Role of Blood Stasis Syndrome of Kampo Medicine in the Early Pathogenic Stage of Atherosclerosis: A Retrospective Cross-Sectional Study

Abstract

In Kampo medicine, blood stasis (BS) syndrome is strongly associated with microangiopathy and can lead to atherosclerosis. Vascular endothelial dysfunction (VED), evaluated through flow-mediated dilation (FMD), plays an important role in the early stages of atherosclerosis. However, the association of BS syndrome with VED, as determined using FMD, has not been reported. This study investigated the association between BS syndrome and VED using FMD. Forty-one patients with normal glucose tolerance or impaired glucose tolerance (IGT) and without macrovascular complications were evaluated using FMD from May 2017 to August 2017. Based on the BS score, the patients were divided into the non-BS (n = 19) and BS syndrome (n = 22) groups. Physical and background characteristics, physiological function test results, and laboratory data were compared. Univariate analysis revealed that FMD and a history of dyslipidemia/IGT were significantly different between the two groups (p < 0.05). Multiple logistic regression analysis showed that BS syndrome was significantly associated with FMD (odds ratio: 6.26; p=0.03) after adjusting for the history of dyslipidemia/IGT. The receiver operating characteristic curve showed that the area under the curve for BS syndrome (0.74; p < 0.001) and history of IGT (p < 0.007) provided good diagnostic accuracy for FMD. The area under the curve for "BS syndrome + IGT" showed very good accuracy (0.80; p < 0.0001) and was higher than that for BS syndrome or IGT alone. In conclusion, the results of this study suggest that the BS score in Kampo medicine could be a useful tool for detecting the early pathogenic stages of atherosclerosis.

Figure 1

Participant selection. The patients were divided into the NBS group and BS syndrome group. Three patients were excluded from laboratory data analysis because we could not obtain informed consent. The variables found to be associated with the BS score were further tested by multiple logistic regression analysis to investigate the independent factors associated with FMD. To assess the ability of each variable to discriminate FMD, the areas under the ROC curves were calculated. NBS: non-blood stasis; BS: blood stasis; IGT: impaired glucose tolerance; DLP: dyslipidemia; FMD: flow-mediated dilation; ROC; receiver operating characteristic.

Figure 2

The diagnostic accuracy of blood stasis (BS) syndrome + impaired glucose tolerance (IGT), BS syndrome alone, IGT alone, and dyslipidemia (DLP) for predicting flow-mediated dilation (FMD). The receiver operating characteristic (ROC) curves depict that BS syndrome and IGT have good diagnostic utility for FMD, with BS syndrome + IGT having better diagnostic accuracy; DLP demonstrates poor diagnostic utility. In each graph, the solid diagonal line is the line of no discrimination (true area = 0.50), and the optimal cutoff points are indicated on the curves. AUC: area under the curve; CI: confidence interval.