Role of P-glycoprotein in the intestinal absorption of tanshinone IIA, a major active ingredient in the root of Salvia miltiorrhiza Bunge

The extracts from the roots of Salvia miltiorrhiza Bunge (Danshen) are widely and traditionally used in the treatment of angina pectoris, acute myocardial infarct, hyperlipidemia and stroke in China and other Asian countries. In this study, we have investigated the role of P-glycoprotein (P-gp) in the intestinal absorption of tanshinone IIA (TSA), a major active constituent of Danshen, using several in vitro and in vivo models. The oral bioavailability of TSA was about 2.9

Cardiovascular surveys : manual of operations

Cardiovascular disease (CVD) is the leading cause of death and hospitalization in both men and women in nearly all countries of Europe. The most frequent forms of CVD are those of an atherosclerotic origin, mainly ischaemic heart disease, stroke and heart failure. The magnitude of the problem contrasts with the usual paucity and poor quality of data available on incidence and prevalence of CVD, except for few rigorous but limited studies.

The objectives of the health interview and health examination surveys (HIS/HES) are to evaluate the frequency and the distribution of the disease, to evaluate trends and treatment effectiveness, to estimate risk factors distribution and prevalence of high risk conditions and to monitor prevention programmes.

According to the EUROCISS project (EUROpean Cardiovascular Surveillance Set) recommendations, surveys are aimed at describing the prevalence of the following CVD conditions: myocardial infarction, heart failure, angina pectoris, peripheral arterial disease, stroke, and ischaemic heart disease.

HIS and HES were developed to supplement information collected from routine databases and population-based registers to implement consistent public health policies. HIS can be repeated periodically in a new sample of the population, or can follow up over time the population recruited at baseline. Procedures and methods to collect information from participants include self-administered questionnaires, direct interviewer-administered questions and telephone interviews. A minimum set of questions to be administered every year, along with a longer, more detailed module to be administered periodically are recommended to evaluate CVD prevalence. The addition of HES provides more detailed and objective information that can be used to improve estimates regarding prevalence of both risk factors and disease status.

The selection of more specialized CVD-specific tests will depend on the objective the survey is designed to achieve, the assumed response rate and the cost and time considerations. For HES on CVD the minimum required is to perform the following measurements: height, weight, blood pressure, waist circumference, total and high density lipoprotein-cholesterol and glucose assay in a nonfasting blood sample. The next appropriate step would be to perform an electrocardiogram. High costs usually make HES difficult to carry out.

Standardization of measurements, training of personnel and quality control are essential to assure reliable data. A high response rate is extremely important, as nonrespondents tend to have different health characteristics from the rest of the sample and their omission therefore results in bias.

This manual of operations is intended for health professionals and policy makers and provides a standardized and simple model for the implementation of a CVD survey.

Using the Rose Angina Questionnaire cross-culturally : the importance of consulting lay people when translating epidemiological questionnaires

Objectives. The Rose Angina Questionnaire (RAQ) is an important measure of coronary heart disease prevalence. It has been shown to perform inconsistently across some ethnic groups in Britain. This study investigates whether the best available versions of the RAQ in Punjabi and Cantonese were linguistically equivalent to the English version.

Design. Interviews were carried out with lay people from the Pakistani, Chinese and European-origin communities in Scotland to assess the versions of the RAQ used in the Newcastle Heart Project (the best available versions). For each questionnaire item, participants were asked to elaborate on their understanding of the question and the meaning of keywords or phrases.

Results. Problems were discovered with the Punjabi and Cantonese translations of the RAQ. For example, the translation for ‘chest’ was interpreted by some Pakistani and Chinese women to mean ‘breasts’. ‘Walking uphill’ was translated in Chinese as ‘walking the hill’, without stipulation of the direction, so that some Cantonese speakers interpreted the question as pertaining to walking downhill. Many Chinese interpreted RAQ items to be referring to breathlessness rather than chest pain due to ambiguous wording.

Conclusion. Existing versions of the RAQ are unlikely to be yielding data that are cross-culturally valid or comparable. For robust health survey research in languages other than that in which the questionnaire was developed, lay assessment of questionnaires prior to and after translation is a necessity rather than a luxury.

The incidence of V˙O2 plateau at V˙O2max in a cardiac-diseased population

We sought to determine the incidence of V˙O(2) plateau at V˙O(2)max in a cardiovascular-diseased (CVD) population using 4 different sampling intervals (15-breath moving average, 15 s, 30 s, and 60 s) and 3 different V˙O(2) plateau criteria (≤50 mL · min(-1), ≤80 mL · min(-1), and ≤150 mL · min(-1)). A total of 69 people (62 ± 10 yrs.) with recently diagnosed CVD performed a maximal exercise test (10:07 ± 2:24 min) on a treadmill. The test was classified as maximal (n = 57, 2 430 ± 605 mL · min(-1)) if self-terminated due to fatigue or classified as symptom-limited (n = 12, 1 683 ± 438 mL · min(-1)) if symptoms presented. Chi-square analysis revealed a significant (p < 0.05) effect of sampling interval on incidence of V˙O(2) plateau at V˙O(2)max across all 3 V˙O(2) plateau criteria. The sampling interval had an increasingly stronger influence on the incidence of V˙O(2) plateau at V˙O(2)max with smaller criterion thresholds as evidenced by the Cramer's V statistics: [≤50 mL · min(-1) (Cramer's V = 0.548, p < 0.05], ≤80 mL · min(-1) [Cramer's V = 0.489, p < 0.05], ≤150 mL · min(-1) [Cramer's V = 0.214, p < 0.05]. Incidence of V˙O(2) plateau at V˙O(2)max in CVD individuals is significantly influenced by the sampling interval applied. Based on our findings we recommend a15 breath moving average and V˙O(2) plateau criterion of ≤50 mL · min(-1).