A Preliminary Study on the Inhibitory Effect of Chunghyul-dan on Stroke Recurrence in Patients with Small Vessel Disease

다국어 초록 (Multilingual Abstract)

Background: Chunghyul-dan is a combinatorial herbal medicine; previous studies reported it had therapeutic effects for microangiopathy, a major part in the progression of small vessel disease, as well as having anti-hypertensive, anti-hyperlipidemic, anti-apoptotic, anti-oxidative, and anti-inflammatory activities. Therefore, we examined the inhibitory effect of Chunghyul-dan on stroke recurrence in patients with small vessel disease.
Methods: We prescribed Chunghyul-dan at 600 mg a day to patients with small vessel disease, and monitored stroke recurrence, drug compliances, and adverse effect for 1 year. We then performed follow-up brain MRI to find new vascular lesions after 1 year of Chunghyul-dan medication. For the subjects lost to follow-up, we assessed their prognosis after 1 year by telephone.
Results: There were 73 subjects treated with Chunghyul-dan for 1 year; new vascular events were found in 3. Of the 85 subjects lost to follow-up, fifty four could be contacted, and eight of them had stroke recurrence. One year of Chunghyul-dan medication reduced the odds ratio of stroke recurrence by 75% compared to the subjects lost to follow-up and the rate increased to 88%, when adjusted for other relevant risk factors for stroke occurrence. These reductions were much higher than those of aspirin and other kinds of conventional anti-platelets. There was no adverse effect in any of the study subjects.
Conclusions: We suggest Chunghyul-dan could be useful for inhibition of stroke recurrence. Further study with a randomized controlled trial is needed to confirm this suggestion.

참고문헌 (Reference)

1 The SALT Collaborative Group. Swedish AspirinLow-dose Trial, "of 75 mg aspirinas secondary prophylaxis after cerebrovascularischemic events. Lancet 1991" 1345-1349, 1991

2 Hayakawa J, "Yakugadu Zasshi. Studies on physicalchemical quality evaluation of crude drugspreparations. III. Analysis of gardenia fruitsand its preparations 1986" 996-1000, 1986

3 Petty GW, "Survival and recurrence after first cerebral infarction: a population- based study in Rochester, Minnesota, 1975 through 1989" 50 (50): 208-216, 1998

4 "Special report from the National Institute ofNeurological Disorders and Stroke. Classificationof cerebrovascular diseases III. Stroke.1990" 637-676, 1990

5 Dominick JH, "Prevention of ischaemicstroke - antiplatelets" 56 (56): 510-525, 2000

6 Sacco RL, "Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community. The Northern Manhattan Stroke Study" 626-634, 1994

7 Burn J, "Long-term risk of recurrencestroke after a first-ever stroke. TheOxfordshire Community Stroke Project 1994" 333-337, 1994;

8 Cho KH, "Inhibitory Effect of Chunghyul-dan in Prostaglandin E2 and Nitric Oxide Biosynthesis of Lipopolysaccharideinduced RAW 264.7 Cells" 27 (27): 1810-1813, 2004

9 Diener HC, "European Stroke Prevention Study 2: Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke" 143 : 1-13, 1996

10 Cho KH, "Efficacy and Safety of Chunghyul-dan (Qingxie-dan) in Patients with Hypercholesterolemia" 33 (33): 241-248, 2005

11 Kim YS, "Daio-Orengedokuto inhibits HMGCoA reductase and pancreatic lipase" 25 (25): 1442-1445, 2002

12 Cho KH, "Daio-Orengedokudo Works as a Cell-Proliferating Compound in Endothelial Cells" 82 : 380-386, 2004

13 Cho KH, "Clinical Assessment on the Safety of Chunghyul-dan (Qingxie-dan)" 24 (24): 45-50, 2003

14 Algra A, "Aspirin at any dose above 30 mg offers only modest protection after cerebral ischemia" 60 : 197-199, 1996

15 "Antiplatelet Trialists’ Collaboration. Collaborativeoverview of randomized trials of antiplatelettherapy - I Prevention of death and stroke by prolongedantiplatelet therapy in various categories ofpatients. BMJ 1994" 81-106, 1994

16 Yun SP, "Antihypertensive effect Chunghyul-dan on stage I hypertensive patients with stroke" 25 (25): 195-201, 2004

17 Kim YS, "Anti-hyperlipidemic effect of Daehwanghwangryeonhaedok- tang on hyperlipidemia" 32 (32): 145-152, 2001

18 Hass WK, "Adams HP for theTiclopidine Aspirin Stroke Study Group Arandomized trial comparing ticlopidine hydrochloridewith aspirin for the prevention ofstroke in high risk patients. N Engl J Med1989" 501-507, 1989