The standard Chinese medication qiliqiangxin decreases hospitalization for heart failure and cardiovascular death in clients with heart failure and a minimized ejection portion (HFrEF), according to late-breaking research study provided in a Hot Line session at ESC Congress 2023. In a pilot study, qiliqiangxin minimized N-terminal pro– B-type natriuretic peptide (NT-proBNP) levels and better heart failure symptoms in patients with HFrEF when included to established heart failure treatment.3 Preclinical research studies have likewise suggested that qiliqiangxin has useful results on attenuating myocardial fibrosis and cardiac improvement. Patients were randomized in a 1:1 fashion to get qiliqiangxin (four pills, three times day-to-day) or placebo on top of basic medications for chronic heart failure. An overall of 3,110 patients were consisted of in the analysis, with 1,555 randomized to qiliqiangxin and 1,555 randomized to placebo. The effect of qiliqiangxin on the main result was generally constant across prespecified subgroups consisting of in the subgroups defined according to age and NT-proBNP level, and in patients with or without angiotensin receptor/neprilysin inhibitors (ARNIs).
New research shows qiliqiangxin, a traditional Chinese medicine, successfully lowers hospitalizations and cardiovascular deaths in heart failure clients with lowered ejection fraction (HFrEF). Credit: SciTechDaily.com
Qiliqiangxin, a traditional Chinese herb mix, effectively decreases heart failure hospitalizations and deaths, showing advantageous and safe in a large-scale scientific trial.
The traditional Chinese medication qiliqiangxin reduces hospitalization for heart failure and cardiovascular death in patients with heart failure and a decreased ejection fraction (HFrEF), according to late-breaking research presented in a Hot Line session at ESC Congress 2023. [1] Qiliqiangxin is a standard Chinese medicine extract acquired from 11 kinds of herbs (Table 1). [2] In a pilot study, qiliqiangxin lowered N-terminal pro– B-type natriuretic peptide (NT-proBNP) levels and better heart failure symptoms in patients with HFrEF when added to established cardiac arrest treatment.3 Preclinical studies have actually also indicated that qiliqiangxin has advantageous effects on attenuating myocardial fibrosis and heart improvement. [4-7]
Financing: National Key Technologies R&D Program (CN, Project No. 2017YFC1700500, 2017YFC1700505); Key Program of National Natural Science Foundation (CN, Project No. 81730106); General Program of National Natural Science Foundation (CN, 81970339, 82270394, 82200425). Shijiazhuang Yiling Pharmaceutical Co., Ltd. (Shijazhuang, Peoples Republic of China) offered part of the research study and the funding drug for this research study. All funding sources were not involved in the style of the research study and collection, enrolment, statistical analysis, interpretation of data and in composing the manuscript.
Disclosures: Prof. Xinli Li reports getting grant assistance (all grant support noted paid to the First Affiliated Hospital with Nanjing Medical University) from Novartis and China Heart Failure Center, receiving lecture charges and consulting charges from AstraZeneca, Bayer, Novartis, Roche, and Yiling.
Table 1: Ingredients of qiliqiangxin. Credit: European Society of Cardiology
The QUEST Trial: A Comprehensive Evaluation
The QUEST trial assessed the clinical effectiveness and security of qiliqiangxin on major cardiac arrest results in HFrEF clients. The trial was carried out at 133 hospitals in mainland China and Hong Kong SAR of China.
The trial enrolled adult HFrEF patients with a left ventricular ejection portion of 40% or below and NT-proBNP of 450 pg/ml or greater who had been on a steady standardized standard treatment routine for a minimum of two weeks prior to enrolment. Clients were randomized in a 1:1 fashion to receive qiliqiangxin (4 pills, three times daily) or placebo on top of basic medications for chronic cardiac arrest. The primary endpoint was a composite of rehospitalization for aggravating heart failure or cardiovascular death.
An overall of 3,110 patients were included in the analysis, with 1,555 randomized to qiliqiangxin and 1,555 randomized to placebo. The average age was 62 years and 72.1% were males. At baseline, the mean left ventricular ejection portion was 32%, and the average NT-proBNP was 1730.80 pg/ml.
Substantial Reduction in Heart Failure Outcomes
During a typical follow-up of 18.3 months, the main endpoint happened in 389 clients (25.02%) in the qiliqiangxin group and in 467 clients (30.03%) in the placebo group (threat ratio [HR], 0.78; 95% confidence period [CI], 0.68 to 0.90; p<< 0.001). This impact was related to both lower risks of rehospitalization for aggravating cardiac arrest (HR, 0.76; 95% CI, 0.64 to 0.90; p= 0.002) and cardiovascular death (HR, 0.83; 95% CI, 0.68 to 0.996; p= 0.045) in the qiliqiangxin group. The result of qiliqiangxin on the main outcome was typically constant throughout prespecified subgroups including in the subgroups specified according to age and NT-proBNP level, and in clients with or without angiotensin receptor/neprilysin inhibitors (ARNIs).
Secondary Findings and Safety Analysis
Analysis of security endpoints showed no considerable difference in all-cause mortality, which occurred in 221 patients (14.21%) in the qiliqiangxin group and 262 clients (16.85%) in the placebo group (HR, 0.84; 95% CI, 0.70 to 1.01; p= 0.058). Qiliqiangxin capsules were well-tolerated, without any significant differences between the 2 groups in negative occasions including gastrointestinal symptoms, worsening kidney function, and increased liver enzymes.
Professional Opinion and Conclusion
Principal private investigator Professor Xinli Li of the First Affiliated Hospital of Nanjing Medical University, Nanjing, China said: "To our understanding, this was the very first randomized, double-blind regulated trial of a conventional Chinese medicine for the treatment of persistent heart failure. Our findings demonstrate meaningful scientific advantage with qiliqiangxin in clients with HFrEF, which support the usage of qiliqiangxin as an accessory therapy for treating cardiac arrest."
Recommendations
QUEST was talked about during Hot Line 2 in room Amsterdam.
Reference: "Study protocol for a randomized regulated trial: Qiliqiangxin in cardiac arrest: evaluation of reduction in morTality (QUEST)" by Wenming Yao, Iokfai Cheang, Shengen Liao, Yanli Zhou, Fang Zhou, Dongjie Xu, Zhenhua Jia, Liping Chang, Haifeng Zhang and Xinli Li, 5 February 2020, BMC Complementary Medicine and Therapies.DOI: 10.1186/ s12906-020-2821-0.
" A Multicenter, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study of the Effects of Qili Qiangxin Capsules in Patients With Chronic Heart Failure" by Xinli Li, Jian Zhang, Jun Huang, Aiqun Ma, Jiefu Yang, Weimin Li, Zonggui Wu, Chen Yao, Yuhui Zhang, Wenming Yao, Boli Zhang and Runlin Gao, 7 June 2013, Journal of the American College of Cardiology.DOI: 10.1016/ j.jacc.2013.05.035.
" Qiliqiangxin relieves Ang II-induced CMECs apoptosis by downregulating autophagy via the ErbB2-AKT-FoxO3a axis" by Fuhai Li, Jingfeng Wang, Yu Song, Dongli Shen, Yongchao Zhao, Chaofu Li, Mingqiang Fu, Yanyan Wang, Baozheng Qi, Xueting Han, Aijun Sun, Jingmin Zhou and Junbo Ge, 27 February 2021, Life Sciences.DOI: 10.1016/ j.lfs.2021.119239.
" Traditional Chinese medicine qiliqiangxin attenuates phenylephrine-induced heart hypertrophy via upregulating PPARγ and PGC-1α" by Rong-Rong Gao, Xiao-Dong Wu, Hui-Min Jiang, Yu-Jiao Zhu, Yan-Li Zhou, Hai-Feng Zhang, Wen-Ming Yao, Yong-Qin Li and Xin-Li Li, 26 April 2018, Annals of Translational Medicine.DOI: 10.21037/ atm.2018.04.14.
" Qiliqiangxin enhances cardiac function and attenuates cardiac renovation in doxorubicin-induced cardiac arrest rats" by Xutao Sun, Guozhen Chen, Ying Xie, Deyou Jiang, Jieru Han, Fei Chen andYunjia Song, 19 May 2023, Pharmaceutical Biology.DOI: 10.1080/ 13880209.2020.1761403.
" Qiliqiangxin Modulates the Gut Microbiota and NLRP3 Inflammasome to Protect Against Ventricular Remodeling in Heart Failure" by Yingdong Lu, Mi Xiang, Laiyun Xin, Yang Zhang, Yuling Wang, Zihuan Shen, Li and Xiangning Cui, 13 April 2022, Frontiers in Pharmacology.DOI: 10.3389/ fphar.2022.905424.