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COURAGECOURAGE
Clinical Outcomes Utilizing
Revascularization and
Aggressive Guideline-Driven
Drug Evaluation
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BackgroundBackgroundMore than 1 million PCI procedures are performed in the
U.S. annually, the great majority of which are undertaken
electively in patients with stable CAD
Although successful PCI of flow-limiting stenoses might
be expected to reduce the rate of death, MI or
hospitalization for ACS, prior studies have shown only that
PCI decreases the frequency of angina and improves
short-term exercise performance
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ConclusionsConclusions
As an initial management strategy in patients withAs an initial management strategy in patients with
stable coronary artery disease, PCI did not reducestable coronary artery disease, PCI did not reducethe risk of death, MI, or other majorthe risk of death, MI, or other majorcardiovascular events when added to optimalcardiovascular events when added to optimal
medical therapymedical therapy
As expected, PCI resulted in better angina reliefAs expected, PCI resulted in better angina relief
during most of the followduring most of the follow--up period, but medicalup period, but medicaltherapy was also remarkably effective, with notherapy was also remarkably effective, with nobetweenbetweengroup difference in anginagroup difference in angina--free status at 5free status at 5
yearsyears
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ImplicationsImplications
Our findings reinforce existing ACC/AHA clinicalOur findings reinforce existing ACC/AHA clinical
practice guidelines, which state that PCI can be safelypractice guidelines, which state that PCI can be safelydeferred in patients with stable CAD, even in thosedeferred in patients with stable CAD, even in thosewith extensive,with extensive, multivesselmultivessel involvement and inducibleinvolvement and inducible
ischemia, provided that intensive, multifaceted medicalischemia, provided that intensive, multifaceted medicaltherapy is instituted and maintainedtherapy is instituted and maintained
Optimal medical therapy and aggressive managementOptimal medical therapy and aggressive managementof multiple treatment targets without initial PCI can beof multiple treatment targets without initial PCI can beimplemented safely in the majority of patients withimplemented safely in the majority of patients with
stable CADstable CADtwotwo--thirds of whom may not requirethirds of whom may not requireeven a first revascularization during longeven a first revascularization during long--term followterm follow--
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ImplicationsImplications
Our findings reinforce existing ACC/AHA clinicalOur findings reinforce existing ACC/AHA clinical
practice guidelines, which state that PCI can be safelypractice guidelines, which state that PCI can be safelydeferred in patients with stable CAD, even in thosedeferred in patients with stable CAD, even in thosewith extensive,with extensive, multivesselmultivessel involvement and inducibleinvolvement and inducible
ischemia, provided that intensive, multifaceted medicalischemia, provided that intensive, multifaceted medicaltherapy is instituted and maintainedtherapy is instituted and maintained
Optimal medical therapy and aggressive managementOptimal medical therapy and aggressive managementof multiple treatment targets without initial PCI can beof multiple treatment targets without initial PCI can beimplemented safely in the majority of patients withimplemented safely in the majority of patients with
stable CADstable CADtwotwo--thirds of whom may not requirethirds of whom may not requireeven a first revascularization during longeven a first revascularization during long--term followterm follow--
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TriCardinTriCardinwas successfully launched inwas successfully launched inPakistan by Trigen Pharma in March 2006Pakistan by Trigen Pharma in March 2006
HIGHEST SELLINGHIGHEST SELLING Cardiac MedicineCardiac Medicinein China and is available worldwide in 34in China and is available worldwide in 34
countriescountries Single Largest Selling Drug in anySingle Largest Selling Drug in any
therapeutic categorytherapeutic category
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Over 100,000 international clinical trials haveOver 100,000 international clinical trials haveprovedprovedTriCardinTriCardin as the most effective drug toas the most effective drug to
treat cardiovascular diseases andtreat cardiovascular diseases andmicroangiopathiesmicroangiopathies
TriCardinTriCardin is widely used in all Chinese Armyis widely used in all Chinese Army
Hospitals and other hospitals asHospitals and other hospitals asFIRST LINE OF TREATMENTFIRST LINE OF TREATMENT
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TriCardin is a very highTriCardin is a very high--profile, safe, multiprofile, safe, multi--functionalfunctional
research medicine, manufactured onresearch medicine, manufactured on 44thth Generation HiGeneration Hi--Tech Dripping Pills Technology PlantTech Dripping Pills Technology Plantthe only of itsthe only of its
kind in the worldkind in the world
Dripping Pills Technology ensures very quick onset ofDripping Pills Technology ensures very quick onset ofaction, rapid absorption and immediate improvement inaction, rapid absorption and immediate improvement in
symptomssymptoms
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Highest Quality StandardsHighest Quality Standards Tasly Pharma Group isTasly Pharma Group is
highly certifiedhighly certified TriCardinTriCardin isis FDAFDAINDIND
approved medicine, withapproved medicine, with
99.99% purity and99.99% purity andaccurate composition ofaccurate composition of
ingredients, ensured byingredients, ensured by
patentedpatented multimulti--fingerprint technologyfingerprint technology
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International RegistrationsInternational Registrations
USA
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2121stst Century ConceptCentury Conceptofof
Treating Cardiovascular System &Treating Cardiovascular System &
MicroangiopathiesMicroangiopathies
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COMPOSITION OFCOMPOSITION OF
TriCardinTriCardin
The ingredients ofThe ingredients ofTricardin are registeredTricardin are registered
in Chinesein Chinese PharmacopiaPharmacopia
DanshenformCompound
Salvia Miltiorrhiza
207mg
Notogenseng
40.5mg
Borneol
2.5mg
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SALVIA MILTIORRHIZA (SM)SALVIA MILTIORRHIZA (SM)
WaterWater soluablesoluable
compounds of SM:compounds of SM: ProtocatechuicProtocatechuic aldehydealdehyde
ProtocatechuicProtocatechuic acidacid
CaffeicCaffeic acidacid 3,43,4 dihydroxyphenoldihydroxyphenol
lactic acidlactic acid
LithospermicLithospermic acidacid SalvianolicSalvianolic acid A & Bacid A & B
RosmarinicRosmarinic acidacid
LipophilicLipophilic compounds ofcompounds of
SM:SM: TanshinoneTanshinone II
TanshinoneTanshinone IIA & IIBIIA & IIB
CryptotanshinoneCryptotanshinone TanshinodiolTanshinodiol CC
15,1615,16 dihydrotanshinonedihydrotanshinone
II IsotanshinoneIsotanshinone II
IsotanshinoneIsotanshinone IIII
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ROLE OFROLE OF TriCardinTriCardin
Improves MicrocirculationImproves Microcirculation
Large Arteries & Veins onlyLarge Arteries & Veins onlyact as a passage.act as a passage.
Microcirculation transportsMicrocirculation transports
blood cells and substancesblood cells and substances(O2, CO2, Nutrients,(O2, CO2, Nutrients,Hormones, Water) to andHormones, Water) to andfrom the tissues. It alsofrom the tissues. It also
contribute to tissuecontribute to tissue colourcolourand stiffnessand stiffness
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MICROCIRCULATIONMICROCIRCULATION
Microcirculation comprises the greatest portionMicrocirculation comprises the greatest portion
of the peripheral vasculature in terms of lengthof the peripheral vasculature in terms of lengthand surface area of blood vessels, so it is theand surface area of blood vessels, so it is the
bulk of peripheral circulationbulk of peripheral circulation
(Microcirculation in Hypertension: Circulation. 2001;104:735(Microcirculation in Hypertension: Circulation. 2001;104:735--740)740)
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REPERFUSION INJURYREPERFUSION INJURY
Microcirculation is the prime site involved in theMicrocirculation is the prime site involved in the
pathophysiologypathophysiologyof reperfusion injury. It is an important site ofof reperfusion injury. It is an important site ofnitric oxide production & superoxide (free radical) formation.nitric oxide production & superoxide (free radical) formation.
It is the primary location for leukocyteIt is the primary location for leukocyte-- endothelial cellendothelial cell
interaction which is the hall mark of reperfusion injuryinteraction which is the hall mark of reperfusion injury
Reperfusion injury is initiated within minutes of reperfusion byReperfusion injury is initiated within minutes of reperfusion by
the generation of superoxide radicals that inactivate NO. Thethe generation of superoxide radicals that inactivate NO. The
reduced bioavailability of NO triggers an endothelial dysfunctioreduced bioavailability of NO triggers an endothelial dysfunctionn
that promotesthat promotes neutrophilneutrophil adherence and injuryadherence and injury( ( 3 .3 1998)3 .3 1998)
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ENDOTHELIAL CELLSENDOTHELIAL CELLS These cells are the majorThese cells are the major
functional element of blood vesselfunctional element of blood vessel
wall that allow arterioles,wall that allow arterioles,capillaries andcapillaries and venulesvenules to carryto carry
out their functions.out their functions.
Endothelial cells produce varietyEndothelial cells produce variety
of substances that can affectof substances that can affect
underlying smooth muscle cellsunderlying smooth muscle cells
and circulating blood cells.and circulating blood cells.
Endothelial dysfunctionEndothelial dysfunction
contributes to the pathogenesis ofcontributes to the pathogenesis of
number of cardiovascularnumber of cardiovascular
diseases, includingdiseases, including
atherosclerosis, hypertension,atherosclerosis, hypertension,insulin resistance (diabetesinsulin resistance (diabetes
mellitus) & hypercholesterolemiamellitus) & hypercholesterolemia
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LEUKOCYTELEUKOCYTE--ENDOTHELIAL CELLENDOTHELIAL CELL
ADHESIONADHESION
Circulating leukocytes areCirculating leukocytes are
recruited to sites ofrecruited to sites of
inflammation and tissueinflammation and tissueinjury by a highly coinjury by a highly co--
ordinatedordinated processprocess
Adhesion molecules areAdhesion molecules are
expressed on the surfaceexpressed on the surfaceof the endothelial cells andof the endothelial cells and
their respective circulatingtheir respective circulating
leukocytesleukocytes
SelectinsSelectins (P and E)(P and E)mediate leukocyte rollingmediate leukocyte rolling
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LEUKOCYTELEUKOCYTE--ENDOTHELIAL CELLENDOTHELIAL CELL
ADHESIONADHESION Endothelial cell adhesion molecules that ensure firm adhesion ofEndothelial cell adhesion molecules that ensure firm adhesion of
leukocytes includes intercellular adhesion moleculeleukocytes includes intercellular adhesion molecule--11 (ICAM(ICAM--1)1) &&
vascular cell adhesion moleculevascular cell adhesion molecule--11 (VCAM(VCAM--1)1) Nitric oxide &Nitric oxide & ProstacyclinProstacyclin produced by endothelial cells tendproduced by endothelial cells tend
to prevent adhesion, while the oxygen radicals (superoxide,to prevent adhesion, while the oxygen radicals (superoxide,
hydrogen peroxide) generated by activated leukocytes andhydrogen peroxide) generated by activated leukocytes and
endothelial cells promote leukocyte adhesionendothelial cells promote leukocyte adhesion
Vascular endothelial cells serves as a barrier to the movement oVascular endothelial cells serves as a barrier to the movement off
fluid and proteins from blood tofluid and proteins from blood to interstitiuminterstitium. The barrier is lost. The barrier is lost
due to damage of endothelial cells which results in increasedue to damage of endothelial cells which results in increase
vascular permeability.vascular permeability.
LeukocyteLeukocyte--endothelial cell adhesion and increased vascularendothelial cell adhesion and increased vascularpermeability is present in cardiovascular system and regionalpermeability is present in cardiovascular system and regional
circulatory disorder (Hypertension, Stroke, Diabetes Mellitus)circulatory disorder (Hypertension, Stroke, Diabetes Mellitus)
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MICROCIRCULATORYMICROCIRCULATORY
DYSFUNCTIONDYSFUNCTION
HypercoagulabilityPlatelet
activation
Endothelial
Injury
Cell
adhesion
peroxide
Vascular
Permeability
Microcirculatorydysfunction
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EFFECTS OF IMPAIREDMICROCIRCULATION
ON BRAIN:
CERBRALISCHEMIA
INFARCTION
PARALYSIS
ON EYES:DAMAGE TO
RETINALVESSELS
RETINOPATHY
BLINDNESS
ON HEART:
ANGINA
M.I
DEATH
ON LUNGS:PLUMONARYINFARCTION
ACUTE RT. HEARTFAILURE
DEATH
ON KIDNEY:PARENCHYMAL
DAMAGE
RENAL FAILURE
DEATH
ON LEGS:
GANGRENE
DEATH
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Action of Tricardin onAction of Tricardin on HeartHeart
Tricardin stimulates nitric oxide production of endothelial cellTricardin stimulates nitric oxide production of endothelial cells bys byincreasing endothelial nitric oxideincreasing endothelial nitric oxide synthasesynthase ((eNOSeNOS) expression level.) expression level.( & :10.1016/..2007.09.00( & :10.1016/..2007.09.008)8)
TriCardin scavenge oxygen free radicals and inhibits myocardialTriCardin scavenge oxygen free radicals and inhibits myocardial cellcellapoptosis.apoptosis.( 2005;45:1345( 2005;45:13451359)1359)
TriCardin inhibits CaTriCardin inhibits Ca++++ aggregation in cardiac cells and preventsaggregation in cardiac cells and preventsCaCa++++ overloadoverload( , 2005;45:1345( , 2005;45:13451359)1359)
Tricardin inhibits homocysteine and protects the myocardial cellTricardin inhibits homocysteine and protects the myocardial cellssagainst homocystenemiaagainst homocystenemia( , 2005;45:1345( , 2005;45:13451359)1359)
Tricardin inhibits DNA synthesis ofTricardin inhibits DNA synthesis of noncardiomyocytesnoncardiomyocytes and inhibitsand inhibitsStressStress--activated protein (SAP) kinase activity.activated protein (SAP) kinase activity.( , 2005;45:1345( , 2005;45:13451359)1359)( , 45, 5, ( , 45, 5, 2005) 2005)
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Action of TriCardin onAction of TriCardin on Blood VesselsBlood Vessels
TriCardin increases endothelium derivesTriCardin increases endothelium derivesprostacyclinprostacyclin or PGI2or PGI2(potent vasodilator & platelet aggregation inhibitor) and inhibi(potent vasodilator & platelet aggregation inhibitor) and inhibitstsThromboxaneThromboxaneA2 (potent vasoconstrictor) and B2A2 (potent vasoconstrictor) and B2( , 2005;45:1345( , 2005;45:13451359) ( , 2003;126:1359) ( , 2003;126:140414041410)1410)
TriCardin inhibits endotheliumTriCardin inhibits endothelium--derived vasoconstrictorderived vasoconstrictorendothelinendothelin--1 (ET1 (ET--1)1)( , 2003;126:1404( , 2003;126:14041410)1410)
Tricardin inhibits the activation of nuclear transcription factoTricardin inhibits the activation of nuclear transcription factor NFr NF--kB by blocking its translocation from cytoplasm to nucleikB by blocking its translocation from cytoplasm to nuclei( , 45, 5, ( , 45, 5, 2005) 2005)
TriCardin stimulates glutathione synthesis (an intracellularTriCardin stimulates glutathione synthesis (an intracellular
antioxidant) which inhibits NFantioxidant) which inhibits NF--kB activation and resultantkB activation and resultantadhesion molecule expression.adhesion molecule expression.( ( 45, 5 2005)45, 5 2005)
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Action of TriCardin onAction of TriCardin on BloodBlood
TriCardin dissolves preformed microthrombi, interferes withTriCardin dissolves preformed microthrombi, interferes with
extrinsic blood coagulation and exhibit antithrombin III likeextrinsic blood coagulation and exhibit antithrombin III likeactivity.activity.(( 2001 , 35) 2001 , 35)
Tricardin significantly decreases PTricardin significantly decreases P--selectin, G IIb/IIIaselectin, G IIb/IIIaexpression and intracellular calcium in both unactivated andexpression and intracellular calcium in both unactivated and
ADP activated platelet.ADP activated platelet.(( & &17:25917:259264,2006.264,2006. & ) & )
Inhibits mast cellInhibits mast cell degranulationdegranulation( & :10.1016/..2007.09.00( & :10.1016/..2007.09.008)8)
Inhibits cytokines releaseInhibits cytokines release( & :10.1016/..2007.09.00( & :10.1016/..2007.09.008)8)
Effectively reduces the expression of VCAMEffectively reduces the expression of VCAM--1 and ICAM1 and ICAM--1 on1 onvascular endothelium.vascular endothelium.(( , 45, 5, , 45, 5, 2005)2005)
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Action of TriCardin onAction of TriCardin on Lipid ProfileLipid Profile
Total cholesterol, TG and LDL cholesterol levels wereTotal cholesterol, TG and LDL cholesterol levels weresignificantly reduced by 28.3%, 34.3% and 29.9% respectivelysignificantly reduced by 28.3%, 34.3% and 29.9% respectivelyand HDL cholesterol was significantly high by 33.2%and HDL cholesterol was significantly high by 33.2%( . 1998;18;481( . 1998;18;481486)486)
Tricardin inhibits LDL oxidation by inhibiting 1Tricardin inhibits LDL oxidation by inhibiting 1--diphenyldiphenyl--22--
picrylhydrazyl radicals.picrylhydrazyl radicals.( . 1998;18;481( . 1998;18;481486)486)
Tricardin prevents of uptake of LDL by cultured macrophages.Tricardin prevents of uptake of LDL by cultured macrophages.( . 1998;18;481( . 1998;18;481486)486)
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VASCULAR COMPLICATIONS OFVASCULAR COMPLICATIONS OF
DIABETES MELLITUSDIABETES MELLITUS MicrovascularMicrovascular ComplicationsComplications
( )( )
Diabetic foot is often due to aDiabetic foot is often due to a
combination of neuropathycombination of neuropathy
and arterial disease, may causeand arterial disease, may cause
skinskin ulcerulcer andand infectioninfection and, inand, inserious cases,serious cases, necrosisnecrosis andand
gangrene.gangrene.
MacrovascularMacrovascular ComplicationsComplications
It leads to cardiovascularIt leads to cardiovasculardisease, to which accelerateddisease, to which accelerated
atherosclerosisatherosclerosis is ais a
contributorcontributor
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ROLE OFROLE OF TriCardinTriCardin
IN DMIN DM The effect of oralThe effect of oral hypoglycaemicshypoglycaemics is only aimed to lower level ofis only aimed to lower level of
blood glucose where asblood glucose where asTriCardinTriCardin acts multi dimensionally inacts multi dimensionally in
diabetes mellitus:diabetes mellitus:
TriCardinTriCardin minimizes insulin resistance by promoting bloodminimizes insulin resistance by promoting blood
microcirculationmicrocirculation
TriCardinTriCardin
reduces whole blood viscosity and decreases urinary albuminreduces whole blood viscosity and decreases urinary albumin& retards the process of diabetic nephropathy& retards the process of diabetic nephropathy
TriCardinTriCardin significantly increases the superoxidesignificantly increases the superoxide dismutasedismutase (SOD) levels;(SOD) levels;
it resists lipidit resists lipid peroxidationperoxidation injury and be helpful for diabeticinjury and be helpful for diabetic
complicationscomplications No side effects as compared to those of oralNo side effects as compared to those of oral hypoglycaemicshypoglycaemics
((hypoglycaemiahypoglycaemia, lactic acidosis, GI upset), lactic acidosis, GI upset)
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ROLE OFROLE OF TriCardinTriCardin ININ
METABOLIC SYNDROMEMETABOLIC SYNDROME People with metabolic syndrome are at increasedPeople with metabolic syndrome are at increased
risk of CHD, Stroke, PVD & DMrisk of CHD, Stroke, PVD & DM AHA recommendation for managing metabolicAHA recommendation for managing metabolic
syndrome is to reduce the risk for CV diseases &syndrome is to reduce the risk for CV diseases &
DM Type2 by reducing LDL, controlling BPDM Type2 by reducing LDL, controlling BPand glucose levelsand glucose levels
TriCardin (2xBID or 1xTID)TriCardin (2xBID or 1xTID) is the only optionis the only option
available to achieve above targets by improvingavailable to achieve above targets by improvingmicrocirculationmicrocirculation
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ROLE OFROLE OF TriCardinTriCardin ININ
HYPERTENSIONHYPERTENSION The reduction or improvement in endThe reduction or improvement in endorgan damage seenorgan damage seen
during antiduring anti--hypertensive therapy do not always correlate wellhypertensive therapy do not always correlate well
with the reduction in arterial blood pressure achieved.with the reduction in arterial blood pressure achieved. There seemsThere seems
to be a need for new therapeutic perspective in the treatment ofto be a need for new therapeutic perspective in the treatment ofhypertensionhypertension
One important new perspective is provided by an enhancedOne important new perspective is provided by an enhanced
appreciation of the importance of the microcirculation in theappreciation of the importance of the microcirculation in thepathophysiologypathophysiologyand treatment of hypertension.and treatment of hypertension. (Microcirculation in(Microcirculation inHypertension: Circulation. 2001;104:735Hypertension: Circulation. 2001;104:735--740)740)
By addingBy adding Tricardin (2xBID or 1xTID)Tricardin (2xBID or 1xTID) hypertensionhypertension
control can be achieved because it overcomes the vascularcontrol can be achieved because it overcomes the vascularresistance offered by the microcirculationresistance offered by the microcirculation
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INDICATIONS OFINDICATIONS OF TriCardinTriCardin
Tricardin is indicated in the treatment &Tricardin is indicated in the treatment &
prevention of the following:prevention of the following: Ischemic Heart Diseases (Angina Pectoris/MI)Ischemic Heart Diseases (Angina Pectoris/MI)
HyperlipidemiaHyperlipidemia
Atherosclerosis/ArteriosclerosisAtherosclerosis/Arteriosclerosis Diabetic & Hypertensive Nephropathy, RetinopathyDiabetic & Hypertensive Nephropathy, Retinopathy
& Neuropathy& Neuropathy
Stroke & PVDStroke & PVD Metabolic SyndromeMetabolic Syndrome
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DOSAGE OFDOSAGE OF TriCardinTriCardin
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TriCardinTriCardinAS AN ANTIAS AN ANTI--ANGINALANGINALA Meta AnalysisA Meta Analysis
TriCardinTriCardin (SM) for the treatment of chronic stable angina(SM) for the treatment of chronic stable anginapectoris compared with Nitratespectoris compared with Nitrates , 2006;12(1):1, 2006;12(1):177
: 26369479: 26369479
....
Compared with Nitrates,treatment withCompared with Nitrates,treatment with TriCardinTriCardin hadhadsignificant effect on improvement of angina symptoms,significant effect on improvement of angina symptoms,showed greater increased effect on the improvement ofshowed greater increased effect on the improvement of
ECG results and the percentage of patients with adverseECG results and the percentage of patients with adverseevents was significantly decreased in comparison withevents was significantly decreased in comparison withnitratesnitrates
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TriCardinTriCardinAS ANTIAS ANTI--ATHEROSCLEROSIS, ANTIATHEROSCLEROSIS, ANTI--
THROMBOTIC & ANTITHROMBOTIC & ANTI--HYPERLIPIDEMICHYPERLIPIDEMIC
Increase of Vitamin E content in LDL and ReductionIncrease of Vitamin E content in LDL and Reduction
of Atherosclerosis in Cholesterolof Atherosclerosis in Cholesterol--Fed Rabbits byFed Rabbits byTriCardinTriCardin (Salvia Miltiorrhiza)(Salvia Miltiorrhiza)
....1998;18;481....1998;18;481486486 ://..////18/3/481://..////18/3/481
TriCardinTriCardin (SM) acts as a potent anti(SM) acts as a potent anti--oxidant thusoxidant thus
inhibiting LDL oxidation,inhibiting LDL oxidation, TriCardinTriCardin reducedreduced
endothelial damage and severity of atherosclerosisendothelial damage and severity of atherosclerosis
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TriCardinTriCardin AS AN ANTIAS AN ANTI--PLATELETPLATELET
Inhibitory Effects ofInhibitory Effects of TriCardinTriCardin on Platelet Functionon Platelet Function
in Dogs Fed a Highin Dogs Fed a High
--Fat DietFat Diet
& &2006, 17:2592006, 17:259264264 & &
Compared with Aspirin,Compared with Aspirin, TriCardinTriCardin showed a moreshowed a more
exaggerated inhibitory effect on platelet function.exaggerated inhibitory effect on platelet function.The lipid lowering and antiThe lipid lowering and anti--oxidant effects ofoxidant effects of
TriCardinTriCardin are responsible for this result.are responsible for this result.
Research has suggested thatResearch has suggested that TriCardinTriCardinproduceproducemultiple beneficial effects on cardiovascularmultiple beneficial effects on cardiovascularprotection.protection.
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VERY HIGH SAFETY PROFILE &VERY HIGH SAFETY PROFILE &
TOLERABLITY OFTOLERABLITY OF TriCardinTriCardin Rarely reported mild effects are headache,Rarely reported mild effects are headache,
dizziness and flushing (1.93%) and GI upsetdizziness and flushing (1.93%) and GI upset(1.14%). Will disappear with continuous usage(1.14%). Will disappear with continuous usage
No animal died even after administration of 700No animal died even after administration of 700times oral dose or 350 timestimes oral dose or 350 times intraperitonealintraperitoneal dosedoseof that used clinically for adultsof that used clinically for adults
Proven wide safety marginProven wide safety margin
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CONTRAINDICATIONSCONTRAINDICATIONS TriCardinTriCardin
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CONVENTIONAL MANAGEMENTCONVENTIONAL MANAGEMENT
OF ISCHEMICOF ISCHEMIC HEARTHEART DISEASEDISEASE
AspirinAspirin
ClopidogrelClopidogrel
AntiAnti--anginalanginal
BetaBeta--BlockersBlockers Calcium AntagonistsCalcium Antagonists
NitratesNitrates
StatinsStatins
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ADDITION OFADDITION OF TriCardinTriCardin
AspirinAspirin
ClopidogrelClopidogrel
AntiAnti--anginalanginal BetaBeta--BlockersBlockers
Calcium AntagonistsCalcium Antagonists NitratesNitrates
StatinsStatins
Net Result:Net Result:
Reduction in number ofReduction in number ofmedications. Patient will feelmedications. Patient will feelgoodgood
Significant decrease inSignificant decrease in
anginalanginal episodesepisodes Marked improvement inMarked improvement in
ECG and ETTECG and ETT
Improvement in EjectionImprovement in Ejection
fractionfraction Remarkable improvement inRemarkable improvement in
General Condition of patientGeneral Condition of patientwithin weekswithin weeks
Better quality of lifeBetter quality of life
AddingAddingTriCardin 1TriCardin 1--2 Capsules2 Capsules
two to three times a daytwo to three times a day
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Recently ConcludedRecently ConcludedLocal Clinical TrialsLocal Clinical Trials
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Clinical Trial Conducted atClinical Trial Conducted atThe Department ofThe Department of
Cardiology, Lady ReadingCardiology, Lady Reading
Hospital, PeshawarHospital, Peshawar
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Efficacy ofEfficacy ofTriCardinTriCardin forforimproving Ischemic Symptoms &improving Ischemic Symptoms &
reducing episodes of Angina inreducing episodes of Angina in
patients with known cases of CADpatients with known cases of CADProfessor Dr. Mohammad HafizullahProfessor Dr. Mohammad Hafizullah
Dr. Mahmood ul HassanDr. Mahmood ul Hassan
Dr.Dr.
SaqibSaqib
QureshiQureshi
Dr. MohammadDr. Mohammad FahimFahim
Dr.Dr. CheraghCheragh HassanHassan
Cardiology Department,Postgraduate Medical Institute, Lady ReadiCardiology Department,Postgraduate Medical Institute, Lady Reading Hospital,ng Hospital,
Peshawar.Peshawar.
LRH
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ObjectiveObjective: To assess the efficacy of: To assess the efficacy of TriCardinTriCardin in patient with anginain patient with anginapectorispectoris already on optimal dosealready on optimal dose for reducing the duration of episode of anginafor reducing the duration of episode of angina
attacks subjectively and to see it objectively on ETT in our popattacks subjectively and to see it objectively on ETT in our population.ulation.
Material and methodsMaterial and methods: Twenty patients who are known cases of CHD: Twenty patients who are known cases of CHDwith CCSwith CCS--II Angina included in the study who were already taking optimumII Angina included in the study who were already taking optimum
doses of antidoses of anti anginalanginal medications like aspirin,beta blocker, lipid loweringmedications like aspirin,beta blocker, lipid lowering
nitrates,ACE inhibitors andnitrates,ACE inhibitors and clopidegrolclopidegrol..Patients were exercised on treadmill according to Bruce pPatients were exercised on treadmill according to Bruce protocol at baseline androtocol at baseline and
one week later. At second week TriCardin 500mg was given for fouone week later. At second week TriCardin 500mg was given for four weeks. Atr weeks. At
the end of four weeks again exercise tolerance test was performethe end of four weeks again exercise tolerance test was performed. Duration andd. Duration and
number ofnumber of anginalanginal episodes before and at the end of fourth week recorded.episodes before and at the end of fourth week recorded.Total exercise time, onset of ST segment depression before and aTotal exercise time, onset of ST segment depression before and after treatmentfter treatment
with TriCardin recorded.with TriCardin recorded.
LRH
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CLINICAL VARIABLES OF THECLINICAL VARIABLES OF THE
RESPONDENTSRESPONDENTS
LRH
Total duration of anti-anginal med 7.95 + 7.7 months
Total duration of Angina 8.5 + 7.7 months
Total no. 19Male 13 (68.4%)Female 6 (31.6%)Age (years) 46.74 + 8.73Heart rate 77.37 + 15.86
Prior MI 3 (15.8%)HTN 6(31.6%)DM 1( 5.3%)
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Comparison of variablesComparison of variables
0.0010.0018.328.32 ++ 2.332.336.526.52 ++ 1.931.93Exercise durationExercise duration
7.717.71++ 1.681.68
1.471.47++ 1.641.64
After treatmentAfter treatment
5.855.85 ++ 1.741.74
4.264.26++ 2.422.42
Before TreatmentBefore Treatment
0.0010.001Onset of STOnset of ST
depressiondepression
0.0010.001Anginal episodesAnginal episodes
P valueP valuevariablesvariables
LRH
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RESULTSRESULTS The number ofThe number of anginalanginal episodesepisodes after 4after 4
weeks treatment withweeks treatment with TriCardinTriCardinwaswasreduced significantly from 4.2 to 1.6 /reduced significantly from 4.2 to 1.6 /
week (p=0.001)week (p=0.001)
AnginalAnginal class improved significantlyclass improved significantly
after 4 weeks treatment withafter 4 weeks treatment withTriCardinTriCardin(p(p=0.001)=0.001)
LRH
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CONCLUSIONCONCLUSION
TriCardinTriCardin is effective inis effective in reducingreducing anginalanginal episodesepisodes
increasing exercise durationincreasing exercise duration improving functionalimproving functional anginalanginal classclass
delaying the onset of ST depression ondelaying the onset of ST depression on
ETT in patients with ischemic heartETT in patients with ischemic heartdiseasedisease
LRH
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Clinical trial at NICVD 2006Clinical trial at NICVD 2006--0707 Name of doctors participating in the trialName of doctors participating in the trial
Dr. Azhar Masood A. FarooquiDr. Azhar Masood A. FarooquiDr. Tariq AshrafDr. Tariq Ashraf
Dr. Syed Ishtiaq RasoolDr. Syed Ishtiaq Rasool
Dr. Hamid TirmiziDr. Hamid Tirmizi
NICVD
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NICVD TRIALNICVD TRIAL ::To observe ST segment changes in patients undergoingTo observe ST segment changes in patients undergoing
ETT after giving TriCardinETT after giving TriCardin
: :Thirty patients were taken from ETTThirty patients were taken from ETTdepartment. After having history and physical examination, patiedepartment. After having history and physical examination, patients takingnts takingno cardiac medication and ETT positive for ischemia were taken.no cardiac medication and ETT positive for ischemia were taken.TheseThesepatients were given TriCardin caps 250mg, 2+2+2 for ten days andpatients were given TriCardin caps 250mg, 2+2+2 for ten days and 2+0+22+0+2
for eleven days as a monotherapy. Patients called on first day ofor eleven days as a monotherapy. Patients called on first day of fourth weekf fourth weekfor repeat ETT.for repeat ETT.
Another group of 30 patients with similar characteristics, diagnAnother group of 30 patients with similar characteristics, diagnosis andosis andECG changes or ETT were given isosorbide dinitrate(Elantan) 10 mECG changes or ETT were given isosorbide dinitrate(Elantan) 10 mg TDSg TDSfor three weeks and Aspirin 150mg OD.for three weeks and Aspirin 150mg OD.
The two groups with ECG changes were compared.The two groups with ECG changes were compared.
NICVD
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ResultResult:: Before treatment(n=20)Before treatment(n=20)
2(10%)2(10%)5(25%)5(25%)3mm3mm
16(80%)16(80%)15(75%)15(75%)2mm2mm0.1900.190
2(10%)2(10%)
1mm1mm
ISDNISDNTriCardinTriCardin
PP--valuevalueTreatmentTreatmentSTST--SegmentSegmentdepression(mdepression(m
m)m)
NICVD
Aft T t t( 20)
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0.5980.5982(10%)2(10%)2(10%)2(10%)3mm3mm
0.008*0.008*11(55%)11(55%)3(15%)3(15%)2mm2mm
0.001*0.001*2(10%)2(10%)14(70%)14(70%)1mm1mm
0.1840.1845(25%)5(25%)1(5%)1(5%)NoneNone
ISDNISDNTriCardinTriCardin
PP--valuevalueTreatmentTreatmentSTST--SegmentSegmentdepression (mm)depression (mm)
After Treatment(n=20)
NICVD
After TriCardinTriCardin treatment ST-segment depression 1 mm wereSignificantly high (70%) as compared to ELANTANpatients (10%) p
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ISDNISDNTriCardinTriCardin
001(5%)1(5%)DizzinessDizziness
17(85%)17(85%)1(5%)1(5%)HeadacheHeadache
17(85%)17(85%)2(10%)2(10%)YESYES
0.001*0.001*3(15%)3(15%)18(90%)18(90%)NONO
PP--valuevalueTreatmentTreatmentSide effectsSide effects
Side effects were significantly less in TriCardinTriCardin (10%)as compared to Elantan (85%) (p
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Ongoing trialsOngoing trials 300 patients of unstable angina registered.300 patients of unstable angina registered.
150 Post150 Post--PCI and postPCI and post--CABG patients.CABG patients. 50 patients of ischemic50 patients of ischemic cardiomyopathycardiomyopathy..
Also being evaluated in ischemic stroke.Also being evaluated in ischemic stroke. Evaluation for its role proposed in HAPE, HACE.Evaluation for its role proposed in HAPE, HACE.
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HIGHLIGHTSHIGHLIGHTS
TriCardinTriCardin
100% Imported100% Imported
FDAFDA INDIND approvedapproved
Improves Microcirculation at all levelsImproves Microcirculation at all levels
Inhibits platelet adhesion & aggregation (more effective than asInhibits platelet adhesion & aggregation (more effective than aspirin)pirin)
Potent antioxidant; eliminates free radicalsPotent antioxidant; eliminates free radicals
Promotes the production of nitric oxide & inhibits endothelinPromotes the production of nitric oxide & inhibits endothelin--11
Lowers total blood cholesterol; inhibits oxidation of LDL; improLowers total blood cholesterol; inhibits oxidation of LDL; improves HDLves HDL
More effective than nitroglycerin for improving heart function aMore effective than nitroglycerin for improving heart function and circulationnd circulation
Significantly improves ECG, ETT and general condition of patientSignificantly improves ECG, ETT and general condition of patient
Improves survival rate after heart attackImproves survival rate after heart attack Effectively treat & prevent diabetic vascular complicationsEffectively treat & prevent diabetic vascular complications
Modern TCM with virtually no side effectsModern TCM with virtually no side effects
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SUMMARYSUMMARYWhen u add Tricardin 2 x BID or 1 x TID toWhen u add Tricardin 2 x BID or 1 x TID to
your patient, you will get:your patient, you will get: Amazing improvement in the generalAmazing improvement in the general
condition within dayscondition within days
Significant improvement in ECG and ETTSignificant improvement in ECG and ETT
Significant reduction inSignificant reduction in anginalanginal episodesepisodes
Significant improvement in ejection fractionSignificant improvement in ejection fraction
Your patient will definitely share smile with youYour patient will definitely share smile with you
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