Abstract
Ginkgo biloba extract (GBE) has well-documented cardioprotective effects on coronary flow and positive
effects on vasodilation through endothelium-derived nitric oxide in experimental animals,
but these impacts in patients with coronary artery disease (CAD) have not yet been
investigated. We designed this study to test the effects of GBE on distal left anterior
descending coronary artery (LAD) blood flow and endothelium-dependent brachial artery
flow-mediated dilation (FMD) in patients with CAD. Eighty CAD patients were randomly
assigned to either GBE or saline (control) groups. LAD blood flow and brachial artery
FMD were measured non-invasively using high-resolution ultrasound before and after
intravenous administration of GBE or saline. GBE significantly increased LAD blood
flow in maximal diastolic peak velocity (MDPV), maximal systolic peak velocity (MSPV)
and diastolic time velocity integral (DTVI) compared with the control group (16.14
± 10.93 % vs. 0.28 ± 2.14 %, 9.14 ± 8.23 % vs. 0.79 ± 2.56 %, and 15.23 ± 7.28 % vs.
0.42 ± 2.43 %, respectively, p < 0.01). Brachial artery FMD was also increased by
69.75 % (from 3.95 ± 1.49 % to 6.55 ± 2.51 %, p < 0.01). A linear correlation was
found between the percentage changes in MDPV, MSPV, or DTVI of LAD blood flow and
the percentage change in brachial artery FMD following treatment with GBE (r = 0.612,
0.486, or 0.521, respectively, p < 0.01). In summary, our data demonstrate that GBE
treatment in CAD patients leads to an increase of LAD blood flow in MDPV, MSPV and
DTVI, and the increase response might relate to the improved endothelium-dependent
vasodilatory capacity.
Abbreviations
CAD: coronary artery disease
DTVI: diastolic time velocity integral
FMD: flow-mediated dilation
GBE: Ginkgo biloba extract
LAD: distal left anterior descending coronary artery
MDPV: maximal diastolic peak velocity
MSPV: maximal systolic peak velocity
NO: nitric oxide
TTDE: transthoracic Doppler echocardiography
Key words
Ginkgo biloba
- Ginkgoaceae - coronary artery disease - endothelial function - flow-mediated dilation
- transthoracic Doppler echocardiography
References
- 1
Dubey A K, Shankar P R, Upadhyaya D, Deshpande V Y.
Ginkgo biloba-an appraisal.
Kathmandu Univ Med J.
2004;
2
225-9.
- 2
Zhang C Q, Zu J, Shi H M, Liu J Y, Qin C Y.
The effect of Ginkgo biloba extract (EGb 761) on hepatic sinusoidal endothelial cells and hepatic microcirculation
in CCl4 rats.
Am J Chin Med.
2004;
32
21-31.
- 3
Rioufol G, Pietri S, Culcasi M, Loufoua J, Staat P, Pop C. et al .
Ginkgo biloba extract EGb 761 attenuates myocardial stunning in the pig heart.
Basic Res Cardiol.
2003;
98
59-68.
- 4
Varga E.
The protective effect of EGb 761 in isolated isochemical/reperfused rat hearts.
Acta Pharm Hung.
2002;
72
265-71.
- 5
Zhu G Y, Zhu X L, Geng Q X, Zhang X, Shao J.
Change of peripheral blood monocytes derived macrophage scavenger receptors activity
in patients with coronary heart disease, and the intervention effect of Ginkgo biloba extract.
Zhongguo Zhong Xi Yi Jie He Za Zhi.
2004;
24
1069-72.
- 6
Deng Y K, Wei F, An B Q.
Effects of ginaton on the markers of myocardial injury during cardiopulmonary bypass.
Zhongguo Zhong Xi Yi Jie He Za Zhi.
2006;
26
316-8.
- 7
Halcox J P, Schenke W H, Zalos G, Mincemoyer R, Prasad A, Waclawiw M A. et al .
Prognostic value of coronary vascular endothelial dysfunction.
Circulation.
2002;
106
653-8.
- 8
Chen X, Salwinski S, Lee T J.
Extracts of Ginkgo biloba and ginsenosides exert cerebral vasorelaxation via a nitric oxide pathway.
Clin Exp Pharmacol Physiol.
1997;
24
958-9.
- 9
Delaflotte S, Auguet M, DeFeudis F V, Baranes J, Clostre F, Drieu K. et al .
Endothelium-dependent relaxations of rabbit isolated aorta produced by carbachol and
by Ginkgo biloba extract.
Biomed Biochim Acta.
1984;
43
S212-6.
- 10
Kubota Y, Tanaka N, Kagota S, Nakamura K, Kunitomo M, Umegaki K. et al .
Effects of Ginkgo biloba extract feeding on salt-induced hypertensive Dahl rats.
Biol Pharm Bull.
2006;
29
266-9.
- 11
Liebgott T, Miollan M, Berchadsky Y, Drieu K, Culcasi M, Pietri S.
Complementary cardioprotective effects of flavonoid metabolites and terpenoid constituents
of Ginkgo biloba extract (EGb 761) during ischemia and reperfusion.
Basic Res Cardiol.
2000;
95
368-77.
- 12
Chatterjee S S, Gabard B.
Studies on mechanism of action of an extract of Ginkgo biloba, a drug used for treatment of ischemic vascular diseases.
Naunyn Schmiedebergs Arch Pharmacol.
1982;
321
207.
- 13
Daimon M, Watanabe H, Yamagishi H, Kuwabara Y, Hasegawa R, Toyoda T. et al .
Physiologic assessment of coronary artery stenosis without stress tests: noninvasive
analysis of phasic flow characteristics by transthoracic Doppler echocardiography.
J Am Soc Echocardiogr.
2005;
18
949-55.
- 14
Celermajer D S, Sorensen K E, Gooch V M, Spiegelhalter D J, Miller O I, Sullivan I D.
et al .
Non-invasive detection of endothelial dysfunction in children and adults at risk of
atherosclerosis.
Lancet.
1992;
340
1111-5.
- 15
Matsuo S, Matsumoto T, Takashima H, Ohira N, Yamane T, Yasuda Y. et al .
The relationship between flow-mediated brachial artery vasodilation and coronary vasomotor
responses to bradykinin: comparison with those to acetylcholine.
J Cardiovasc Pharmacol.
2004;
44
164-70.
- 16
Teragawa H, Ueda K, Matsuda K, Kimura M, Higashi Y, Oshima T. et al .
Relationship between endothelial function in the coronary and brachial arteries.
Clin Cardiol.
2005;
28
460-6.
- 17
Kubota Y, Tanaka N, Kagota S, Nakamura K, Kunitomo M, Umegaki K. et al .
Effects of Ginkgo biloba extract on blood pressure and vascular endothelial response by acetylcholine in spontaneously
hypertensive rats.
J Pharm Pharmacol.
2006;
58
243-9.
- 18
Linke A, Erbs S, Hambrecht R.
Exercise and the coronary circulation-alterations and adaptations in coronary artery
disease.
Prog Cardiovasc Dis.
2006;
48
270-84.
- 19
Bridi R, Crossetti F P, Steffen V M, Henriques A T.
The antioxidant activity of standardized extract of Ginkgo biloba (EGb 761) in rats.
Phytother Res.
2001;
15
449-51.
- 20
Carini M, Aldini G, Rossoni G, Morazzoni P, Facino R M.
Complexation of Ginkgo biloba extract with phosphatidylcholine improves cardioprotective activity and increases
the plasma antioxidant capacity in the rat.
Planta Med.
2001;
67
326-30.
- 21
Kubota Y, Tanaka N, Umegaki K, Takenaka H, Mizuno H, Nakamura K. et al .
Ginkgo biloba extract-induced relaxation of rat aorta is associated with increase in endothelial
intracellular calcium level.
Life Sci.
2001;
69
2327-36.
- 22
Sun B L, Xia Z L, Yang M F, Ge B L.
Effects of Ginkgo biloba extract on cerebral ischemia during early stage of subarachnoid hemorrhage.
Chin J Pathophysiol.
2000;
16
266-8.
- 23
Lippy P.
Inflammation in atherosclerosis.
Nature.
2002;
420
868-74.
- 24
Griffiths K A, Sader M A, Skilton M R, Harmer J A, Celermajer D S.
Effects of raloxifene on endothelium-dependent dilation, lipoproteins, and markers
of vascular function in postmenopausal women with coronary artery disease.
J Am Coll Cardiol.
2003;
42
698-704.
- 25
Zhang W D, Chen H, Zhang C, Liu R H, Li H L, Chen H Z.
Astragaloside IV from Astragalus membranaceus shows cardioprotection during myocardial ischemia in vivo and in vitro
.
Planta Med.
2006;
72
4-8.
- 26
Nishida S, Satoh H.
Mechanisms for the vasodilations induced by Ginkgo biloba extract and its main constituent, bilobalide, in rat aorta.
Life Sci.
2003;
72
2659-67.
- 27
Krieglstein J, Beck T, Seibert A.
Influence of an extract of Ginkgo biloba on cerebral blood flow and metabolism.
Life Sci.
1986;
39
2327-34.
Yuzhou Wu and Wei Cui, MD
Department of Cardiology
Second Hospital of Hebei Medical University
Shijiazhuang 050000
People’s Republic of China
Telefon: +86-311-8722-2941
eMail: caswu@126.com