Use of medicinal plants in cardiovascular diseases

Сърдечно-съдовите заболявания са група болести, засягащи сърцето и кръвоносните съдове (артерии и вени). Причините за сърдечно-съдовите заболявания са различни, но най-честите са атеросклерозата и артериалната хипертония. Те са най-значимата причина за смъртността в световен мащаб. Над 17,6 милиона души в света умират всяка година в резултат на сърдечно-съдови заболявания.Проблемът е особено актуален за нашата страна, като данните сочат, че в България на всеки 3 човека 2 умират от сърдечно-съдови заболявания. Разходите за здравеопазването в България за 2013 са 3,3 млрд. лв. Около 18% от бюджета на НЗОК отива за лечение на сърдечно-съдови заболявания.Днес антихипертензивното лечение най-общо може да се раздели на лечение с класически медикаменти и лекарства от нови генерации. Трябва да бъдем наясно, че невинаги монотерапията ще постигне желания ефект, средният брой лекарства, необходими за достигане и трайно поддържане на желаните нива на артериалното налягане, е около и над 3. Следователно много често се използва комбинираната терапия за избор на медикаменти с изявена органна протекция, при която да се достигнат прицелните нива на артериалното налягане. Оптималният контрол на налягането спомага за намаляване на сърдечно-съдовата болест и смъртност.Поддържането на здравословно и балансирано хранене, както и здравословен начин на живот може да помогне да се избегне рискът от високо кръвно налягане.Главното действие на билките, които прила гаме при сърдечно-съдовите заболявания, е да подобрят кръвоснабдяването на сърдечния мускул и крайниците, както и да заздравят стените на кръвоносните съдове.На билколечение и профилактика подлежат неусложнените случаи с коронарна недостатъчност и с ритъмни и проводни нарушения. За целта се използват дроги, чиито съставки разширяват коронарните съдове и имат диуретично действие. Такъв ефект имат цвета от глог - Fl.Crataegi ; стръкове от горицвет - Hb.Adonidis vernalis; чесънът - Allium sativum; момина сълза - Convallaria majalis f.Liliaceae.Cardiovascular diseases are a group of conditions affecting the heart and the blood vessels (arteries and veins). The reasons for the cardiovascular diseases are different, but the most frequent ones are atherosclerosis and arterial hypertonia. They are the most significant reasons for mortality on an international scale. Over 17.6 million of people in the world die each year as a result of cardiovascular diseases. The problem is especially pressing in our country, where the data shows that in Bulgaria of every 3 persons, 2 die from cardiovascular illnesses. The health care costs in Bulgaria for 2013 are 3.3 billion BGN. Around 18% of the budget of the National Fund for Health Insurance go for treatment of cardiovascular diseases.Today the treatment for hypertension in general can be divided into treatment with classical medications and such with new generation medications. We must be aware that monotherapy will not always achieve the desired effect. The average number of medications, required for achieving and sustaining longterm levels of arterial pressure is around and above 3. Therefore, combined therapy is used very often for choosing medications with obvious organ protection, which reach the target levels of arterial pressure. The optimal control of pressure helps decrease the amount cardiovascular diseases and their mortality. Maintaining a healthy and balanced diet, as well as healthy lifestyle can help avoid the risk of high blood pressure.The main effect of herbs, which we use in cardiovascular diseases, is improving the blood supply to the hearth muscle and limbs, as well as strengthening of the blodd vessel walls.Subject to herb treatment and prevention are non-complicated cases of coronary insufficiency and rhythm and conduction disorders. For that purpose we use drugs, whose ingredients widen the coronary vessels and act as diuretics. Such effect have the flower of hawthorn - Fl.Crataegi; sprigs of pheasant‘s eye - Hb.Adonidisvernalis; garlic - Alliumsativum; lily-ofthe- valley - Convallariamajalis f.Liliaceae

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes

BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo