Recent advances in diagnosis and management of ischemic heart diseases in perspective of contemporary and Ayurveda medicine—a comprehensive review

Aishwarya Ashish Joglekar; Mahesh K Vyas; Meera K Bhojani

doi:10.4103/jism.jism_92_22

REVIEW ARTICLES

Year : 2023 | Volume : 11 | Issue : 1 | Page : 41-50

Recent advances in diagnosis and management of ischemic heart diseases in perspective of contemporary and Ayurveda medicine—a comprehensive review

Aishwarya Ashish Joglekar¹, Mahesh K Vyas¹, Meera K Bhojani²
¹ Department of Samhita Siddhant, All India Institute of Ayurveda, New Delhi, Delhi, India
² Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, Delhi, India

Date of Submission	09-Nov-2022
Date of Decision	02-Jan-2023
Date of Acceptance	05-Jan-2023
Date of Web Publication	15-Apr-2023

Correspondence Address:
Aishwarya Ashish Joglekar
Samhita Siddhant, Dr. D.Y. Patil Ayurved College and Research Centre, Pimrpti, Pune
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jism.jism_92_22

Abstract

Ischemic heart disease (IHD) or commonly known as coronary heart disease is considered as of the important cause of morbidity and mortality across the globe. This condition affects both the structure and function of heart muscle. Its prevalence should be considered since the advent of human life as even classical texts of Ayurveda have given ample emphasis on physiology and pathology of Hridroga (heart diseases). This is thus a topic of interest for the cardiologists, Ayurveda physicians, and general physicians. In order to cope with the transformations in the field of medicine, especially critical care, one must be well versed with the recent advances especially concerning this critical field of cardiology. The available classical literature regarding Hridroga and contemporary literature pertaining to IHD is reviewed in the present study with the help of robust search of different databases, published scientific works to present solid knowledge foundation for effective diagnosis, management, and research opportunities concerning filed of cardiology. The advances concerning the different clinical and preclinical trials on interventional drugs in treatment of IHD along with the different observational and exploratory studies done to understand the pathophysiology of Hridroga are highlighted in this article. Encouraging findings were achieved by the means of a thorough review put forth in the article which elaborates to highlight the recent advances in the research, diagnosis, management, and prevention of IHD in terms of both Ayurvedic and contemporary approaches.

Keywords: Ayurveda, cardioprotective activity, ischemic heart disease, research advances in cardiac care

How to cite this article:
Joglekar AA, Vyas MK, Bhojani MK. Recent advances in diagnosis and management of ischemic heart diseases in perspective of contemporary and Ayurveda medicine—a comprehensive review. J Indian Sys Medicine 2023;11:41-50

How to cite this URL:
Joglekar AA, Vyas MK, Bhojani MK. Recent advances in diagnosis and management of ischemic heart diseases in perspective of contemporary and Ayurveda medicine—a comprehensive review. J Indian Sys Medicine [serial online] 2023 [cited 2023 Jun 7];11:41-50. Available from: https://www.joinsysmed.com/text.asp?2023/11/1/41/374259

Introduction

Ischemic heart disease (IHD) or commonly known as coronary heart disease is still the most important cause of morbidity and mortality across the globe. This condition affects both the structure and function of heart muscle.^[1] In IHD, there is imbalance in the demand and supply of oxygen pertaining to cardiac muscles and coronary vessels. Atherosclerosis is considered to be the main cause of this condition including many patho-physiological phenomena elaborated further in the article text. As per the estimated study, IHD affects around 126 million individuals (1655 per 100,000), which is approximately 1.72% of the world’s population and more than 9 million deaths were caused by IHD globally.^[2] Preponderance of this disease is more in men than the female population. It is most commonly observed after the age of 50; however, younger populations are also found to be at risk recently. Also referred to as coronary artery disease and atherosclerotic cardiovascular disease, IHD is the major cause of cardiac disability. The major consequences of this condition include myocardial infraction (MI or acute coronary syndrome), cardiac failure, and ultimately death.

Classics of Ayurveda have given ample emphasis on physiology and pathology of Hridroga (heart diseases). Hridaya (heart) is described as the important component of Trimarma, that is (three major sites of vitality in the body, i.e., Shira (head), Hridaya and Basti (urinary bladder)) and is mentioned as the residence of Chetana (vitality).^[3]Charaka has dealt with the pathophysiology, diagnosis, and treatment of Hridroga in Sutrasthana at two instances namely Kiyanta-shirasiya^[4] and Arthedashamahamooliya Adhyaya.^[5] While the treatment aspect is further elaborated in Trimarmiya Chikitsa Adhyaya^[6] in Chikitsasthana and Trimarmiya Siddhi Adhyaya^[7] in Siddhisthana of Charaka Samhita. Such a wide importance given to cardiac conditions in the texts of Ayurveda underlines its prevalence and severity in ancient period as well. To cope with the transformations in the field of medicine, especially critical care, one must be well versed with the recent advances especially pertaining to the IHD which is likely to be most common cause of heart diseases in near future. Hence, this review attempts to elaborate the recent advances in the research, diagnosis, management, and prevention of IHD in terms of both Ayurvedic and contemporary approaches.

Materials and Methods

Available classical literature regarding Hridroga and contemporary literature regarding IHD is reviewed in the present study. Data include information available in printed as well as digital form. Science of Ayurveda is based on concept of Triskandha, that is, Hetu (symptomatology), Linga (Signs and symptoms) and Aushadh (therapeutic measures); hence, all these components concerning IHD were considered while compiling the review. The published articles regarding the concept of IHD and Hridroga were studied from the databases and search engines including Pub-med, Google Scholar, AYUSH portal, etc.

Research Advances Pertaining to Causes and Risk Factors (Hetu Factor)

Recent studies have identified range of risk factors related to cardiovascular disorders arising from urbanization and changing lifestyle. According to the epidemiological studies like the Framingham cohort,^[8] cluster of multiple risk factors for IHD have been identified. Almost every individual is exposed to some or the other kind of risk for IHD. Studies prove that more than 70% of at-risk individuals have multiple risk factors for IHD whereas only 2–7% of the general population have the absence of risk factors.^[9] The causes of IHD are well-established, which can also be considered as risk factors and are enumerated as below. Prior screening of the population should be done in order to prevent the progression of diseases [Figure 1].

Figure 1: Etiology of IHD major risk factors

Click here to view

Westernization of diet and increased consumption of calorie-dense processed foods, unbalanced or unhealthy diet for instance consuming high fat, energy rich diet in place of fiber rich one.^[10]

Stress, diminished mental health: Both the mental disorders and heart diseases can have similar etiology and clinical manifestations.^[11] The observational studies have proved that not only the mental illnesses such as anxiety, but also depression to more severe conditions such as bipolar disorders and schizophrenia negatively impact the cardiac health.

Sedentary lifestyle and lack of physical activities: Changing lifestyle has led to increase in sedentary life and physical inactivity especially in testing situations such as Corona pandemic. This is commonly associated with atherosclerosis, obesity, and type 2 diabetes mellitus.^[12]

Cigarette smoking, tobacco consumption, alcohol consumption: These directly affect the endothelial function leading to the constriction of vessels impairing the function of tissues due to nicotine toxicity and vessel inflammation.^[13] Avoidance of this major factor alone can reduce the risk or improve the prognosis for IHD.

Diabetes, obesity, hypertension, and dyslipidemia (high LDL, low HDL) related disorders: Most patients present with insulin resistance leading to microvascular pathology nesting array of complications. These can also be considered as systemic manifestations of IHD. Diabetes plays a major role and is also recently being considered as a cardiovascular disorder.^[14] Thus the metabolic syndrome and related disorders can affect cardiovascular and related outcomes to a greater extent^.

Genetic factors:^[15] Familial hypercholesterolemia and dyslipidemias are associated with increased cardiac risk according to recent studies. It is believed that presence of some genetic factors such as C151565T, C677T, and R353Q, polymorphisms of glycoprotein IIIa (GPIIIa) is involved in IHD. This can be understood through the presence of symptoms such as Xanthoma or Xanthelasma across various families harnessing the risk of potential heart disease.^[16]

Pathophysiology of IHD^[

17] (Samprapti Factor)

The fundamental pathophysiologic defect in the IHD is inadequate perfusion.

Ischemia is associated with both insufficient oxygen supply and reduced availability of nutrients leading to inadequate removal of metabolic end products. This can also be related with secondary factors such as congestive heart failure or anemia.

Endothelial dysfunction: This disease results from the chronic inflammation of the vessel wall leading to atherosclerotic changes and accumulation of lipid macrophages and T cells within the tunica intima layer. Thus, the endothelial dysfunction results in the loss of elasticity of the vessels leading to increased chances of plaque formation.

Silent plaques formation: Initially there is remodeling of the arterial wall reducing the degree of luminal narrowing. Here the plaques are silent, and ischemic injury is arrested by maintenance of the tissue perfusion.

As the disease progresses, inflammation of vessels leads to the failure in meeting the myocardial demands causing initial hypoxia and progressive vessel stenosis.

Symptoms appear when the plaque encroaches and engulfs the entire luminal cavity blocking the blood flow to the organ.

In some instances, there is rupture of the fibrous cap leading to thrombosis, dislodgement of plaque, and infarction.

In recent times, the corona virus infection has resulted in increased deaths among patients with cardiavascular disease due to activation of inflammatory, cytokine, and coagulation pathways.^[18]

Thus, the pathology of IHD can involve one or more of the following aspects [Figure 2].

Figure 2: Factors involved in pathology of IHD-stage-wise and severity-wise depiction

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Symptomatology (Linga)

IHD can be both symptomatic and asymptomatic showing similar prognosis and risks. Symptomatic IHD is often related with chest discomfort due to angina pectoris and acute coronary syndrome or symptoms depicting progression into one. There can be presence of cardiomegaly (most commonly left ventricular hypertrophy), arrhythmia, cardiac distress, dyspnea, and heart failure associated with it. In case of asymptomatic IHD, there is silent ischemia; however, the changes can be determined electrographically.^[18]

Recent Advances in the Diagnostic Considerations for IHD (Vyadhi Bodhaka Factor)

Diagnosis of IHD is an important step to safeguard the standards of care and intervention in the individuals. Accurate diagnosis is the most vital to prevent and manage the associated complications and acute conditions. It is observed that these days very few family practitioners and physicians are well versed with the physical examination cardiovascular system due to the development of diagnostic technologies. Since last few decades’ revolutionary advancements are observed in this field. Some of the most basic and important aspects are discussed below.

Blood parameters and inflammatory markers

Small study which attempted to followed up 72 patients who were admitted to hospital with chest pain refractory to medical treatment was unable to establish the strong correlation between blood parameters and manifestation of condition. Due to the small number of patients, the end points taken in this study suggested transient myocardial ischemia and the presence of multi-vessel coronary disease or intracoronary thrombus on angiography.^[19] However, large prospective population studies suggest that the systemic level of inflammatory markers may also be predictive of the risk of future cardiovascular events in otherwise asymptomatic or apparently healthy individuals.^[20] The level of the acute phase protein fibrinogen was found to be directly related to the future risk of MI and stroke in men.^[21] Thus, these reflect the chronic inflammation and endothelial dysfunction proving to be potentially strong markers for diagnosis of IHD. There is derangement in the lipid values suggestive of atherosclerosis. Screening for blood sugar level is also of diagnostic and prognostic importance. C reactive protein and fibrinogen values are higher in most of the cases of IHD.

Cardiac biomarkers

(a) Creatinine phospho-kinase has also emerged as a sensitive biomarker for the assessment of risk of mortality and morbidity in IHD. It is an enzyme that assesses the injury to the heart muscles.^[22]

(b) Cardiac Troponins I and T^[23]: These are the most sensitive markers for assessing the cardiac injury in acute myocardial infarction. They also assess the risk for stable IHD along with the other related metabolic disorders and syndromes thus also presenting its prognostic value.

Unstable angina and non-Q wave ST segment elevation on electrocardiography (ECG)^[

24]

These are still the most important considerations for the hospital admissions suspecting active coronary syndrome.

ECG^[

25]

Inversion of T waves and in severe cases the displacement of ST segment are diagnostic of ischemia. Transient T wave inversion reflects transmural intra-myocardial ischemia, transient ST segment depression reflects sub-endocardial ischemia, and ST segment elevation represents the most severe form of the disease, that is, acute MI.

Stress testing or treadmill test^[

26]

Most commonly used test of diagnostic, risk assessment, and prognostic value carried out on a 12-lead ECG before, during, and after exercise usually on a treadmill. This helps to understanding the exercise-induced hypoxic injury in the suspected patients. This is sensitive and often conclusive test.

Invasive methodology

This includes angiography with interventional revascularization therapy (if necessary) and coronary computed tomography (CT) angiography. This assesses the lumina of coronary arteries for suspected obstruction. CT angiography includes software based technology to understand the situation with every coronary vessel. The three dimensional and color coded images are obtained.^[27]

Cardiac imaging/functional assessment using non-invasive nuclear or magnetic resonance technology (CMR)/CT-based fractional flow reserve^[

28]

This is done when the resting ECG is abnormal. Positron emission tomography) scan is also being used recently to assess the perfusion. Pharmacological coronary steal phenomenon is created by the injection of certain drugs such as adenosine that assess the degree of diseased arteries. These are the most sophisticated and skilled procedures providing precise and pinpoint information about the pathology.

Echocardiography (2D echo)^[

29]

This assesses the ventricular function and blood flow. Stress echocardiography is more sensitive method for the diagnosis of IHD. Nowadays, 3D echocardiography imaging greatly helps in obtaining well defined images of cardiac structures. Research is being done to study Doppler method and ultrasound techniques for assessment of the heart.^[30]

These diagnostic aspects are mentioned in [Figure 3].

Figure 3: Diagnostic aspects pertaining ischemic heart disease

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Contemporary Research Pertaining to IHD

Literature search revealed extensive research pertaining to large-scale randomized controlled trials and prospective cohort studies for better management and prevention of IHD along with MI. Some of the important milestones in cardiac research are enumerated in [Table 1].

Table 1: Important milestones in cardiac research pertaining to IHD and myocardial infarction

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Recent Advances in the Treatment Considerations in IHD (Aushadh Vichara)

The treatment modalities in IHD include pharmacological interventions, surgical interventions, stem cell and gene-based therapy, and cardiac rehabilitation for prevention and management. The recent advances in this field can be summarized as below.

Pharmacological therapies

Lipid lowering agents: Use of statins, fibrates, and niacin-like drugs are used to prevent the atherosclerotic changes that are important to avoid the infarction and dislodgement of plaque as well. Newer cholesterol or lipid lowering drugs are being developed based on the genetic studies that are targeted toward the reduction of low-density lipoproteins.^[41]

Nitrates: These help in the management of angina, cause veno-dilation, and reduce the blood pressure. Most commonly used medications are nitroglycerin (GTN), isosorbid dinitrate, and isosorbid mononitrate. Recent researches on nitrates have proved their widespread application of organic and inorganic nitrates in pulmonary and cardiovascular diseases.^[42]

Anti-hypertensive^[43]: These are significant in reducing the heart rate, arterial pressure. and myocardial contractibility. These are necessary for the long-term management of IHD and prevention of hypertensive complications. Beta adrenergic blockers such as metoprolol, atenolol, and propranolol, and calcium channel blockers such as amlodipine and nifedipine are found to be of greater clinical experience and efficacy over the years. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are also emerging as drug of choice for those at the risk of vascular injuries.

Anti-platelet drugs: These again help in the maintenance of the endothelial wall structure by preventing the risk of thrombosis/platelet aggregation further leading to avoidance of infarction. The aspirin or acetyl-salicylic acid is most effective and abundantly used drug of this category. Recently it is also combined with new drug Clopidogrel reducing the incidences of death or ischemic events. Newer antiplatelet agents such as prasugrel and ticagrelor are also available lately.^[44]

Fibrinolytic^[45]: These are plasminogen activators used in the condition of acute myocardial infarction to dissolve the thrombus or clots. Streptokinase, alteplase, and tenecteplase are the most widely used thrombolytic agents across the world. Extensive research is currently being carried out to find newer and safer thrombolytic agents.

Revascularization/Interventional-invasive surgeries

Percutaneous coronary intervention is indicated in unstable cases at high risk for the development of myocardial infarction or in those who are suffering from acute coronary syndrome and has improved the survival rate to a greater extent. Thus, the percutaneous transluminal coronary angioplasty remains the first line of treatment in the active high-risk group. Recent technological boom has led to the development of medicated stents or more precisely the drug eluting stents that release drugs into the coronary artery wall further delaying restenosis. This are however also associated with risk for subacute stent thrombosis.^[46]

Stem cell transplant and gene therapy^[

47]

Preclinical research on the stem cell transplant has created a new hope for the better prevention of IHD. Encouraging results such as reduction in myocardial death, promotion of angiogenesis, and improvement in cardiac functions have been observed. However, the clinical trials have not been conclusive and present with dilemma pertaining to cell engraftment, cell survival, and monitoring. Thus, there is huge scope in this field to open new vistas in preventive and promotive cardiology.

Coronary artery bypass grafting (CABG) surgery^[

48]

This is performed in individuals with multiple vessel coronary disease, restenosis post angioplasty procedure, and complete or near complete obstruction of major vessel like left anterior descending coronary artery. This is a major interventional surgical procedure involving high risk accompanied with longer hospital stay and recovery period. Researchers have been conducted to compare the efficacy of combined medical therapy with and without CABG. The invasive nature of this procedure demands proper and prior assessment to avoid long-term complications.

Cardiac rehabilitation^[

49]

This is an emerging field to safeguard the wellbeing of cardiac patients to resume the physical activity and balanced life after the coronary ischemic attacks. This is also an important part of preventive cardiac care in secondary disease conditions. It involves a multidisciplinary approach involving the patient, caretakers, and health workers as well. The main aims of this therapy are to reduce the risk factors, provide lifestyle modifications, and render the psychological support. It is a combination of various interventions such as weight management, nutritional assessment, lipid management, diabetes management, physical activity guidance, and management of psychosocial and professional issues. However, it is observed that this modality is underutilized and more research should be undertaken to reap the benefits.

Preventive therapy including diet and lifestyle interventions^[

50]

Studies revealed that the intensified lifestyle measures and modifications helped in the reversal of coronary heart diseases. These are as important as the other therapeutic interventions suggested for the IHD. Preventive therapy and lifestyle modifications can be summarized as below:

(1)< b>Weight control measures: Arresting the obesity helps in decreasing the risk factor to a greater extent. Weight control measures are again the combination of diet, physical activity, and exercise intervention aimed at prevention of both primary and secondary cardiac conditions.

(2) Exercise: Physical activity is recommended by assessing the metabolic equivalent tasks. Physical activity helps in improving the insulin sensitivity, reduces dyslipidemia, normalizes blood pressure, and provides nitric oxide to the coronary arteries.^[51] This is an important factor for the prevention and control of the other related conditions such as hyperglycemia, dyslipidemia, hypertension, and inflammation by reducing the tissue oxidation.

(3) Quitting smoking and tobacco products: Cigarette smoking and consumption of tobacco products cause atherosclerosis accelerating the risk of thrombosis, plaque instability, myocardial infarction, and death. The prevention of these products only will reduce the risk by 50–60%.^[52]

(4) Diet modifications: Diet low in saturated and trans unsaturated fatty acid is advised along with the reduced calorie intake. This involves the consumption of healthy diet consisting of fruits, vegetables, whole grains, nuts, legumes, low fat, low in sweetened refined and artificial products.^[53] Seafood is suggested as it contains omega 3 fatty acids while the non-vegetarian diet like poultry and red meat should be avoided. Alcohol consumption should also be limited. The proper balance of macro and micro nutrients such as vitamins and minerals are essential. It can thus be observed that traditional Indian cuisine and diet style can be beneficial for the maintenance of cardiac health.

(5) Yoga and Pranayama: Ministry of AYUSH has recommended Yoga and Pranayama on a daily basis for the prevention and management of IHD considering the increasing prevalence of the cardiovascular diseases. Mind Sound Resonance Technique, Deep Relaxation Technique, Nadisuddhi Pranayama, breathing techniques such as hands in-and-out breathing (Pranayama), hands stretch breathing (Tadasana), Tiger breathing, Sukshma Vyayama (loosening exercises of joints), and meditation. Many RCT’s have been undertaken to prove the efficacy of Yoga. These are also potent stress mitigation techniques thus providing complete physical and mental wellbeing.^[54]

Recent Advances Pertaining to the Research in Ayurveda in IHD

Ayurveda has been extensively described the Hridroga and related Marmagata Vyadhi along with its etiological factors, types, and treatment. In the recent times, more focused research is being conducted on IHD to validate and establish the efficacy of Ayurveda intervention. This involves RCT’s, drug research, novel drug development, observational and epidemiological studies and even conceptual research on the topic. Few important findings are discussed as given below:

(1) Independent research studies: Study that was carried out at Madhavbaug Heart Research centre, Thane revealed that 90 days’ treatment with low carbohydrate diet and ischemia reversal program (consisting of Snehana, Swedana, Basti and Kadha i.e. Decoction) caused significant improvement in VO2 peak, Duke’s treadmill score, body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) of patients suffering from IHD with obesity and hypertension.^[55] Similar studies were carried out at the same institute depicting the use of different interventions in the management of IHD.

(2) Research on Ayurveda herbal drugs: According to the modern research on the herbal and pharmacological drugs, several herbal medicines have been shown to possess antiplatelet, hypo-lipidemic, anti-inflammatory, hypoglycemic, and hypotensive actions. Ayurveda has mentioned many drugs possessing Hridya (cardio-protective) and Rasayana (immunomodulatory and anti-oxidant) property which can help in the better management of the heart related disorders. This is summarized in [Table 2].

Table 2: Researches on some important herbs rendering cardio-protective activity in Ayurveda

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Other Researches Carried Out in the Field of Ayurveda

a. An observational study carried out to assess the association between constitutional type or Prakriti and cardiovascular risk factors, inflammatory markers, and insulin resistance suggested that the individuals having Vata-Kapha and Kapha dominant Prakriti had raised inflammatory markers and were prone for the cardiac diseases as compared to the other types.^[67] Thus, a genome-wide Prakriti analysis can help to assess the risk and susceptible population at initial stage arresting the advancement of disease in these individuals.

b. Literature related search on the Ayush Research Portal^[68] revealed a variety of clinical researches on the IHD. There is evidence of research on the use of Lekhaniya (therapeutic scrapping), for example, herbs such as Vacha (Acorus calamus), Herbo-mineral composition such as Hridyarnava Rasa, Kakubhadi, and Yavanyadi Choorna, different Panchakarma procedures such as Vamana, Virechana, and Basti (Lekhaniya and Hridya) have also proved to be beneficial in this condition.

c. Similarly, other local modalities such as Hrid-Basti, Hrid-Dhara, Shirodhara, Nasya, and Lepa are also used in the routine practice by many Ayurveda physicians.

Discussion

IHD is leading cause of death and disability across the globe. In India, during the year 2019, IHD alone claimed approximately 1.5 million deaths with a mortality rate of 109.23 deaths per 100,000 populations.^[69] This makes it an important topic for extensive research in contemporary and Ayurveda sciences. The article thus throws light upon the Trisutratmaka (Hetu-Linga-Aushadha based) knowledge of the condition as per the conventional sciences and advances in the research field with respect to Ayurveda and contemporary sciences. The recent research on causes or risk factors of IHD involves the increased incidence of westernization of diet and lifestyle or Gramya Aahara as mentioned in the Ayurveda texts. Other factors such as Teekshna Karma (similar to alcohol consumption and cigarette smoking), Ama Utpatti (due to sedentary lifestyle), Karshana (generalized debilitation), and Chinta Bhaya (psychological factors) are also observed in today’s era.^[70] The pathophysiology involves marked endothelial dysfunction, inflammation, atherosclerosis leading to decreased perfusion and tendency of clot formation resembling the Vimargagamana (diversion to the flow of the contents to the improper channels), Strotosanga (obstructions in channel), and Granthi Utpatti (clot or thrombus formation) as per Ayurveda based pathophysiology. The symptomatology also involves the symptoms similar to those mentioned in the text, where Ruja (pain) in form of Angina and Gaurava (heaviness in chest) dominate. The diagnostic considerations also involve array of diagnostic test ranging from blood parameters to electrophysiological and sonographic analysis, interventional cardiology as the condition is life-threatening and requires timely intervention. As the condition often results in myocardial infarction, the recent research studies were directed more toward the efficacy of interventional over conservative therapy. The attempts are being made to develop potent anti-platelet and thrombolytic agents, and newer less invasive surgical techniques are being developed to reduce the effects of therapy. The cardiac rehabilitation and preventive therapy are also gaining popularity over the period of time in the management of cardiac diseases. The Ayurveda research aspect focused on the clinical, cohort, and preclinical studies. The Ayurveda herbs are being studied extensively clinically, preclinical, and based on the extracts and active ingredients of the herbs. Many observational studies are being carried out to assess different dynamics such as Prakriti, in the manifestation of IHD. Large-scale Phase 3 and Phase 4 clinical trials should be carried to validate the herbo-mineral combinations and the role of panchakarma procedures in the treatment of IHD. Integrated approach can be implemented for better management of life-threatening conditions such as IHD.

Conclusion

(1) Ever evolving diagnostic techniques either invasive or not are guiding in better diagnosis and management of IHD.

(2) Newer drugs are being developed to effectively manage and prevent the myocardial infarction. Large sample cohort and randomized controlled trials are being developed to invent newer drugs for the management of IHD.

(3) Non-invasive treatment strategies like lifestyle changes and dietary modifications are gaining popularity over the time.

(4) The domain of Ayurveda research pertaining cardiac disorders is ever growing ranging from clinical trials, research on Ayurveda herbs, observational studies focusing on the Hetu, and different risk factors of Hridroga.

Thus, it is evident that the IHD is an ever-growing burden on the universal health system having the potential threat to the life of millions of people across the globe. Thus, this being a life-threatening condition evolving, and dynamic research is ongoing in this field with respect to diagnosis, treatment, and prevention of the condition in Ayurveda and contemporary fields of sciences.

Acknowledgement

Author would like to thank Vd. Sumedh Joshi for the valuable inputs on the structuring of the articles.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

None.

[71]

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