Holistic Health Articles and Research Related to Herbal Medicines, Foods and Phytochemicals

Sunday, 1 December 2013

Angina pectoris - Treatments In Traditional Chinese medicine perspective

Traditional Chinese medicine defines angina as a diseases as a result of Ischemic heart disease (belongs to the categories of "xiong bi", "xin tong", "xin ji", "jue xin tong" and "zhen xin tong)either caused by Stagnation of Heart Blood of which leads to symptoms of localized stabbing chest pain aggravated at night, palpitation,restlessness, dark purple tongue, etc. in most cases or Heart Yin Deficiency of which lead to symptoms of chest pain and oppression, restlessness, insomnia, palpitation, night sweating, lumbago, weak waist and knees, dizziness, tinnitus. etc., in most cases

C.1. Formula(61)(62)

1. Jing Zhi Guan Xin Pian used for coronary heart disease, angina pectoris due to stagnation of heart blood

2. Ingredients

a. Radix Salviae Miltiorrhizae (Dan Shen)

b. Radix Rubra (Chi Shao)

c. Chuanxiong rhizome (Chuan Xion)

d. Flos Carthami. (Hong Hua)

e. Lignum Dalbergiae Odoriferae (Jiang Xiang0

C.2. Heart Yin Deficiency
1. Tian Wang Bu Xin Wan used for coronary heart disease, angina pectoris due to heart Yin Deficiency
2. Ingredients
a. Radix Salviae Miltiorrhizae (Dan Shen)
b. Rhizoma Acori Tatarinowii (Shi Chang Pu)
c. Radix Rehmanniae Glutinosae (Di Huang)
d. Radix Angelica Sinensis (Dang Gui)
e. Fructus Schisandrae Chinensis (Wu Wei Zi)
f. Tuber Ophiopogonis Japonici (Mai Men Dong)
g. Semen Ziziphi Spinosae (Suan Zao Ren)
h. Semen Biotae Orientalis (Semen Platycladi) (Bai Zi Ren)
i. Radix Codonopsis Pilosulae (Dang Shen)
j. Sclerotium Poriae Cocos (Fu Ling)
k. Radix Scrophulariae Ningpoensis (Xuan Shen)
l. Radix Polygalae Tenuifoliae (Yuan Zhi)
m. Radix Platycodi Grandiflori (Jie Geng)
n. Radix Glycyrrhizae Uralensis (Gan Cao)

Please consult with your doctor or related field specialist before applying

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Sources

(61) http://www.herbsbuy360.com/tongrentang-jing-zhi-guan-xin-pianfor-chd-p-1367.html#.UpvfX-Ja-QI

(62) http://www.activeherb.com/tianwang/

Angina pectoris - Treatments In Herbal medicine perspective

1. Organic Soybean is the genus Glycine, belonging to the family Fabaceae, one of the legumes that contains twice as much protein per acre as any other major vegetable or grain crop, native to Southeast Asia. Now, it is grown worldwide with suitable climate for commercial profit and a a healthy foods. The herb has been used in traditional medicine for the proper functioning of the bowels, heart, kidney, liver, stomach. etc.
a. Insulin sensitive
Soybean helps to normalize plasma glucose and insulin homeostasis, according to "Increased insulin sensitivity and changes in the expression profile of key insulin regulatory genes and beta cell transcription factors in diabetic KKAy-mice after feeding with a soy bean protein rich diet high in isoflavone content" by Nordentoft I, Jeppesen PB, Hong J, Abudula R, Hermansen K.(50)

b. Cardiovascular diseases
Soy protein reduces reduces the levels of serum lipoprotein, decrease in low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), LDL-C/high-density lipoprotein cholesterol (HDL-C), triacylglycerol/HDL-C and TC/HDL-Cpostmenopausal women are at risk of cardiovascular disease, according to "Effects of soy bean on serum paraoxonase 1 activity and lipoproteins in hyperlipidemic postmenopausal women" by Shidfar F, Ehramphosh E, Heydari I, Haghighi L, Hosseini S, Shidfar S.(51)

2. Garlic (Allium sativum) is a species in the onion genus, belonging to family Amaryllidaceae, native to central Asia. It has been used popularly in traditional and Chinese medicine in treating common cold and flu to the Plague, blood pressure cholesterol levels, natural antibiotic, etc.
a. Cholesterol

Eating 4 cloves of garlic a day can cut total CHOLESTEROL by 70%(Fresh or Supplement). The member of the allium family fights poor circulation.The sulfur compound in garlic keep your platelets from clumping together. It helps UNCLOG your Arteries but check with your Doctor if you are taking Blood thinning medications. Cook with both Garlic and onion to fight high blood pressure effectively. Try to take them everyday if you have high blood pressure and Cholesterol.

b. Blood pressure
In the assessment of garlic extract and its effect of hypertension. found that Aged garlic extract was generally well tolerated and acceptability of trial treatment was high (92%) and aged garlic extract is superior to placebo in lowering systolic blood pressure similarly to current first line medications in patients with treated but uncontrolled hypertension, according to "Aged garlic extract lowers blood pressure in patients with treated but uncontrolled hypertension: a randomised controlled trial" by Ried K, Frank OR, Stocks NP.(52)

7. Atherosclerosis
In the demonstration of aged garlic extract therapy with supplements (AGE+S) and theirs effect on cardiovascular diseases found that CAC progression was significantly lower and TR significantly higher in the AGE+S compared to the placebo group after adjustment of cardiovascular risk factors (p<0.05). Total cholesterol, LDL-C, homocysteine, IgG and IgM autoantibodies to MDA-LDL and apoB-immune complexes were decreased, whereas HDL, OxPL/apoB, and Lp (a) were significantly increased in AGE+S to placebo and concluded that AGE+S is associated with a favorable improvement in oxidative biomarkers, vascular function, and reduced progression of atherosclerosis., according to "Aged garlic extract supplemented with B vitamins, folic acid and L-arginine retards the progression of subclinical atherosclerosis: a randomized clinical trial" by Budoff MJ, Ahmadi N, Gul KM, Liu ST, Flores FR, Tiano J, Takasu J, Miller E, Tsimikas S.(53)

3. Alfalfa
a. Antioxidant
In a study of measurements of pH, water holding capacity, color, oxymyoglobin content, TBARS and oxidation-reduction potential in evaluating the effects of a dietary protein-xanthophylls (PX) concentrate of alfalfa to turkey diets conducted by University of Life Sciences in Lublin, Skromna 8, 20-704 Lublin, (54), researchers found that TBARS and oxidation-reduction potential values suggested that the inclusion of the concentrate to turkey diets acts as an antioxidant in the raw meat.

2. Cholesterol
In a study to test the effect of Alfalfa used in traditional medicine to treat high blood cholesterol conducted by Malinow MR, McLaughlin P, Stafford C.(55), in 3 human volunteers during ingestion of diets containing alfalfa seeds (AS) for 3 weeks, researchers found that Plasma cholesterol concentrations were reduced and No signs of toxicity were detected through serum determinations of multiple parameters. The ingestion of AS in rats decreased the concentration of plasma cholesterol, reduced intestinal absorption of exogenous and endogenous cholesterol, and increased fecal biliary excretion.

3. Hyperlipoproteinemia
In a study of Fifteen patients with hyperlipoproteinemia (HLP), types IIA (n = 8), IIB (n = 3) and IV (n = 4) were given 40 g of heat prepared alfalfa seeds 3 times daily at mealtimes for 8 weeks with otherwise unchanged diet, conducted by Mölgaard J, von Schenck H, Olsson AG.(3), found that patients with type II HLP alfalfa treatment caused after 8 weeks a maximal lowering of pretreatment median values of total plasma cholesterol from 9.58 to 8.00 mmol/l (P less than 0.001) and low density lipoprotein (LDL) cholesterol from 7.69 to 6.33 mmol/l (P less than 0.01), which corresponds to decreases of 17% and 18%, respectively. Maximal decrease was 26% in total cholesterol and 30% in LDL cholesterol. In two patients with hypercholesterolemia the LDL cholesterol decreased less than 5%. Apolipoprotein B decreased in the same period from 2.17 to 1.43 g/l (P less than 0.05) in type II HLP, corresponding to 34% decrease, whereas apolipoprotein A-I did not change. Body weight increased slightly during the first 4 weeks of alfalfa treatment (P less than 0.001) probably because of the caloric content in the alfalfa seeds. After cessation of treatment, all lipoprotein concentrations returned to pretreatment levels. We conclude that alfalfa seeds can be added to the diet to help normalize serum cholesterol concentrations in patients with type II HLP.

4. Ginkgo biloba
a. Hypertension
Ginkgo enhanced endothelium-dependent vasodilation and elevation of the endothelial intracellular Ca(2+) level in SHR, resulting in hypotension, according to the study of "Effects of Ginkgo biloba extract on blood pressure and vascular endothelial response by acetylcholine in spontaneously hypertensive rats" by Kubota Y, Tanaka N, Kagota S, Nakamura K, Kunitomo M, Umegaki K, Shinozuka K.(56)

b. Cardiovascular tissues
Ginkgo biloba extract (EGb) has shown the protection of the cardiovascular tissues against HgCl(2)-induced oxidative damage, according to the study of "Protective effects of Ginkgo biloba extract against mercury(II)-induced cardiovascular oxidative damage in rats" by Tunali-Akbay T, Sener G, Salvarli H, Sehirli O, Yarat A.(57)

c. Hyperlipidemia
Ginkgo biloba leaves (EGB) has demonstrated the activities of limitation of the absorption of cholesterol, inactivation of HMGCoA and favorable regulation of profiles of essential polyunsaturated fatty acid (EFA), according to the study of "Application of GC/MS-based metabonomic profiling in studying the lipid-regulating effects of Ginkgo biloba extract on diet-induced hyperlipidemia in rats" by Zhang Q, Wang GJ, A JY, Wu D, Zhu LL, Ma B,(58)

5. Grape seed extract
Grape Seed Extract is the commercial extracts from whole grape seeds that contains many concentrations, including vitamin E, flavonoids, linoleic acid, oligomeric proanthocyanidins(OPCs), etc..The herb has been used in traditional medicine as antioxidant, anti-inflammatory agents and to treat skin wounds with less scarring, allergies, macular degeneration, arthritis, enhance circulation of blood vessels, lower cholesterol, etc.
a. Antioxidant Activity
in the assessment of phenolic content, antioxidant activity of White and red wines spiked with green tea extract and grape seed extract found that the green tea extract and grape seed extract increased antioxidant activity dose-dependently and the CRTs varied considerably between the Korean and Australian groups, with Koreans preferring wines spiked with green tea extract and Australians showing a preference for wines spiked with grape seed extract, according to "Total Phenolic Content, Antioxidant Activity and Cross-Cultural Consumer Rejection Threshold in White and Red Wines Functionally Enhanced with Catechin-Rich" by Yoo YJ, Saliba A, Prenzler PD, Ryan DM.(59)

b. Atherosclerosis
in the association of consumption of red wine and other polyphenolic compounds and prevention of cardiovascular diseases found that aortic atherosclerosis evaluated as the cholesterol content in aortic tissue was comparable in the control and GSE-dosed females, but it was significantly reduced in the abdominal part of GSE-dosed male compared to the controls (P < 0.05). In conclusion, feeding GSE extract to Watanabe heritable hyperlipidemic (WHHL) rabbits had no significant effects in females but was associated with transient less hypercholesterolemic response to semisynthetic diet, according to "Effects of red grape skin and seed extract supplementation on atherosclerosis in Watanabe heritable hyperlipidemic rabbits" by Frederiksen H, Mortensen A, Schrøder M, Frandsen H, Bysted A, Knuthsen P, Rasmussen SE.(60).
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Sources
(50) http://www.ncbi.nlm.nih.gov/pubmed/18522411
(51) http://www.ncbi.nlm.nih.gov/pubmed/18608549
(52) http://www.ncbi.nlm.nih.gov/pubmed/20594781
(53) http://www.ncbi.nlm.nih.gov/pubmed/19573556
(54) http://www.ncbi.nlm.nih.gov/pubmed/20580166
(55) http://www.ncbi.nlm.nih.gov/pubmed/7379953
(56) http://www.ncbi.nlm.nih.gov/pubmed/16451753
(57) http://www.ncbi.nlm.nih.gov/pubmed/17072828
(58) http://www.ncbi.nlm.nih.gov/pubmed/19960012
(59) http://www.ncbi.nlm.nih.gov/pubmed/22133028
(60) http://www.ncbi.nlm.nih.gov/pubmed/17441214

Angina pectoris - Treatments In conventional medicine perspective

Treatments

A. In conventional medicine perspective

In the summation of the evidences of angina pectoris' optimal treatment, Dr. Jánosi A. at the Fovárosi Onkormányzat Szent János Kórház-Rendelointézet III. Belgyógyászat, indicated that the first steps of therapy are - after the diagnosis - the influence of risk factors, life-style changes and optimal medical therapy. The optimal medical therapy consists of statin, aspirin and ACE inhibitor treatment besides antianginal therapy, where the beta blockers are regarded as first drugs of choice. Percutaneous interventions as initial treatment option are not recommended because we have no evidences that this intervention prolongs life and prevents myocardial infarction. If the patient remains symptomatic after medical treatment, it is necessary to perform revascularization(43a).

A.1. Medical treatments
1. 1. Nitroglycerin
a. Nitroglycerin is used to treat ischemic cardiac pain. and improve blood flow to the heart. Transdermal nitrate delivery systems improve the quality of life in ambulant patients: anginal attacks are reduced with a minimum of side effects. The widespread acceptance of this novel form of drug delivery has stimulated its application in other therapeutic avenues. The efficacy of transdermal nitroglycerin in the suppression of silent ischemic attacks has been demonstrated(43)
b. Side effects are not limit to
b.1. Dizziness
b.2. Lightheadedness, or fainting when sitting up or standing
b.3. Flushing of face and neck
b.4. Headache
b.5. Irritation
b.6. Nausea
b.7. Vomiting
b.8. Etc.

1.2. Beta-blockers
a. Beta blocker has been used to lower heart rate, blood pressure, and enhance oxygen to the heart. In the study of The 248 cases presented with new coronary heart disease from 1982 through 1984, and the 737 controls were a probability sample of health maintenance organization patients free of coronary heart disease. A withdrawal syndrome immediately following the cessation of beta-blocker use may be an acute precipitant of angina and myocardial infarction in hypertensive patients who have no prior history of coronary heart disease(44).
b. Side effects are not limit to
b.1. the medicine can cause allergic reaction to certain people, such as: rash, itching, swelling, dizziness, trouble breathing.
b.2. Easy bruising or bleeding,
b.3. Swollen hands or feet,
b.4. Confusion,
b.5. Depression
b.6. Etc.

1.3. Calcium channel blockers
a. The medicine used to relax arteries, lower blood pressure, and reduce strain on the heart. Researchers suggested that Compared with clopidogrel without calcium-channel blockers (CCBs), clopidogrel with CCB does not increase the mortality or composite thromboembolic events in elderly CAD patients, but clopidogrel combined with nondihydropyridine CCB is associated with significantly increased composite thromboembolic events in comparison with dihydropyridine CCB(45).
b. Side effects are not limit to
b.1. Stomach pain
b.2. Constipation
b.3. Drowsiness
b.4. Fatigue Feelings of a rapidly or forcefully beating heart (palpitations)
b.5. Flushing or hot flashes
b.6. Headaches
b.7. Nausea
b.8. Etc.

1.4. Statins
a. The medicine used to lower cholesterol. Dr. Biasucci LM, and the scientists at the Sacro Cuore University, in the study of Statins and coronary artery disease:clinical evidence and future perspective said "The introduction of more powerful statins in the market offered the opportunity to study whether an intensive lipid lowering treatment could yields even better cardiovascular outcomes than a moderate statin therapy and several clinical trial confirmed this hypothesis. Statins have also pleiotropic effect behind their lipid lowering function: they reduce inflammation, which plays an important role in the atherosclerotic process"(46).
b. Side effects are limit to
b.1. Headache
b.2. Nausea
b.3. Vomiting
b.4. Constipation
b.5. Diarrhea
b.6. Weakness
b.7. Muscle pain
b.8. Etc.

1.5. Aspirin
a. Many researchers believe that daily intake aspirin can reduce the risk of blood clots from forming in your arteries. In the study to determine the cardiovascular and coronary risk thresholds at which aspirin for primary prevention of coronary heart disease is safe and worthwhile, Dr. Sanmuganathan PS and the research team at the Royal Hallamshire Hospital, indicated that Aspirin treatment for primary prevention is safe and worthwhile at coronary event risk >/= 1.5%/year; safe but of limited value at coronary risk 1%/year; and unsafe at coronary event risk 0.5%/year. Advice on aspirin for primary prevention requires formal accurate estimation of absolute coronary event risk(47).
b. Side effects are not limit to
b.1. Stomach pains
b.2. Feelings of nausea
b.3. Vomiting.
b.4. Allergic reaction to some people
b.5. Aspirin may interact with other medicine, such as blood thinning medicine
b.6. Etc.

2. If the underline causes of Angina is a result of Ischemic heart disease, then
a. Percutaneous Coronary Intervention (PCI )
Percutaneous Coronary Intervention (PCI ) is one therapeutic treatment used to treat the narrowed coronary arteries of the heart found in coronary heart disease and Ischemic heart disease. In study of a total of 282 patients (74.1% females) with mean age of 57.0±3.2 years were studied. Most of the patients (89.7%) underwent elective PCI. Angiographic and procedure success rates were 95.7% and 94.6%, respectively. In-hospital MACE included two cases of death (0.7%) and one MI (0.3%); 2/29 (6.9%) of the emergent PCI and 1/253 (0.4%) of the elective PCI cases. MACE during follow-up included three cases of death (1.0%) and two MI (0.7%); 2/252 (0.8%) of the elective PCI and 1/28 (3.5%) of the emergent PCI cases. The overall MACE was calculated as 8 cases (2.8%) which included 5/29 (17.2%) of the emergent and 3/253 (1.1%) of the elective cases; P<0.001, concluded that PCI is performed with an acceptable success rate in our center in Isfahan and mortality and complications are within the range reported by other highly specialized centers in IRAN. Further studies with larger sample size are needed to find predictive factors(48).

b. Coronary revascularisation
Coronary artery bypass grafting (CABG)
Coronary artery bypass grafting (CABG) is a surgical procedure performed to reduce the risk of death from coronary artery disease by bypass atherosclerotic narrowings as arteries or veins from elsewhere in the patient's body are grafted to the coronary arteries to improve the blood supply to the heart muscle. some researchers suggested that transthoracic echocardiography(TEE) prior to coronary artery bypass surgery can provides higher resolution images than transthoracic echocardiography (TTE). Therefore one can conclude that TEE is the imaging modality of choice for detecting aortic atheromatous plaques but in patients with low risk for stroke and aortic atheromas, a detailed TTE may be sufficient for the pre-operative assessment(49).
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Sources
(43a) http://www.ncbi.nlm.nih.gov/pubmed/18258559
(43) http://www.ncbi.nlm.nih.gov/pubmed/3088957
(44) http://www.ncbi.nlm.nih.gov/pubmed/1968518
(45) http://www.ncbi.nlm.nih.gov/pubmed/22543122
(46) http://www.ncbi.nlm.nih.gov/pubmed/22495163
(47) http://www.ncbi.nlm.nih.gov/pubmed/11179262
(48) http://www.ncbi.nlm.nih.gov/pubmed/22577441
(49) http://www.ncbi.nlm.nih.gov/pubmed/22614701

Angina pectoris - The Antioxidants

1. Nitric oxide (NO)
Nitric oxide (NO), one of the antioxidant and peroxynitrite can inhibit pathways of oxygen radical generation, and, in turn, oxidants can inhibit NO synthesis from NOS.

2. Glutathione and vitamin E
Reduced form of glutathione may act as a first line of defense against oxidative stress during ischemia–reperfusion while vitamin E may act later on during severe oxidative stress by rendering resistance to the heart against the ischemic–reperfusion injury

3. 2-dithiole-3-thione (D3T)
Researcher found that in rat cardiac H9c2 cells, D3T and time-dependent induction of a number of cellular antioxidants and phase 2 enzymes, including catalase, reduced glutathione (GSH), GSH peroxidase, glutathione reductase (GR), GSH S-transferase (GST), and NADH:quinone oxidoreduc- tase-1 (NQO1) help to protect against H9c2 cell injury caused by various oxidants and simulated ischemia-reperfusion. D3T pretreatment also resulted in decreased intracellular accumulation of reactive oxygen in H9c2 cells after exposure to the oxidants as well as simulated ischemia-reperfusion.

4. Selenium
Deficiency of of a co-enzyme selenium, which is required in maintaining the glutathione redox cycle, also promote more susceptible to oxidative injure.

5. Etc.

Angina pectoris - The Phytochemicals

1. 1. Omega-3 Fatty Acids
a. Systolic blood pressure, triglycerides and LDL cholesterol
In the ccomparison of the cardiovascular risk-reduction potential of three major polyunsaturated fatty acids in a double-blind study. showed that for the diet supplemented with EPA plus DHA compared with the linoleic acid diet systolic blood pressure fell 5.1 mm Hg (p = 0.01); plasma triglyceride and VLDL cholesterol fell by 39% (p = 0.001) and 49% (p = 0.01), respectively; and LDL cholesterol rose by 9% (p = 0.01). There were no significant changes with the diet supplemented with alpha-linolenic acid. The net effect on cardiovascular risk therefore is complex and the systolic blood pressure reduction was substantial, according to "n-3 fatty acids of marine origin lower systolic blood pressure and triglycerides but raise LDL cholesterol compared with n-3 and n-6 fatty acids from plants" by Kestin M, Clifton P, Belling GB, Nestel PJ.(34)

b. Cardiovascular effects
In the comparison of the effects of alpha-linolenic acid (ALA, C18:3n-3) to those of eicosapentaenoic acid (EPA, C20:5n-3) plus docosahexaenoic acid (DHA, C22:6n-3) on cardiovascular risk markers in healthy elderly subjects, found that Both n-3 fatty acid diets did not change concentrations of total-cholesterol, LDL-cholesterol, HDL-cholesterol, triacylglycerol and apoA-1 when compared with the oleic acid-rich diet. However, after the EPA/DHA-rich diet, LDL-cholesterol increased by 0.39 mmol/l (P = 0.0323, 95% CI (0.030, 0.780 mmol/l)) when compared with the ALA-rich diet. Intake of EPA/DHA also increased apoB concentrations by 14 mg/dl (P = 0.0031, 95% CI (4, 23 mg/dl)) and 12 mg/dl (P = 0.005, 95% CI (3, 21 mg/dl)) versus the oleic acid and ALA-rich diet, respectively. Except for an EPA/DHA-induced increase in tissue factor pathway inhibitor (TFPI) of 14.6% (P = 0.0184 versus ALA diet, 95% CI (1.5, 18.3%)), changes in markers of hemostasis and endothelial integrity did not reach statistical significance following consumption of the two n-3 fatty acid diets, according to "Effects of alpha-linolenic acid versus those of EPA/DHA on cardiovascular risk markers in healthy elderly subjects" by Goyens PL, Mensink RP.(35)

c. Obesity
in the determination of whether obesity modifies the association between plasma phospholipid polyunsaturated fatty acids (PUFAs) and markers of inflammation and endothelial activation in Multi-Ethnic Study of Atherosclerosis (MESA) participants, found that the modifying effect of obesity on the association of plasma PUFAs with IL-6 and sICAM-1 suggests differences in fatty acid metabolism and may also have implications in dietary fatty acid intake for obese individuals, particularly for linoleic and EPAs. Further study is warranted to confirm and explain the strong associations of dihomo-γ-linolenic acid (DGLA) with inflammatory and endothelial activation markers, according to "Obesity modifies the association between plasma phospholipid polyunsaturated fatty acids and markers of inflammation: the Multi-Ethnic Study of Atherosclerosis" by Steffen BT, Steffen LM, Tracy R, Siscovick D, Hanson NQ, Nettleton J, Tsai MY.(36)

3. Catechin

Catechin is phytochemical of Flavan-3-ols, in the group of Flavonoids (polyphenols), found abundantly in white tea, green tea, black tea, grapes, wine, apple juice, cocoa, lentils, etc.
a. Body-weight regulation
Green tea has been proposed as a tool for obesity management as strategies for weight loss and weight maintenance, as researchers found that a green tea-caffeine mixture improves weight maintenance, through thermogenesis, fat oxidation, and sparing fat free mass. The sympathetic nervous system is involved in the regulation of lipolysis, and the sympathetic innervation of white adipose tissue may play an important role in the regulation of total body fat in general, according to "Green tea catechins, caffeine and body-weight regulation" by Westerterp-Plantenga MS.(37)

b. Antioxidant activity
In the research on polyphenolic compounds (included catechins) in the berries of edible honeysuckle and their biological effects, including recommended utilization, are reviewed found that These berries seem to be prospective sources of health-supporting phytochemicals that exhibit beneficial anti-adherence and chemo-protective activities, thus they may provide protection against a number of chronic conditions, e.g., cancer, diabetes mellitus, tumour growth or cardiovascular and neurodegenerative diseases, according to "Phenolic profile of edible honeysuckle berries (genus lonicera) and their biological effects" by Jurikova T, Rop O, Mlcek J, Sochor J, Balla S, Szekeres L, Hegedusova A, Hubalek J, Adam V, Kizek R.(38)

c. Cholesterol and glucose levels
In the examination of the effect of the main green tea catechin, epigallocatechin gallate (EGCG), taken in a green tea extract, Polyphenon E (PPE) and their effect on circulating hormone levels, an established breast cancer risk factor, found that Glucose and insulin levels decreased nonsignificantly in the PPE groups but increased in the placebo group; statistically significant differences in changes in glucose (P=0.008) and insulin (P=0.01) were found. In summary, green tea (400 and 800 mg EGCG as PPE; ~5-10 cups) supplementation for 2 months had suggestive beneficial effects on LDL cholesterol concentrations and glucose-related markers, according to "Effect of 2-month controlled green tea intervention on lipoprotein cholesterol, glucose, and hormonal levels in healthy postmenopausal women" by Wu AH, Spicer D, Stanczyk FZ, Tseng C, Yang CS, Pike MC.(39)

3. Theaflavin with reddish in color, is a phytochemical of Flavan-3-ols, in the group of Flavonoids (polyphenols), formed in tea leaves during fermentation.
a. Cholesterol
In the investigation of 240 men and women 18 years or older on a low-fat diet with mild to moderate hypercholesterolemia were randomly assigned to receive a daily capsule containing theaflavin-enriched green tea extract (375 mg) or placebo for 12 weeks, found that after 12 weeks, the mean ± SEM changes from baseline in total cholesterol, LDL-C, HDL-C, and triglyceride levels were -11.3% ± 0.9% (P = .01), -16.4% ± 1.1% (P = .01), 2.3% ± 2.1% (P = .27), and 2.6% ± 3.5% (P = .47), respectively, in the tea extract group. The mean levels of total cholesterol, LDL-C, HDL-C, and triglycerides did not change significantly in the placebo group. No significant adverse events were observed, according to "Cholesterol-Lowering Effect of a Theaflavin-Enriched Green Tea Extract" by David J. Maron, MD; Guo Ping Lu, MD; Nai Sheng Cai, MD; Zong Gui Wu, MD; Yue Hua Li, MD; Hui Chen, MD; Jian Qiu Zhu, MD; Xue Juan Jin, MS; Bert C. Wouters, MA; Jian Zhao, PhD.(40)

b. Antioxidant effects
In the investigation of four main TF derivatives (theaflavin (TF(1)), theaflavin-3-gallate (TF(2)A), theaflavin-3'-gallate (TF(2)B), and theaflavin-3,3'-digallate (TF(3))) in scavenging reactive oxygen species (ROS) in vitro, their properties of inhibiting superoxide, singlet oxygen, hydrogen peroxide, and the hydroxyl radical, and their effects on hydroxyl radical-induced DNA oxidative damage, found that compared with (-)-epigallocatechin gallate (EGCG), TF derivatives were good antioxidants for scavenging ROS and preventing the hydroxyl radical-induced DNA damage in vitro. TF(3) was the most positive in scavenging hydrogen peroxide and hydroxyl radical, and TF(1) suppressed superoxide. Positive antioxidant capacities of TF(2)B on singlet oxygen, hydrogen peroxide, hydroxyl radical, and the hydroxyl radical-induced DNA damage in vitro were found, according to "Evaluation of the antioxidant effects of four main theaflavin derivatives through chemiluminescence and DNA damage analyses" by Wu YY, Li W, Xu Y, Jin EH, Tu YY.(41)

c. Cardio-protective activities
In the analyzing the protective effect of theaflavin (TF1) and its underlying mechanism,
found that (1) compared with the control group, TF1 (10, 20, 40 μmol/l) displayed a better recovery of cardiac function after ischemia/reperfusion in a concentration-dependent manner. At 60 min of reperfusion, LVDP, ± LVdP/dt (max) and CF in the TF1 group were much higher than those in the control group, whereas left ventricular end-diastolic pressure (LVEDP) in the TF1 group was lower than that in the control group (P < 0.01). (2) Pretreatment with glibenclamide (10 μmol/l), a K(ATP) antagonist, completely abolished the cardioprotective effects of TF1 (20 μmol/l). Also, most of the effects of TF1 (20 μmol/l) on cardiac function after 60 min of reperfusion were reversed by 5-HD (100 μmol/l), a selective mitochondria K(ATP) antagonist. (3) Atractyloside (20 μmol/l), a mitochondrial permeability transition pore (mPTP) opener, administered at the beginning of 15 min of reperfusion completely abolished the cardioprotection of TF1 (20 μmol/l), according to "ATP-dependent potassium channels and mitochondrial permeability transition pores play roles in the cardioprotection of theaflavin in young rat" by Ma H, Huang X, Li Q, Guan Y, Yuan F, Zhang Y.(42)

4. Resveratrol is a type of natural phenol in the group of Stilbenoids, produced naturally by many plants when under attack by bacteria or fungi. It has been studied by many researchers for it health benefits in treating chronic diaereses, including cancer, diabetes, heart disease, etc.
a. In a study of "Resveratrol: a promising agent in promoting cardioprotection against coronary heart disease." by Penumathsa SV, Maulik N. (Source from Molecular Cardiology and Angiogenesis Laboratory, Department of Surgery, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1110, USA.), posted in PubMed, researchers indicated in abstract that many studies have provided evidence that resveratrol possesses antioxidant and antiapoptotic effects apart from activation of longevity proteins (such as SIRT-1). We have recently reported the angiogenic, antihypercholesterolemic, and antihypercholesterolemic, antihypercholesterolemic, antidiabetic effects of resveratrol and the mechanisms involved in reduced ventricular remodeling and increased cardiac functions. We have also shown different strategic target molecules involved in resveratrol-mediated.
cardioprotection.

b. Lipid metabolism
in a study of " [Effects of resveratrol on lipid metabolism in C57BL/6J mice]."[Article in Chinese]

by Ren Y, Li Y, Zhao Y, Yu F, Zhan Z, Yuan Y, Yang J. (Source from Department of Nutrition and Food hygiene, School of Public Health, China Medical University, Shenyang 110001, China. renyahao0512@sohu.com) researchers found that The serum TC, LDL-C, HDL-C levels of high-fat diet and resveratrol groups were higher than those of control group (P < 0.05), and the serum TC and LDL-C levels of high-fat diet were also higher than those of resveratrol group (P < 0. 05). But the serum TG levels of high-fat diet and resveratrol groups were lower than those of control group (P < 0.05). The TC content of liver in high-fat diet group were higher than those of control and resveratrol groups (P < 0.05), and concluded that The TC content in C57BL/6J mice can be decreased by resveratrol (22.5 mg/kg BW).

c. Diabetes and Obesity
According to the study of " Resveratrol, obesity and diabetes." by Szkudelska K, Szkudelski T. (Source from Department of Animal Physiology and Biochemistry, Poznan University of Life Sciences, Poznan, Poland. tszkudel@jay.up.poznan.pl) posted in PubMed, researchers found that The accumulating evidence also indicates the benefits of resveratrol in diabetes and diabetic complications. It is known that resveratrol affects insulin secretion and blood insulin concentration. In animals with hyperinsulinemia, resveratrol was found to reduce blood insulin. Moreover, numerous data indicate that in diabetic rats, resveratrol is able to reduce hyperglycemia. The mechanism of resveratrol's action is complex and is demonstrated to involve both insulin-dependent and insulin-independent effects. These data point to the potential possibility of use of resveratrol in preventing and/or treating both obesity and diabetes.

Sources

(34) http://www.ncbi.nlm.nih.gov/pubmed/1971991
(35) http://www.ncbi.nlm.nih.gov/pubmed/16482073
(36) http://www.ncbi.nlm.nih.gov/pubmed/21829163
(37) http://www.ncbi.nlm.nih.gov/pubmed/20156466
(38) http://www.ncbi.nlm.nih.gov/pubmed/22269864
(39) http://www.ncbi.nlm.nih.gov/pubmed/22246619
(40) http://archinte.ama-assn.org/cgi/content/abstract/163/12/1448
(41) http://www.ncbi.nlm.nih.gov/pubmed/21887850
(42) http://www.ncbi.nlm.nih.gov/pubmed/21503789

Angina pectoris - The Diet

Angina pectoris, also known as Angina, a symptoms of Ischemic heart disease, is defined as a condition of chest pain caused by poor blood flow through the blood vessels due to obstruction or spasm of the coronary arteries resulting of lack of blood that lead to lack of oxygen supply and waste removal.
Preventions
Diet to prevent angina
The aims of the diet is to reduce the unhealthy diet and coronary artery disease risk factors causes of Angina pectoris, the symptom of Ischemic heart disease
1. Avocados are a commercially valuable fruit and are cultivated in tropical climates throughout the world, it is a green-skinned, pear-shaped fruit that ripens after harvesting and native to the Caribbean, Mexico, South America and Central America, belonging to the flowering plant family Lauraceae.
a. Cholesterol
In the determination of the atherogenicity of avocado oil relative to saturated (coconut oil), monounsaturated (olive oil) and polyunsaturated (corn oil) fats found that Coconut oil was the most atherogenic fat. Corn oil was only slightly less atherogenic than either olive or avocado oils. Percentage of serum HDL cholesterol was highest in the rabbits fed the two monounsaturated fats, according to "Cholesterol vehicle in experimental atherosclerosis 24: avocado oil" by Kritchevsky D, Tepper SA, Wright S, Czarnecki SK, Wilson TA, Nicolosi RJ.(21)

b. Dietary fiber
Daily intake of right amount of fibers can prevent and treat Diabetes. Increased consumption of vegetables, whole grains, and soluble and insoluble fiber is associated with improved glucose metabolism in both diabetic and nondiabetic individuals. Improvements in insulin sensitivity and glucose homeostasis were more evident in participants following a plant-based diet compared with other commonly used diets, according to the study of "Efficacy of high-fiber diets in the management of type 2 diabetes mellitus" by Wolfram T, Ismail-Beigi F.(22)

c. Heart diseases
c.1.The chemical compound Beta-Sitosterol is found effectively in reducing the bad cholesterol and leaving the good cholesterol untouched by inhibiting the amount our body can absorb, thus reducing the risk of plague building up in the arterial walls, leading to heart diseases, according to the study of "The Effect of Beta Sitosterol on the Serum Lipids of Young Men with Arteriosclerotic Heart Disease" by JOHN W. FARQUHAR M.D.; RALPH E. SMITH M.D.; MARY E. DEMPSEY M.S., posted in Circulation(23)

c.2. It also reduce the risk of autoimmune diseases such as multiple sclerosis, according to the study of "Effect of vitamin D and β-sitosterol on immune function of macrophages" by Alappat L, Valerio M, Awad AB.(24)

2. Salmon is the common name for Salmonidae. They are anadromous, born in fresh water, migrate to the ocean, then travel thousands of miles in the deep sea cold water throughout their life cycle and within to five years returning to the exacted location where they were born to reproduce and die.
a. Triacylglycerols
In the investigation of Intake of fish and omega-3 (n-3) fatty acids is associated with a reduced concentration of plasma triacylglycerols (TAG) found that intake of cod or salmon when compared with the control group. In conclusion, both lean and fatty fish may lower TAG, possibly by reducing the 18:1n-9/18:0 ratio related to allosteric inhibition of SCD1 activity, rather than by influencing the synthesis of enzyme protein, according to "Daily Intake of Cod or Salmon for 2 Weeks Decreases the 18:1n-9/18:0 Ratio and Serum Triacylglycerols in Healthy Subjects" by Telle-Hansen VH, Larsen LN, Høstmark AT, Molin M, Dahl L, Almendingen K, Ulven SM.(25)

b. Weight loss
In the investigation of supplementation with n3 long-chain polyunsaturated fatty acids (n3-LCPUFA) and its effect in body weight, found that At the end of the 1-month period, 16 children lost weight and 27 children gained weight. Multiple analysis demonstrated that supplementation with n3-LCPUFA decreased HOMA-IR by 15% after adjusting for puberty, treatment adherence, changes in adipokines, and weight loss. Interaction between supplementation and weight loss was significant (p = 0.007), according to "Supplementation of n3 Long-chain Polyunsaturated Fatty Acid Synergistically Decreases Insulin Resistance with Weight Loss of Obese Prepubertal and Pubertal Children" by López-Alarcón M, Martínez-Coronado A, Velarde-Castro O, Rendón-Macías E, Fernández J.(26)

c. Cholesterol
In the assessment of an increasing drive to replace fish oil (FO) in finfish aquaculture diets with vegetable oils (VO), driven by the short supply of FO derived from wild fish stocks,
found that these effects are most likely mediated by SREBP2, which responds to reductions in dietary cholesterol. These changes are sufficient to maintain whole body cholesterol levels but not HUFA levels, according to "Functional genomics reveals increases in cholesterol biosynthetic genes and highly unsaturated fatty acid biosynthesis after dietary substitution of fish oil with vegetable oils in Atlantic salmon (Salmo salar)" by Leaver MJ, Villeneuve LA, Obach A, Jensen L, Bron JE, Tocher DR, Taggart JB.(27)

d. Coronary heart disease
In determination of Omega-3-fatty acids play a protective role in the prevention of CHD,
found that The treatment with salmon oil led to a decrease of triglycerides in patients with hypertriglyceridemia and to an increase of cholesterol in hypercholesterolemia. Following the increase of malondialdehyde as measure of the lipid peroxidation a substitution of antioxidants, like vitamin E and vitamin C, seems to be useful. Further investigations are necessary before wide use of fish-oil capsules, not least to avoid side-effects, according to "[Changes in parameters of lipid metabolism and anti-oxidative potentials in elderly hyperlipoproteinemic patients treated with omega-3 fatty acids].[Article in German]" by Reuter W, Vorberg B, Sauer I, Krumpolt C.(28)

e. Antioxidants
In the research of the antioxidant effect of vitamin E after ingestion of salmon found that that megadoses of vitamin E, far from having pro-oxidative activity, actually increase the anti-oxidative capacity of the liver, especially after ingestion of salmon oil, according to "Effects of megadoses of dietary vitamin E on the antioxidant status of rats fed lard or salmon oil" by Flader D, Brandsch C, Hirche F, Eder K.(29)

3. Soy sauce is a seasoning produced by fermenting soybeans and filamentous fungus, along with water and salt after a period of sometime, it yields a moromi or thick mash of cereal to obtain soy sauce by pressing it to liquid form. Tamari is made by collecting the liquid which was pressed and the liquid drained drains from miso after a certain time of fermentation.
a. Cardiovascular health
In the investigation of dietary proteins and their effect in heart diseases found that a direct cholesterol lowering effect of proteins has not been shown. Despite earlier research indicating that soy protein has cardioprotective effects as compared to other proteins, these observations have not been confirmed by randomized placebo-controlled trials. However, most experts recommend the consumption of foods rich in plant proteins as alternatives to meat and dairy products rich in saturated fat and containing cholesterol, according to "Dietary proteins and atherosclerosis" by Darioli R.(30)

b. Hypolipidemic effect
In the observation of Soy sauce (Shoyu), a traditional Japanese fermented seasoning and its effect on cholesterol level found that in a 4-week randomized, double-blind, placebo-controlled parallel group study, hyperlipidemic men (TG >150 mg/dl) were treated with 600 mg of SPS (n=15) or placebo (n=15) daily. After 4 weeks, serum TG levels in the SPS-treated group were significantly (P<0.05) lower than the baseline (0 week). In conclusion, SPS of soy sauce reduce lipid absorption, and soy sauce is a potentially promising seasoning for the treatment of hyperlipidemia through food, according to "Hypolipidemic effect of Shoyu polysaccharides from soy sauce in animals and humans" by Kobayashi M, Magishi N, Matsushita H, Hashimoto T, Fujimoto M, Suzuki M, Tsuji K, Saito M, Inoue E, Yoshikawa Y, Matsuura T.(31)

4. Tomato is a red, edible fruit, genus Solanum, belongs to family Solanaceae, native to South America. Because of its health benefits, tomato is grown world wide for commercial purpose
and often in green house.
a. Cardiovascular diseases
In the review of patents and products within the context of lycopene and CVD prevention and health claims indicated that in vitro data and results from animal experiments partly showed promising preventive mechanisms of lycopene. In contrast, until now, human intervention studies mostly failed to show any CVD prevention. However, there is still an encouraging situation, giving hints for antioxidant as well as anti-inflammatory effects of lycopene. These mechanisms could be the background for cardio-protective effects of tomatoes and tomato products, according to "Lycopene and heart health" by Böhm V.(32)

b. Antioxidative and Cancer Cell-Inhibiting Activities
In the research of Tomato ( Solanum lycopersicum ) plants synthesize nutrients, pigments, and bioactive compounds and their benefit in nutrition and human health found that Tomato extracts promoted growth in normal liver (Chang) cells, had little effect in normal lung (Hel299) cells, mildly inhibited growth of lung cancer (A549) cells, and first promoted and then, at higher concentrations, inhibited growth in lymphoma (U937) cells. The relationship of cell growth to measured constituents was not apparent, according to "Free Amino Acid and Phenolic Contents and Antioxidative and Cancer Cell-Inhibiting Activities of Extracts of 11 Greenhouse-Grown Tomato Varieties and 13 Tomato-Based Foods" by Choi SH, Kim HR, Kim HJ, Lee IS, Kozukue N, Levin CE, Friedman M.(33).

Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight

Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer

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Sources
(21) http://www.ncbi.nlm.nih.gov/pubmed/12569114
(22) http://www.ncbi.nlm.nih.gov/pubmed/20713332
(23) http://www.ncbi.nlm.nih.gov/pubmed/20728596
(24) http://www.ncbi.nlm.nih.gov/pubmed/20728596
(25) http://www.ncbi.nlm.nih.gov/pubmed/22139893
(26) http://www.ncbi.nlm.nih.gov/pubmed/22136960
(27) http://www.ncbi.nlm.nih.gov/pubmed/18577222
(28) http://www.ncbi.nlm.nih.gov/pubmed/8091840
(29) http://www.ncbi.nlm.nih.gov/pubmed/12951900
(30) http://www.ncbi.nlm.nih.gov/pubmed/22139566
(31) http://www.ncbi.nlm.nih.gov/pubmed/18813866
(32) http://www.ncbi.nlm.nih.gov/pubmed/22076972
(33) http://www.ncbi.nlm.nih.gov/pubmed/22070764

Angina pectoris - The do and do not list

Preventions

A. The do and do not list

1. Life style change

a. Relaxation

Stress and emotion may increase the risk of Angina pectoris, a symptoms of schemic heart disease. According to the study of Emotional triggering of cardiac events at the University College London. Dr Steptoe A, and the research team indicated that the psychobiological processes underlying emotional triggering may include stress-induced haemodynamic responses, autonomic dysfunction and parasympathetic withdrawal, neuroendocrine activation, inflammatory responses involving cytokines and chemokines, and prothrombotic responses, notably platelet activation. These factors in turn promote coronary plaque disruption, myocardial ischaemia, cardiac dysrhythmia and thrombus formation(9). Music listening may have a beneficial effect on blood pressure, heart rate, respiratory rate, anxiety, and pain in persons with CHD. However, the quality of the evidence is not strong and the clinical significance unclear. Most studies examined the effects of listening to pre-recorded music. More research is needed on the effects of music offered by a trained music therapist(10). Other researchers in the study to determine the prevalence of anxiety and depressive symptoms in patients referred to a cardiology outpatient clinic for performing the stress test suggested that the prevalence of anxiety and depressive symptoms was estimated to be 42% and 31%, respectively, in the total chest pain population. Males with abnormal test were depressed but females experienced more anxiety symptoms. Patients with negative tests had significantly higher scores for anxiety and higher depression scores than those with positive tests. Eleven percent of the patients with positive tests were women and 23% were men(11).

b. If the disease is caused by physical activity, slow down or take rest more often can be helpful

2. Healthy diet

In the study to compare two strategies for atherosclerosis treatment: drugs and healthy lifestyle, found that Statins act mainly as lipid-lowering drugs but pleiotropic actions are also present. Healthy lifestyle, on the other hand, is effective and inexpensive and has no harmful effects. Five items are associated with lower cardiac risk: non-smoking, BMI ≤25, regular exercise (30 min/day), healthy diet (fruits, vegetables, low-saturated fat, and 5-30 g alcohol/day)(12).

a. Low intake of saturated and trans fats

High levels of bad cholesterol and triglyceride partial block the blood flow in the vessels, it not only increases the risk of high blood pressure but also the risk of ischemia if the blood circulation diminishes.

d. Increase intake fish and olive oil

Studies indicate that the use of fish oil is associated with coronary heart disease risk reduction. A number of mechanisms may be responsible for such effects. These include prevention of arrhythmias as well as lowering heart rate and blood pressure, decreasing platelet aggregation, and lowering triglyceride levels. The latter is accomplished by decreasing the production of hepatic triglycerides and increasing the clearance of plasma triglycerides(19). Other researchers indicated that in both sexes consumption of olive oil and vegetable oil was inversely associated with serum cholesterol and glucose levels and systolic blood pressure(13).

c. High amount intake of in fiber

Consumption of dietary fiber from cereals and fruits is inversely associated with risk of coronary heart disease. In a study of over 6 to 10 years of follow-up, 5249 incident total coronary cases and 2011 coronary deaths occurred among 91058 men and 245186 women. After adjustment for demographics, body mass index, and lifestyle factors, each 10-g/d increment of energy-adjusted and measurement error-corrected total dietary fiber was associated with a 14% (relative risk [RR], 0.86; 95% confidence interval [CI], 0.78-0.96) decrease in risk of all coronary events and a 27% (RR, 0.73; 95% CI, 0.61-0.87) decrease in risk of coronary death. For cereal, fruit, and vegetable fiber intake (not error corrected), RRs corresponding to 10-g/d increments were 0.90 (95% CI, 0.77-1.07), 0.84 (95% CI, 0.70-0.99), and 1.00 (95% CI, 0.88-1.13), respectively, for all coronary events and 0.75 (95% CI, 0.63-0.

Fiber is found in whole grains, fruits, and vegetables. A fiber-rich diet not only helps lower your LDL cholesterol level, but also provides nutrients that may help protect against CHD(14).

d. Low intake of salt and sugar

d.1. Manage your blood pressure and reduce intake of salt, beverage and sugar

The worldwide increase in the incidence of metabolic syndrome correlates with marked increase in total fructose intake in the form of high-fructose corn syrup, beverage and table sugar. Increased dietary fructose intake in rodents has been shown to recapitulate many aspects of metabolic syndrome by causing hypertension, insulin resistance and hyperlipidaemia(15).

d.2. Prevent weight gain and control diabetes and prediabetes

In the study to test a 16-week group-based weight reduction intervention combining exercise, diet and behaviour change strategies aimed to increase self-efficacy (Healthy Eating and Exercise Lifestyle Program-HEELP) on weight, body mass index (BMI), waist circumference and exercise, found that The HEELP resulted in weight loss and improved exercise behaviour in obese people with CHD and T2DM(16).

d.3. Mediterranean style low-carb diet

The best approach to the dietary prevention of CVD is a Mediterranean style low-carb diet represented in the LOGI pyramid. Dietary guidelines for the prevention of CVD should to be revised accordingly(17).

2. Tobacco
Cigarette contains high levels of cadmium, inhaling the chemical during smoking or second hand smoke can cause building up of plaque along to the arterial walls as a result of oxidation.

3. Moderate consumption of Green tea, coffee and alcohol

Regular consumption of moderate quantities of coffee and (green) tea seems to be associated with a small protection against CAD, results from randomized clinical trials about their beneficial effects are less evident. As for other diffuse consumption habits, such as that of alcohol, moderation is the key word. In fact, both for coffee and chocolate, the optimal healthy effects on CAD have been observed to be associated with a moderate intake, while healthy outcomes vanish at heavy consumption(18).

4. Maintaining a healthy weight

Obesity increases the risk of ischemia as it is normally associated with high levels of cholesterol, high blood pressure.

5. Managing stress

Music listening may have a beneficial effect on blood pressure, heart rate, respiratory rate, anxiety, and pain in persons with CHD. However, the quality of the evidence is not strong and the clinical significance unclear. Most studies examined the effects of listening to pre-recorded music. More research is needed on the effects of music offered by a trained music therapist(19). Other researchers in the study to determine the prevalence of anxiety and depressive symptoms in patients referred to a cardiology outpatient clinic for performing the stress test suggested that the prevalence of anxiety and depressive symptoms was estimated to be 42% and 31%, respectively, in the total chest pain population. Males with abnormal test were depressed but females experienced more anxiety symptoms. Patients with negative tests had significantly higher scores for anxiety and higher depression scores than those with positive tests. Eleven percent of the patients with positive tests were women and 23% were men(20).

6. Etc.