Long-term effects of Xuezhikang on blood pressure in hypertensive patients with previous myocardial infarction: data from the Chinese Coronary Secondary Prevention Study (CCSPS).

Several previous trials from Western population studies have showed that statins may help reduce blood pressure (BP). However, randomized clinical data is limited. Xuezhikang, a partially extract of red yeast rice, contains a family of naturally occurring statins, and has a marked impact on lipids, but it is unknown whether Xuezhikang has any effect on BP during long-term follow-up in the Chinese population. This is a post-hoc subgroup analysis of a randomized, double-blinded, placebo-controlled, parallel group clinical trial, Chinese Coronary Secondary Prevention Study (CCSPS). A total of 2704 hypertensive patients with previous myocardial infarction (MI) were assigned either to placebo (n = 1341) or to Xuezhikang (n = 1363) daily for an average of 4.5 years. The primary outcome was the unadjusted changes in mean arterial pressure (MAP) from baseline to 6 months. We also assessed systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure. Analysis of covariance was used to calculate the adjusted effects of treatment on changes in these outcomes at 6, 12, 24, and 48 months post-randomization, after controlling for potential confounders. This analysis included 2704/4870 (55.5%) hypertensive patients for whom BP was measured at baseline and at least one follow-up visit after randomization. Median duration of the follow-up was 4.5 years (54 months), and 25 patients (0.92%) were lost to the last follow-up because of adverse effects. The results showed that the unadjusted and adjusted changes in MAP, SBP, DBP, or pulse pressure from baseline were not significantly different for Xuezhikang or placebo recipients at 6, 12, 24, and 48 months after randomization. In this post-hoc subgroup analysis, we failed to demonstrate any significant reducing effects of Xuezhikang on BP in Chinese hypertensive patients with previous MI, suggesting that further prospective study on the effects of statins on BP would be needed, especially in high-risk patients.

Impact of Xuezhikang on coronary events in hypertensive patients with previous myocardial infarction from the China Coronary Secondary Prevention Study (CCSPS).

BACKGROUND:The lowering of cholesterol concentrations in individuals at high risk for cardiovascular disease improves clinical outcome. Xuezhikang has a marked impact on lipids.METHODS:In this randomized, double-blinded, placebo-controlled, parallel-group clinical trial, a total of 2704 hypertensive patients with previous myocardial infarction (MI) were assigned either to placebo (n = 1341) or to Xuezhikang (0.6 g twice daily, n = 1363) for an average of 4.5 years. The primary end-point was recurrent coronary events; the secondary end-point was all-cause mortality and other clinical events, including adverse effects.RESULTS:There were no differences between the Xuezhikang and placebo group in base-line characteristics. However, Xuezhikang treatment reduced the incidence of coronary events by 43.0% (P = 0.02), deaths from coronary heart disease (CHD) by 30.0% (P < 0.01), and all-cause mortality by 35.8% (P = 0.001).CONCLUSIONS:This study, for the first time, demonstrated that long-term Xuezhikang therapy resulted in significant reduction in cardiovascular events and death in Chinese hypertensive patients with previous MI in a safe manner.

Beneficial impact of Xuezhikang on cardiovascular events and mortality in elderly hypertensive patients with previous myocardial infarction from the China Coronary Secondary Prevention Study (CCSPS).

Coronary heart disease, hypertension, and dyslipidemia are highly prevalent and commonly coexist in people who are middle-aged and older. Previous data suggested that lowering cholesterol concentrations in individuals at high risk of cardiovascular disease improved clinical outcomes. Xuezhikang, a partial extract of red yeast rice containing statin, has a marked impact on lipids. The purpose of this study, therefore, was to evaluate the impact of Xuezhikang on reducing cardiovascular events and mortality in elderly Chinese hypertensive patients with a history of myocardial infarction (MI) enrolled in the Chinese Coronary Secondary Prevention Study. In this randomized trial, 1530 elderly hypertensive patients (> or = 65-years-old) with previous MI were assigned either to placebo (n = 758) or to Xuezhikang (n = 772) daily for an average of 4.5 years. The primary endpoint was recurrent coronary events; the secondary endpoint was all-cause mortality and other clinical events, including adverse effects. There were 68 cases of coronary events (8.8%) detected in the Xuezhikang group and 108 cases (14.3%) in the placebo group (38.2% risk reduction by Xuezhikang therapy). Death from coronary heart disease (CHD) totaled 49 cases in the Xuezhikang group (6.4%) and 68 cases in the placebo group (9.0%), indicating that Xuezhikang significantly decreased the risk of CHD death by 29.2%. Our study demonstrated that Xuezhikang therapy could effectively and safely reduce cardiovascular events and all-cause death in Chinese elderly hypertensive patients with previous MI. This finding may have an important implication for the treatment of elderly hypertensive patients with CHD.

Effect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction.

Results of well-controlled prospective clinical trials showed the efficacy of lipid-lowering therapies in the reduction of cardiovascular (CV) events in western populations, but they were not reported with a Chinese population. This multicenter study was conducted to determine the effects of Xuezhikang (XZK), a partially purified extract of red yeast rice, on lipoprotein and CV end points in Chinese patients who experienced a previous myocardial infarction. Nearly 5,000 of these patients with average low-density lipoprotein cholesterol levels at baseline were randomly assigned either to placebo or to XZK daily for an average of 4.5 years. The primary end point was a major coronary event that included nonfatal myocardial infarction and death from coronary heart disease. Frequencies of the primary end point were 10.4% in the placebo group and 5.7% in the XZK-treated group, with absolute and relative decreases of 4.7% and 45%, respectively. Treatment with XZK also significantly decreased CV and total mortality by 30% and 33%, the need for coronary revascularization by 1/3, and lowered total and low-density lipoprotein cholesterol and triglycerides, but raised high-density lipoprotein cholesterol levels. In conclusion, long-term therapy with XZK significantly decreased the recurrence of coronary events and the occurrence of new CV events and deaths, improved lipoprotein regulation, and was safe and well tolerated.

Advance in basic and clinical research of Xuezhikang Capsule.

[China coronary secondary prevention study (CCSPS): outcomes from analysis of coronary heart disease patients with diabetes].

OBJECTIVE:To elucidate whether lipid-lowering therapy with Xuezhikang can induce a decrease of cardiac events and an attenuation of total mortality in coronary heart disease (CHD) patients with diabetes.METHODS:We designed a random, double-blinded, placebo controlled clinical trial in selected 591 patients. All patients were administrated with capsule Xuezhikang (0.6 g, Bid) or placebo in addition to conventional therapy. The mean follow-up period was four years. The primary end-points were nonfatal myocardial infarction and death from CHD.RESULTS:(1) The incidence of CHD events and that of death from CHD were reduced by 50.8% (P = 0.0008) and by 44.1% (P = 0.0246) in treatment group, respectively; Also, the incidence of nonfatal myocardial infarction was reduced by 63.8% (P = 0.0151). (2) The incidence of stroke, tumor, and PCI/CABG were decreased by 20.2%. (3) The total mortality were lowered by 44.1% in treatment group (P = 0.0097).CONCLUSION:Xuezhikang can effectively reduce the incidence of cardiac events and total mortality in CHD patients with diabetes.

[China coronary secondary prevention study (CCSPS)].

OBJECTIVE:The mean level of serum cholesterol in Chinese population with coronary heart disease (CHD) is relatively lower compared to that of western population. Our study aimed to evaluate whether lipid-lowering therapy with Xuezhikang can reduce the risk of cardiac events and total mortality in Chinese CHD patients.METHODS:This study was designed as a random, double-blinded, placebo controlled clinical trial in 66 centers in China and was conducted from may, 1996 to December, 2003. 4870 CHD patients (serum cholesterol level 4.40 - 6.47 mmol/L, age 18 - 75 years, with definite myocardial infarction history) were selected and treated with capsule Xuezhikang (0.6 g Bid) or placebo in addition to conventional therapy (control group). The mean follow-up period was four years. The primary end-points were nonfatal myocardial infarction and deaths from CHD.RESULTS:It has been shown at the end of the trial: (1) The incidence of the primary end-points were 5.72% in Xuezhikang treatment group and 10.41% in control group, with a reduction of relative risk by 45.1% for treatment group (P = 0.0000). Among the primary end points, the incidence of deaths from CHD was 3.79% in the treatment group and 5.49% in the control group, with a reduction of relative risk by 31.0% in treatment group (P < 0.0048); (2) The incidence of nonfatal myocardial infarction reduced by 60.8% in treatment group compared to control group (1.93% vs 4.92%, P < 0.0000); (3) The incidence of the secondary end-points (stroke, tumor, PCI/CABG) also decreased by 31.1% in treatment group compared to control group (6.92% vs 10.04% P < 0.0004). Among the secondary end points, the demand for PCI/CABG was 3.01% in the treatment group and 4.51% in the control group, with a reduction of relative risk by 33.3% in treatment group (P = 0.097); (4) The total mortality was lower in treatment group than control group, with a reduction of relative risk by 33.0% in treatment group (5.19% vs 7.74% P = 0.0003). There were no significant differences in side effects and abnormal laboratory references between the two groups.CONCLUSIONS:Compared to placebo, Xuezhikang can significantly decrease the incidence of nonfatal myocardial infarction and deaths from CHD. It can also reduce significantly the demand for PCI/CABG, the total mortality and the deaths from tumor.

Long-term effects of Xuezhikang on blood pressure in hypertensive patients with previous myocardial infarction: data from the Chinese Coronary Secondary Prevention Study (CCSPS).

Several previous trials from Western population studies have showed that statins may help reduce blood pressure (BP). However, randomized clinical data is limited. Xuezhikang, a partially extract of red yeast rice, contains a family of naturally occurring statins, and has a marked impact on lipids, but it is unknown whether Xuezhikang has any effect on BP during long-term follow-up in the Chinese population. This is a post-hoc subgroup analysis of a randomized, double-blinded, placebo-controlled, parallel group clinical trial, Chinese Coronary Secondary Prevention Study (CCSPS). A total of 2704 hypertensive patients with previous myocardial infarction (MI) were assigned either to placebo (n = 1341) or to Xuezhikang (n = 1363) daily for an average of 4.5 years. The primary outcome was the unadjusted changes in mean arterial pressure (MAP) from baseline to 6 months. We also assessed systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure. Analysis of covariance was used to calculate the adjusted effects of treatment on changes in these outcomes at 6, 12, 24, and 48 months post-randomization, after controlling for potential confounders. This analysis included 2704/4870 (55.5%) hypertensive patients for whom BP was measured at baseline and at least one follow-up visit after randomization. Median duration of the follow-up was 4.5 years (54 months), and 25 patients (0.92%) were lost to the last follow-up because of adverse effects. The results showed that the unadjusted and adjusted changes in MAP, SBP, DBP, or pulse pressure from baseline were not significantly different for Xuezhikang or placebo recipients at 6, 12, 24, and 48 months after randomization. In this post-hoc subgroup analysis, we failed to demonstrate any significant reducing effects of Xuezhikang on BP in Chinese hypertensive patients with previous MI, suggesting that further prospective study on the effects of statins on BP would be needed, especially in high-risk patients.

Impact of Xuezhikang on coronary events in hypertensive patients with previous myocardial infarction from the China Coronary Secondary Prevention Study (CCSPS).

BACKGROUND:The lowering of cholesterol concentrations in individuals at high risk for cardiovascular disease improves clinical outcome. Xuezhikang has a marked impact on lipids.METHODS:In this randomized, double-blinded, placebo-controlled, parallel-group clinical trial, a total of 2704 hypertensive patients with previous myocardial infarction (MI) were assigned either to placebo (n = 1341) or to Xuezhikang (0.6 g twice daily, n = 1363) for an average of 4.5 years. The primary end-point was recurrent coronary events; the secondary end-point was all-cause mortality and other clinical events, including adverse effects.RESULTS:There were no differences between the Xuezhikang and placebo group in base-line characteristics. However, Xuezhikang treatment reduced the incidence of coronary events by 43.0% (P = 0.02), deaths from coronary heart disease (CHD) by 30.0% (P < 0.01), and all-cause mortality by 35.8% (P = 0.001).CONCLUSIONS:This study, for the first time, demonstrated that long-term Xuezhikang therapy resulted in significant reduction in cardiovascular events and death in Chinese hypertensive patients with previous MI in a safe manner.

Beneficial impact of Xuezhikang on cardiovascular events and mortality in elderly hypertensive patients with previous myocardial infarction from the China Coronary Secondary Prevention Study (CCSPS).

Coronary heart disease, hypertension, and dyslipidemia are highly prevalent and commonly coexist in people who are middle-aged and older. Previous data suggested that lowering cholesterol concentrations in individuals at high risk of cardiovascular disease improved clinical outcomes. Xuezhikang, a partial extract of red yeast rice containing statin, has a marked impact on lipids. The purpose of this study, therefore, was to evaluate the impact of Xuezhikang on reducing cardiovascular events and mortality in elderly Chinese hypertensive patients with a history of myocardial infarction (MI) enrolled in the Chinese Coronary Secondary Prevention Study. In this randomized trial, 1530 elderly hypertensive patients (> or = 65-years-old) with previous MI were assigned either to placebo (n = 758) or to Xuezhikang (n = 772) daily for an average of 4.5 years. The primary endpoint was recurrent coronary events; the secondary endpoint was all-cause mortality and other clinical events, including adverse effects. There were 68 cases of coronary events (8.8%) detected in the Xuezhikang group and 108 cases (14.3%) in the placebo group (38.2% risk reduction by Xuezhikang therapy). Death from coronary heart disease (CHD) totaled 49 cases in the Xuezhikang group (6.4%) and 68 cases in the placebo group (9.0%), indicating that Xuezhikang significantly decreased the risk of CHD death by 29.2%. Our study demonstrated that Xuezhikang therapy could effectively and safely reduce cardiovascular events and all-cause death in Chinese elderly hypertensive patients with previous MI. This finding may have an important implication for the treatment of elderly hypertensive patients with CHD.

Effect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction.

Results of well-controlled prospective clinical trials showed the efficacy of lipid-lowering therapies in the reduction of cardiovascular (CV) events in western populations, but they were not reported with a Chinese population. This multicenter study was conducted to determine the effects of Xuezhikang (XZK), a partially purified extract of red yeast rice, on lipoprotein and CV end points in Chinese patients who experienced a previous myocardial infarction. Nearly 5,000 of these patients with average low-density lipoprotein cholesterol levels at baseline were randomly assigned either to placebo or to XZK daily for an average of 4.5 years. The primary end point was a major coronary event that included nonfatal myocardial infarction and death from coronary heart disease. Frequencies of the primary end point were 10.4% in the placebo group and 5.7% in the XZK-treated group, with absolute and relative decreases of 4.7% and 45%, respectively. Treatment with XZK also significantly decreased CV and total mortality by 30% and 33%, the need for coronary revascularization by 1/3, and lowered total and low-density lipoprotein cholesterol and triglycerides, but raised high-density lipoprotein cholesterol levels. In conclusion, long-term therapy with XZK significantly decreased the recurrence of coronary events and the occurrence of new CV events and deaths, improved lipoprotein regulation, and was safe and well tolerated.

Advance in basic and clinical research of Xuezhikang Capsule.

[China coronary secondary prevention study (CCSPS): outcomes from analysis of coronary heart disease patients with diabetes].

OBJECTIVE:To elucidate whether lipid-lowering therapy with Xuezhikang can induce a decrease of cardiac events and an attenuation of total mortality in coronary heart disease (CHD) patients with diabetes.METHODS:We designed a random, double-blinded, placebo controlled clinical trial in selected 591 patients. All patients were administrated with capsule Xuezhikang (0.6 g, Bid) or placebo in addition to conventional therapy. The mean follow-up period was four years. The primary end-points were nonfatal myocardial infarction and death from CHD.RESULTS:(1) The incidence of CHD events and that of death from CHD were reduced by 50.8% (P = 0.0008) and by 44.1% (P = 0.0246) in treatment group, respectively; Also, the incidence of nonfatal myocardial infarction was reduced by 63.8% (P = 0.0151). (2) The incidence of stroke, tumor, and PCI/CABG were decreased by 20.2%. (3) The total mortality were lowered by 44.1% in treatment group (P = 0.0097).CONCLUSION:Xuezhikang can effectively reduce the incidence of cardiac events and total mortality in CHD patients with diabetes.

[China coronary secondary prevention study (CCSPS)].

OBJECTIVE:The mean level of serum cholesterol in Chinese population with coronary heart disease (CHD) is relatively lower compared to that of western population. Our study aimed to evaluate whether lipid-lowering therapy with Xuezhikang can reduce the risk of cardiac events and total mortality in Chinese CHD patients.METHODS:This study was designed as a random, double-blinded, placebo controlled clinical trial in 66 centers in China and was conducted from may, 1996 to December, 2003. 4870 CHD patients (serum cholesterol level 4.40 - 6.47 mmol/L, age 18 - 75 years, with definite myocardial infarction history) were selected and treated with capsule Xuezhikang (0.6 g Bid) or placebo in addition to conventional therapy (control group). The mean follow-up period was four years. The primary end-points were nonfatal myocardial infarction and deaths from CHD.RESULTS:It has been shown at the end of the trial: (1) The incidence of the primary end-points were 5.72% in Xuezhikang treatment group and 10.41% in control group, with a reduction of relative risk by 45.1% for treatment group (P = 0.0000). Among the primary end points, the incidence of deaths from CHD was 3.79% in the treatment group and 5.49% in the control group, with a reduction of relative risk by 31.0% in treatment group (P < 0.0048); (2) The incidence of nonfatal myocardial infarction reduced by 60.8% in treatment group compared to control group (1.93% vs 4.92%, P < 0.0000); (3) The incidence of the secondary end-points (stroke, tumor, PCI/CABG) also decreased by 31.1% in treatment group compared to control group (6.92% vs 10.04% P < 0.0004). Among the secondary end points, the demand for PCI/CABG was 3.01% in the treatment group and 4.51% in the control group, with a reduction of relative risk by 33.3% in treatment group (P = 0.097); (4) The total mortality was lower in treatment group than control group, with a reduction of relative risk by 33.0% in treatment group (5.19% vs 7.74% P = 0.0003). There were no significant differences in side effects and abnormal laboratory references between the two groups.CONCLUSIONS:Compared to placebo, Xuezhikang can significantly decrease the incidence of nonfatal myocardial infarction and deaths from CHD. It can also reduce significantly the demand for PCI/CABG, the total mortality and the deaths from tumor.