposed in medical school for regular treatment of patients. To convince medical practitioners and health workers to accept other forms of healthcare, there is a need to present solid evidence-based research, using western state-of-the-art research tools, to critically examine TCM and ayurvedic products/ supplements, Yoga, and meditation. Similarly, the medical community is mostly skeptical about the beneficial effects of TCM, Ayurveda, Yoga, and meditation and would benefit from insights developed from such a critical examination.

Meditation and Cardiovascular Diseases—An example:  

A number of studies on the beneficial effects of meditation provide important examples of how alternative approaches to medical treatment can be integrated into contemporary western medicine. Conventional drug therapies do not always address the causes of cardiovascular disease, which are often rooted in unhealthy lifestyle behaviors. Furthermore, conventional pharmacological and surgical therapies for cardiovascular disease often lead to serious adverse effects, including adverse drug effects, impairments in quality of life, and increased mortality. For these reasons, national practice guidelines of the American Heart Association, the American College of Cardiology, the National Institutes of Health (NIH), and other professional associations recommend non-drug lifestyle modifications as the first line of therapy for individuals with hypertension and as part of a comprehensive package of lifestyle modifications and drug therapy for individuals with diagnoses of CHD. It is also well established that stress causes, contributes to, and/or exacerbates cardiovascular diseases such as hypertension and coronary heart disease, and a large body of evidence shows that meditation is the most effective stress-reduction technique available for cardiovascular disease patients. Thus, stress reduction limits the physiological and pathological consequences of chronic stress, and alternative medical applications of meditation can provide both a treatment and preventive healthcare solution. 1-7

Scope of the Special Issue:

The Special Issue we propose will provide a platform to enlighten the scientific community, health practitioners, and policy makers about TCM, Ayurveda, Yoga, and meditation. By presenting in-depth and critical analyses and also incorporating an evidenced-based perspective (using randomized cross over clinical trials, where available), the beneficial effects of TCM, Ayurveda, Yoga and meditation will be objectively considered. The Special Issue will encompass a series of reviews, including meta-analyses and systematic reviews and some original representative research papers that examine research of very high quality that has been carried out in these areas. Additionally, such analysis and new approaches based on TCM, Ayurveda, Yoga, and meditation hold much promise for leading the medical community to develop new approaches in both the curative and preventative arenas. Such a detailed exploration and detailed discussion will be a crucial step to remove the biases held by western medical practitioners and educators and shine light on the benefits. 

Finally, this Special Issue also underlines the need for a shift in the educational paradigm of medical training so that aspects related to prevention of disease and promotion of a healthy lifestyle are included in the curriculum. This need was echoed recently by Harvard Medical School, which since September 2018 is reassessing its mission statement away from a purely disease focus toward improving health and wellness for everyone: “To create and nurture a diverse community dedicated to teaching and learning, discovery and scholarship, service and leadership to improve health and wellness for everyone.”, https://todayspractitioner.com/john-weeks/paradigm-shift-harvard-medical-school-considering-mission-reframe-from-sickness-model-to-health/#.W83zNlJRdsM). This review series will provide concrete examples of how the preventative care dimension of TCM, Ayurveda, Yoga, and meditation can be integrated into western medical school curricula and also how research should be carried out in a typical western medical school setting regarding preventative care and healthy living.

References

  1. American Journal of Hypertension 21: 310–316, 2008
  2. Current Hypertension Reports 9: 520–528, 2007.
  3.  Hypertension 26: 820–827, 1995.
  4. Stroke, 2000 Mar., 31(3):568-73.
  5. Ethnicity and Disease, 2004. 14: S2-54.
  6. Archives of Internal Medicine 166: 1218–1224, 2006.
  7. American Journal of Cardiology, 2005. 95(9): 1060- 1064.
  8. Journal of Clinical Psychology, 1989. 45(6): 957–974.

Prof. Dr. Nandu Goswami
Guest Editor

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Keywords

  • TCM
  • Ayurveda
  • Yoga
  • meditation
  • cardiovascular health

Published Papers (7 papers)

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Research

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Article
Effects of Fasting and Lifestyle Modification in Patients with Metabolic Syndrome: A Randomized Controlled Trial
J. Clin. Med. 2022, 11(16), 4751; https://doi.org/10.3390/jcm11164751 - 14 Aug 2022
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Abstract
Background: Lifestyle interventions, such as fasting, diet, and exercise, are increasingly used as a treatment option for patients with metabolic syndrome (MS). This study assesses the efficacy and safety of fasting followed by lifestyle modification in patients with MS compared to lifestyle modification [...] Read more.
Background: Lifestyle interventions, such as fasting, diet, and exercise, are increasingly used as a treatment option for patients with metabolic syndrome (MS). This study assesses the efficacy and safety of fasting followed by lifestyle modification in patients with MS compared to lifestyle modification only. Methods: Single-blind, multicenter, parallel, randomized controlled trial in two German tertiary referral hospitals in metropolitan areas. Interventions: (a) 5-day fasting followed by 10 weeks of lifestyle modification (modified DASH diet, exercise, mindfulness; n = 73); (b) 10 weeks of lifestyle modification only (n = 72). Main outcomes and measures: Co-primary outcomes were ambulatory systolic blood pressure and the homeostasis model assessment (HOMA) index at week 12. Further outcomes included anthropometric, laboratory parameters, and the PROCAM score at weeks 1, 12, and 24. Results: A total of 145 patients with metabolic syndrome (62.8% women; 59.7 ± 9.3 years) were included. No significant group differences occurred for the co-primary outcomes at week 12. However, compared to lifestyle modification only, fasting significantly reduced HOMA index (Δ = −0.8; 95% confidence interval [CI] = −1.7, −0.1), diastolic blood pressure (Δ = −4.8; 95% CI = −5.5, −4.1), BMI (Δ = −1.7; 95% CI = −2.0, −1.4), weight (Δ = −1.7; 95% CI = −2.0, −1.4), waist circumference (Δ = −2.6; 95% CI = −5.0, −0.2), glucose (Δ = −10.3; 95% CI = −19.0, −1.6), insulin (Δ = −2.9; 95% CI = −5.3, −0.4), HbA1c (Δ = −0.2; 95% CI = −0.4, −0.05;), triglycerides (Δ = −48.9; 95% CI = −81.0, −16.9), IL−6 (Δ = −1.2; 95% CI = −2.5, −0.005), and the 10-year risk of acute coronary events (Δ = −4.9; 95% CI = −9.5, −0.4) after week 1. Fasting increased uric acid levels (Δ = 1.0; 95% CI = 0.1, 1.9) and slightly reduced eGRF (Δ = −11.9; 95% CI = −21.8, −2.0). Group differences at week 24 were found for weight (Δ = −2, 7; 95% CI = −4.8, −0.5), BMI (Δ = −1.0; 95% CI = −1.8, −0.3), glucose (Δ = −7.7; 95% CI = −13.5, −1.8), HDL (Δ = 5.1; 95% CI = 1.5, 8.8), and CRP (Δ = 0.2; 95% CI = 0.03, 0.4). No serious adverse events occurred. Conclusions: A beneficial effect at week 24 was found on weight; fasting also induced various positive short-term effects in patients with MS. Fasting can thus be considered a treatment for initializing lifestyle modification for this patient group; however, it remains to be investigated whether and how the multilayered effects of fasting can be maintained in the medium and longer term. Full article
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Article
Anti-Hypertensive Activity of Some Selected Unani Formulations: An Evidence-Based Approach for Verification of Traditional Unani Claims Using LC-MS/MS for the Evaluation of Clinically Relevant Blood Parameters in Laboratory Rats
J. Clin. Med. 2022, 11(15), 4628; https://doi.org/10.3390/jcm11154628 - 08 Aug 2022
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Abstract
Background: Systemic arterial hypertension, which is associated with an increased risk of cardiovascular disease(CVD), is the most significant modifiable risk factor for mortality and morbidity worldwide. WHO has recognized Unanipathy as an alternate system of medicine. The aim of the present study is [...] Read more.
Background: Systemic arterial hypertension, which is associated with an increased risk of cardiovascular disease(CVD), is the most significant modifiable risk factor for mortality and morbidity worldwide. WHO has recognized Unanipathy as an alternate system of medicine. The aim of the present study is to investigate the anti-hypertensive activity of some selected unani formulations using L-NAME model. Method: Group I or hypertensive control group: L-NAME administered for 7 days and left for the next 7 days; Group II or KASgroup: L-NAME administered (i.p) for 7 days and L-NAME + KAS (1000 mg/kg b.w) for the next 7 days; Group III or DMM group: L-NAME administered (i.p) for 7 days and L-NAME + DMM (2000 mg/kg b.w) for the next 7 days; Group IV or MSR group: L-NAME administered (i.p) for 7 days and L-NAME + MSR (300 mg/kg b.w) for the next 7 days; Group V or HJ group: L-NAME administered (i.p) for 7 days and L-NAME + HJ (113 mg/kg b.w) for the next 7 days; Group VI or KGS group: L-NAME administered (i.p) for 7 days and L-NAME +KGS (2000 mg/kg b.w) for the next 7 days. Non-invasive systolic blood pressure and RR-interval (ECG) was measured. Plasma was investigated forsodium, potassium, nitrite, ANP, adrenaline, noradrenaline and aldosterone on day 0, 7 and 14 using LC-MS/MS. Result: Treatment showed a non-significant lowreduction in SBP (systolic blood pressure) of KAS, MSR and HJ while that of DMM was quite significant (p < 0.05), but in the case of KGS, SBP increased. DMM on day 14 significantly (p < 0.05) reduced plasma nitrite while no significant plasma Na+ was noted. In the case of both DMM and KGS, potassium increased significantly (p < 0.05) on day 14. No significant changes in plasma ANP and aldosterone was observed against DMM and KGS while blood levels of adrenaline and noradrenaline significantly (p < 0.05) changed. No significant change in body weight was found. Conclusions: L-NAME KAS, MSR and HJ showed no change in SBP while DMM showed a significant reduction in SBP with decreased plasma nitrite. Probably, DMM may have anti-hypertensive activity mediated through NO inhibition while KGS may involve central sympathomimetic action. Full article
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Article
Who Benefits Most? Interactions between Personality Traits and Outcomes of Four Incremental Meditation and Yoga Treatments
J. Clin. Med. 2022, 11(15), 4553; https://doi.org/10.3390/jcm11154553 - 04 Aug 2022
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Abstract
Mind–Body Medicine (MBM) includes a broad range of interventions with proven preventive and clinical value, such as yoga and meditation. However, people differ in their preferences and response to different MBM treatments and it remains unclear who benefits most from what type of [...] Read more.
Mind–Body Medicine (MBM) includes a broad range of interventions with proven preventive and clinical value, such as yoga and meditation. However, people differ in their preferences and response to different MBM treatments and it remains unclear who benefits most from what type of practice. Thus, finding moderators of treatment outcome seems to be a promising approach. This was the aim of the present study. We conducted a single-case multiple-baseline study investigating the outcomes and moderators of four different MBM treatments. Fifty-seven healthy participants with no prior experience were randomly assigned to three baselines (7, 14, and 21 days) and four eight-week treatments: mantra meditation alone, meditation plus physical yoga, meditation plus ethical education and meditation plus yoga and ethical education. We analysed the data using effect size estimation, multiple regression and cluster analyses. High anxiety, high absorption, low spirituality, low openness and younger age were associated with a range of positive outcomes, such as increased wellbeing or decentering and decreased mind wandering. Receiving ethical education consistently improved wellbeing, while engaging in physical yoga reduced mind wandering. In the cluster analysis, we found that participants with a more maladaptive personality structure enhanced their emotion regulation skills more. Consequently, people do differ in their response to MBM interventions and more vulnerable people, or those high in absorption, seem to benefit more. These findings could support the development of custom-tailored MBM interventions and help clinicians to make scientifically sound recommendations for their patients. Full article
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Article
Diversity of Hemodynamic Reactive Profiles across Persons—Psychosocial Implications for Personalized Medicine
J. Clin. Med. 2022, 11(13), 3869; https://doi.org/10.3390/jcm11133869 - 04 Jul 2022
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Abstract
This study analyzed the individual differences in hemodynamic time patterns and reactivity to cognitive and emotional tasks, and explored the diversity of psycho-physiological profiles that could be used for the personalized prediction of different diseases. An analysis of heart rate (HR)—blood pressure (BP) [...] Read more.
This study analyzed the individual differences in hemodynamic time patterns and reactivity to cognitive and emotional tasks, and explored the diversity of psycho-physiological profiles that could be used for the personalized prediction of different diseases. An analysis of heart rate (HR)—blood pressure (BP) relationship patterns across time using cross-correlations (CCs) during a logical-mathematical task and a task recalling negative emotions (rumination) was carried out in a laboratory setting on 45 participants. The results showed maximum HR–BP CCs during the mathematical task significantly more positive than the maximum HR–BP CCs during the rumination task. Furthermore, our results showed a large variety of hemodynamic reactivity profiles across the participants, even when carrying out the same tasks. The most frequent type showed positive HR–BP CCs under cognitive activity, and several positive–negative HR–BP CCs cycles under negative emotional activity. In general terms, our results supported the main hypothesis. We observed some distinct time-based “coordination strategies” in the reactivity of the autonomic nervous system under emotional vs. cognitive loading. Overall, large individual, as well as situational, specificities in hemodynamic reactivity time patterns were seen. The possible relationships between this variety of profiles and different psychosocial characteristics, and the potential for integrative predictive health within the provision of highly personalized medicine, are discussed. Full article
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Article
Ayurveda in Knee Osteoarthritis—Secondary Analyses of a Randomized Controlled Trial
J. Clin. Med. 2022, 11(11), 3047; https://doi.org/10.3390/jcm11113047 - 28 May 2022
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Abstract
Background: Ayurveda is widely practiced in South Asia in the treatment of osteoarthritis (OA). The aim of these secondary data analyses were to identify the most relevant variables for treatment response and group differences between Ayurvedic therapy compared to conventional therapy in knee [...] Read more.
Background: Ayurveda is widely practiced in South Asia in the treatment of osteoarthritis (OA). The aim of these secondary data analyses were to identify the most relevant variables for treatment response and group differences between Ayurvedic therapy compared to conventional therapy in knee OA patients. Methods: A total of 151 patients (Ayurveda n = 77, conventional care n = 74) were analyzed according to the intention-to-treat principle in a randomized controlled trial. Different statistical approaches including generalized linear models, a radial basis function (RBF) network, exhausted CHAID, classification and regression trees (CART), and C5.0 with adaptive boosting were applied. Results: The RBF network implicated that the therapy arm and the baseline values of the WOMAC Index subscales might be the most important variables for the significant between-group differences of the WOMAC Index from baseline to 12 weeks in favor of Ayurveda. The intake of nutritional supplements in the Ayurveda group did not seem to be a significant factor in changes in the WOMAC Index. Ayurveda patients with functional limitations > 60 points and pain > 25 points at baseline showed the greatest improvements in the WOMAC Index from baseline to 12 weeks (mean value 107.8 ± 27.4). A C5.0 model with nine predictors had a predictive accuracy of 89.4% for a change in the WOMAC Index after 12 weeks > 10. With adaptive boosting, the accuracy rose to 98%. Conclusions: These secondary analyses suggested that therapeutic effects cannot be explained by the therapies themselves alone, although they were the most important factors in the applied models. Full article
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Review

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Review
Artificial Intelligence in Cardiology—A Narrative Review of Current Status
J. Clin. Med. 2022, 11(13), 3910; https://doi.org/10.3390/jcm11133910 - 05 Jul 2022
Viewed by 480
Abstract
Artificial intelligence (AI) is an integral part of clinical decision support systems (CDSS), offering methods to approximate human reasoning and computationally infer decisions. Such methods are generally based on medical knowledge, either directly encoded with rules or automatically extracted from medical data using [...] Read more.
Artificial intelligence (AI) is an integral part of clinical decision support systems (CDSS), offering methods to approximate human reasoning and computationally infer decisions. Such methods are generally based on medical knowledge, either directly encoded with rules or automatically extracted from medical data using machine learning (ML). ML techniques, such as Artificial Neural Networks (ANNs) and support vector machines (SVMs), are based on mathematical models with parameters that can be optimally tuned using appropriate algorithms. The ever-increasing computational capacity of today’s computer systems enables more complex ML systems with millions of parameters, bringing AI closer to human intelligence. With this objective, the term deep learning (DL) has been introduced to characterize ML based on deep ANN (DNN) architectures with multiple layers of artificial neurons. Despite all of these promises, the impact of AI in current clinical practice is still limited. However, this could change shortly, as the significantly increased papers in AI, machine learning and deep learning in cardiology show. We highlight the significant achievements of recent years in nearly all areas of cardiology and underscore the mounting evidence suggesting how AI will take a central stage in the field. Full article
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Other

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Systematic Review
Efficacy and Safety of Different Courses of Tongxinluo Capsule as Adjuvant Therapy for Coronary Heart Disease after Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
J. Clin. Med. 2022, 11(11), 2991; https://doi.org/10.3390/jcm11112991 - 25 May 2022
Viewed by 449
Abstract
Tongxinluo capsule (TXLC) is a widely used traditional Chinese medicine for coronary heart disease (CHD). However, the efficacy and safety of different courses of TXLC for CHD after percutaneous coronary intervention (PCI) have not been systematically evaluated yet. The Cochrane Library, PubMed, Embase, [...] Read more.
Tongxinluo capsule (TXLC) is a widely used traditional Chinese medicine for coronary heart disease (CHD). However, the efficacy and safety of different courses of TXLC for CHD after percutaneous coronary intervention (PCI) have not been systematically evaluated yet. The Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, Wanfang Database, and Chinese Scientific Journal Database were searched from the inception to 26 August 2021. A meta-analysis was performed using a fixed- or random-effects model. The risk of adverse cardiovascular events, mortality, or adverse effects was evaluated by risk ratio (RR) with 95% confidence interval (CI). Thirty-four studies involving 3652 patients were finally included. After the 6-month treatment, compared with conventional treatment alone, TXLC combined with conventional treatment achieved better efficacy in lowering the risk of angiographic restenosis (RR = 0.37, 95% CI = 0.28–0.48, p < 0.001), myocardial infarction (RR = 0.38, 95% CI = 0.25–0.60, p < 0.001), heart failure (RR = 0.32, 95% CI = 0.18–0.56, p < 0.001), angina (RR = 0.26, 95% CI = 0.17–0.38, p < 0.001), revascularization (RR = 0.20, 95% CI = 0.09–0.46, p < 0.001), all-cause mortality (RR = 0.24, 95% CI = 0.10–0.58, p = 0.001), and mortality due to any cardiovascular event (RR = 0.27, 95% CI = 0.09–0.80, p = 0.018). After the 12-month treatment, TXLC reduced the recurrence risk of angina (RR = 0.40, 95% CI = 0.20–0.80, p = 0.009). However, there was no difference in any outcomes after the 3-month treatment. Besides, no difference was found in the incidence of adverse effects after the 3-month and 6-month treatments (3 months: RR = 0.73, 95% CI = 0.35–1.56, p = 0.418; 6 months: RR = 1.71, 95% CI = 0.74–3.93, p = 0.209). The certainty of evidence ranged from very low to moderate due to the risk of bias, inconsistency, and imprecision. TXLC showed beneficial effects on reducing the adverse cardiovascular events without compromising safety for CHD patients after PCI on the 6-month course. However, due to the unavoidable risk of bias, more high-quality and long-term studies are still needed to further evaluate the efficacy and safety of TXLC in many countries, not only in China. Full article
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