Atherosclerosis-related cardiovascular or cerebrovascular diseases
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Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 179 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 252 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
\n'}],latestNews:[{slug:"intechopen-authors-included-in-the-highly-cited-researchers-list-for-2020-20210121",title:"IntechOpen Authors Included in the Highly Cited Researchers List for 2020"},{slug:"intechopen-maintains-position-as-the-world-s-largest-oa-book-publisher-20201218",title:"IntechOpen Maintains Position as the World’s Largest OA Book Publisher"},{slug:"all-intechopen-books-available-on-perlego-20201215",title:"All IntechOpen Books Available on Perlego"},{slug:"oiv-awards-recognizes-intechopen-s-editors-20201127",title:"OIV Awards Recognizes IntechOpen's Editors"},{slug:"intechopen-joins-crossref-s-initiative-for-open-abstracts-i4oa-to-boost-the-discovery-of-research-20201005",title:"IntechOpen joins Crossref's Initiative for Open Abstracts (I4OA) to Boost the Discovery of Research"},{slug:"intechopen-hits-milestone-5-000-open-access-books-published-20200908",title:"IntechOpen hits milestone: 5,000 Open Access books published!"},{slug:"intechopen-books-hosted-on-the-mathworks-book-program-20200819",title:"IntechOpen Books Hosted on the MathWorks Book Program"},{slug:"intechopen-s-chapter-awarded-the-guenther-von-pannewitz-preis-2020-20200715",title:"IntechOpen's Chapter Awarded the Günther-von-Pannewitz-Preis 2020"}]},book:{item:{type:"book",id:"574",leadTitle:null,fullTitle:"Topics in Adaptive Optics",title:"Topics in Adaptive Optics",subtitle:null,reviewType:"peer-reviewed",abstract:"Advances in adaptive optics technology and applications move forward at a rapid pace. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"878",title:"Phytochemicals",subtitle:"A Global Perspective of Their Role in Nutrition and Health",isOpenForSubmission:!1,hash:"ec77671f63975ef2d16192897deb6835",slug:"phytochemicals-a-global-perspective-of-their-role-in-nutrition-and-health",bookSignature:"Venketeshwer Rao",coverURL:"https://cdn.intechopen.com/books/images_new/878.jpg",editedByType:"Edited by",editors:[{id:"82663",title:"Dr.",name:"Venketeshwer",surname:"Rao",slug:"venketeshwer-rao",fullName:"Venketeshwer Rao"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"48438",title:"Complementary Therapy with Traditional Chinese Medicine for Treating Atherosclerosis-Related Diseases",doi:"10.5772/60704",slug:"complementary-therapy-with-traditional-chinese-medicine-for-treating-atherosclerosis-related-disease",body:'Atherosclerosis is the most common type of arteriosclerosis. It is a disease of the arteries characterized by the deposition of fatty plaques on their inner walls, which hardens or narrows medium to large blood vessels, especially the aorta, coronary arteries, and cerebral arteries [1]. Atherosclerosis-related diseases often lead to serious outcomes such as sudden cardiac death, unstable angina pectoris, acute myocardial infarction, stroke, and intermittent claudication due to vessel obliteration or plaque rupture with subsequent thrombosis [1,2]. Epidemiological studies indicate that, because of the adoption of Western lifestyle, the prevalence of atherosclerosis is increasing all over the world and will likely reach epidemic proportions in the coming decades [2]. The earliest visible lesion in the development of atherosclerosis is the fatty streak. It consists of aggregates of foam cells (i.e., lipoprotein-loaded macrophages) in the subendothelial space. Fatty streaks may also include T cells, aggregated platelets, and smooth muscle cells. A fatty streak is the precursor lesion of an atheroma that may become an atheromatous plaque [2]. In response to plaque growth, the arterial wall can remodel itself by increasing its external diameter to accommodate the plaque without narrowing the lumen. Thrombosis is the last stage in the disease process that is responsible for clinically observable adverse events mentioned previously.
Traditional Chinese medicine (TCM), especially herbal medicine, has been used for the treatment of cardiovascular diseases for hundreds of years, as documented in the Yellow Emperor\'s Inner Canon (Huangdi Neijing) and the Essential Prescriptions from the Golden Cabinet (Jin Gui Yao Lue). In Taiwan, Chinese herbal medicine is commonly used as complementary and alternative therapy for the treatment of cardiovascular-related diseases such as hypertension, dyslipidemia, and stroke. Thus, studies of the medicines used for the prevention and treatment of atherosclerosis have received much attention in the recent years. The cellular and molecular details regarding the underlying efficacious mechanisms of Chinese herbal medicine in treating atherosclerosis have just begun to be understood. Therefore, the purpose of this article is to present a brief description of the mechanisms of atherogenesis and to summarize the recent research results regarding the mechanisms of antiatherogenic Chinese herbal compounds commonly used in clinical practice. Other interventions of TCM such as acupuncture, tai chi and meditation will also be briefly discussed.
The pathology of atherosclerosis is a progressive process with increasing age that is related to some risk factors such as hypertension, hyperlipidemia, diabetes mellitus, obesity, and cigarette smoking [1]. Atherosclerosis begins with damage to the endothelium, which results in endothelial vasodilator dysfunction. The endothelium subsequently cannot modulate tone, growth, hemostasis, and inflammation throughout the circulatory system. Injured endothelial cells (EC) produce cell surface adhesion molecules such as vascular cell adhesion molecule-1 (VCAM-1), and thereby cause monocytes and T-lymphocytes to adhere to the endothelium and migrate beneath it [1,2]. Circulating monocytes and T-lymphocytes provoke an inflammatory response. The tight junctions between EC loosen and increase the permeability to lipids, especially low-density lipoprotein (LDL). Once the oxidation of LDL has crossed the damaged endothelium into the intima, monocytes differentiate into macrophages and begin to take up oxidized LDL [1]. Macrophages bite and retain the lipid, and then become foam cells. The fatty streak consisting of lipid-containing foam cells in the arterial wall can evolve into atherosclerotic plaques or atheromas [1]. In addition, T-lymphocytes secrete cytokines that induce vascular smooth muscle cells to migrate from the media to the intima and proliferate shortly thereafter [1]. Over time, a growing lesion consisting of lipid and smooth muscle cells invade and narrow the lumen of the artery. Other extracellular matrix (ECM) components such as collagen, elastin, glycoprotein, and proteoglycans give tensile strength and viscoelasticity to the arterial wall. Increasing the synthesis of ECM components such as matrix metalloproteinases (MMPs) contributes significantly to ECM destruction, which renders the plaque more prone to rupture [1]. Once a plaque ruptures, it can trigger an acute thrombosis or embolism by activating platelets. It may finally lead to myocardial infarction, stroke, and even death.
Atherosclerosis treatment usually begins with lifestyle changes such as a low cholesterol diet, regular exercise, and quitting smoking. Depending on the severity of the disease, a person may be prescribed oral medication such as antiplatelets, angiotensin-converting enzyme (ACE) inhibitors, or beta-blockers. In patients with advanced disease, certain medical procedures such as percutaneous transluminal coronary angioplasty or coronary artery bypass surgery may be necessary.
Conventional medical costs paid by patients or by the Bureau of National Health Insurance (Taipei, Taiwan) are expensive. The caregiver burden on the patients’ families and government has increased yearly. In addition, conventional therapies for atherosclerosis-related diseases have some limitations such as statin-induced rhabdomyolysis or hepatitis, and antiplatelet agent-related gastrointestinal bleeding or peptic ulcer. Complementary and alternative therapy is another option for atherosclerosis medication. Traditional Chinese medicine is the primary complementary therapy used in the Chinese community. The aim of this paper is to explore complementary therapy with traditional Chinese medication for treating atherosclerosis-related diseases.
According to TCM theory, obstructed circulation of blood results in blood stasis syndrome (Xue Yu), which is an important pattern of slowing or retardation of the blood circulation. The main symptoms may include stabbing pain with a fixed position, tenderness, local purpura, lumps, dark-purple lips and finger nails, a blue-purple tongue, and a thready or hesitant pulse. Blood stasis syndrome in TCM corresponds to atherosclerosis in modern Western medicine. Both blood stasis syndrome and atherosclerosis are the predevelopment or initial stage of ischemic heart disease, myocardial infarction, or stroke (Figure 1). With early treatment by medication, the progression of cardiovascular or cerebral vascular disease will not worsen.
Progression from health to cardiovascular or cerebrovascular disease. EKG, electrocardiogram.
Table 1 shows atherosclerosis-related cardiovascular or cerebrovascular diseases. Atherosclerosis can cause embolism, thrombosis, ischemia, infarction, stenosis, or occlusion of the arteries. Some Chinese herbs can promote blood circulation or remove blood stasis and may be useful for treating atherosclerosis-related diseases.
\n\t\t\t\tICD-9-CM\n\t\t\t | \n\t\t\t\n\t\t\t\tDiseases\n\t\t\t | \n\t\t
4140 | \n\t\t\tCoronary atherosclerosis | \n\t\t
4400 | \n\t\t\tAtherosclerosis of the aorta | \n\t\t
4149 | \n\t\t\tChronic ischemic heart disease, unspecified | \n\t\t
4148 | \n\t\t\tOther specified forms of chronic ischemic heart disease | \n\t\t
4118 | \n\t\t\tOther acute and subacute forms of ischemic heart disease | \n\t\t
410 | \n\t\t\tAcute myocardial infarction | \n\t\t
4110 | \n\t\t\tPostmyocardial infarction syndrome | \n\t\t
412 | \n\t\t\tOld myocardial infarction | \n\t\t
4297 | \n\t\t\tOther certain sequelae of myocardial infarction, not elsewhere classified | \n\t\t
444 | \n\t\t\tArterial embolism and thrombosis | \n\t\t
4292 | \n\t\t\tCardiovascular disease, unspecified | \n\t\t
433 | \n\t\t\tOcclusion and stenosis of precerebral arteries | \n\t\t
434 | \n\t\t\tOcclusion of cerebral arteries | \n\t\t
Atherosclerosis-related cardiovascular or cerebrovascular diseases
ICD-9-CM, International Classification of Diseases, 9th\n\t\t\t\t\t\t\t\tRevision, Clinical Modification (US Centers for Disease Control and Prevention (CDC), Salt Lake City, Utah; 1996).
Several strategies exist for the treatment of atherosclerosis and associated diseases such as risk factor modification, antioxidation, anti-inflammation, and antiplatelet accumulation. Hypercholesterolemia, a primary risk factor that leads to atherosclerosis, is associated with the development and progression of atherosclerosis. Hypercholesterolemia and endothelial injury lead to the infiltration of LDL particles into the subendothelial space. Lowering cholesterol can provide the initial blockade [2].
The 10 traditional Chinese herbs commonly used in clinical practice that reportedly reduce the production of LDL and/or oxidative LDL are Salvia miltiorrhiza [3], Panax notoginseng [4], Ginkgo biloba [5], Curcuma longa [6], Crataegus pinnatifida [7], Paeonia lactiflora [8], Prunella vulgaris [9], Polygonum multiflorum [10], Coptis chinensis [11,12], and red yeast rice [13]. Single compounds or crude extracts isolated from Salvia miltiorrhiza [3], Ginkgo biloba [14], Prunella vulgaris [9], Polygonum multiflorum [15], and red yeast rice [16] restore epithelial function by regulating the endothelial nitric oxide synthase/nitric oxide (eNOS/NO) pathway. Oxidized low-density lipoprotein (ox-LDL) in the absence of high-density lipoprotein (HDL) can stimulate EC activation and subsequent expression of adhesion molecules such as the vascular cell adhesion molecule (VCAM-1) and the intercellular adhesion molecule (ICAM-1) [17]. These adhesion molecules recruit circulating macrophages and T-lymphocytes into the subintima; this action is mediated by macrophage chemoattractant protein-1 (MCP-1) [17].
As Table 2 shows, single compounds and/or herbal extracts from these 10 TCM herbs inhibit the expression of adhesion molecules (i.e., VCAM-1 and ICAM-1). Among them, Salvia miltiorrhiza [3], Panax notoginseng [4], and Coptis chinensis [18] can downregulate the expression of MCP-1. Furthermore, ox-LDL can stimulate macrophages and T-lymphocytes to produce inflammatory cytokines such as interleukin-1-beta (IL-1β) and tumor necrosis factor alpha (TNF-α) in the vessel wall, which further activate EC and promote vascular smooth muscle cell (VSMC) proliferation and migration [1]. Salvia miltiorrhiza [3], Curcuma longa [19], Paeonia lactiflora [8], and Coptis chinensis [18] suppress the expression of TNF-α. Nuclear factor kappa B (NF-κB) can regulate the expression of multiple inflammatory cytokines such as MCP and cell adhesion molecules (e.g., ICAM-1 and VCAM-1) so as to affect the atherogenic process. Most of the 10 TCM herbs can block the NF-κB pathway involved in the inflammatory process (Table 2).
\n\t\t\t\tHerb/\n\t\t\t\t \n\t\t\t\tinterventions\n\t\t\t | \n\t\t\t\n\t\t\t\teNOS/NO\n\t\t\t | \n\t\t\t\n\t\t\t\tLDL/ox-LDL\n\t\t\t | \n\t\t\t\n\t\t\t\tVCAM-1\n\t\t\t | \n\t\t\t\n\t\t\t\tICAM-1\n\t\t\t | \n\t\t\t\n\t\t\t\tMMP-9/2\n\t\t\t | \n\t\t\t\n\t\t\t\tCD40\n\t\t\t | \n\t\t\t\n\t\t\t\tMCP-1\n\t\t\t | \n\t\t\t\n\t\t\t\tNF-κB\n\t\t\t | \n\t\t\t\n\t\t\t\tTNF-α\n\t\t\t | \n\t\t
\n\t\t\t\tSalvia miltiorrhiza\n\t\t\t | \n\t\t\t | \n\t | \n | \n | \n | \n | \n | \n | \n | \n
\n\t\tPanax notoginseng\n\t | \n\t\n\t | | \n | \n | \n | \n | \n | \n | \n\n |
\n\t\tGinkgo biloba\n\t | \n\t | \n | \n | \n | \n | \n\n | \n | | \n\n |
\n\t\tCurcuma longa\n\t | \n\t\n\t | | \n | \n | \n | \n\n | \n | | \n | \n
\n\t\tCrataegus pinnatifida\n\t | \n\t\n\t | | \n | \n | \n | \n\n | \n | \n | \n |
\n\t\tPaeonia lactiflora\n\t | \n\t\n\t | | \n | \n | \n\n | \n | \n | | \n | \n
\n\t\tPrunella vulgaris\n\t | \n\t | \n | \n | \n | \n\n | \n | \n | | \n\n |
\n\t\tPolygonum multiflorum\n\t | \n\t\n | \n | \n | \n | \n | ||||
\n\t\tCoptis chinensis\n\t | \n\t\n\t | | \n | \n | \n | \n\n | | \n | \n | \n
Red yeast rice | \n\t | \n | \n | \n | \n | \n\n | \n | | \n\n |
Acupuncture | \n\t | \n | \n\n | | \n | \n\n | | \n\n | | \n
\n\t\tTai chi/yoga | \n\t\n\t | | \n\n | \n | \n | \n | \n | \n | \n |
Multiple signaling molecules involved in atherosclerosis and regulated by Chinese herbs
The up arrow (
eNOS, endothelial nitric oxide synthase; ICAM-1, intercellular adhesion molecule; LDL, low-density lipoprotein; MCP-1, macrophage chemoattractant protein; MMP-9, matrix metalloproteinase-9; NF-κB, nuclear factor-kappaB; NO, nitric oxide; ox-LDL, oxidized low-density lipoprotein; TNF-α, tumor necrosis factor alpha; VCAM-1, vascular cell adhesion molecule-1.
Stimulated by inflammatory cytokines such as interleukin-1α (IL-1α) and TNF-α, VSMCs propagate and migrate from the media to the intima and produce collagen, which forms the substance of the fibrous cap of the mature lesion [1,20]. Signaling interactions between CD40- and CD40L-expressing cells result in the formation of matrix metalloproteinases (MMPs), which degrade collagens and the thin fibrous cap and lead to the formation of vulnerable plaques and rupture [20]. Among the 10 TCM herbs, Salvia miltiorrhiza [3] and Panax notoginseng [21] reduce the expression of CD40 and the activity of MMP-2. In addition, Ginkgo biloba [22], Curcuma longa [19,23], Crataegus pinnatifida [24], Coptis chinensis [25], and red yeast rice [26] have an inhibitory effect on MMP-2 and/or MMP-9. Table 3 summarizes the target activities of these herbal extracts or compounds in atherosclerosis.
\n\t\t\tHerbs\n\t\t | \n\t\t\n\t\t\tCompound/extract\n\t\t | \n\t\t\n\t\t\tTarget\n\t\t | \n\t\t\n\t\t\tReference\n\t\t | \n\t
\n\t\t\tSalvia miltiorrhiza\n\t\t | \n\t\tProtocatechuic Aldehyde | \n\t\tReduce caspase-3, and VSMC migration and proliferation | \n\t\t[28,29] | \n\t
\n\t\t | Cryptotanshinone | \n\t\tIncrease NO; reduce ox-LDL, ICAM-1, VCAM-1, and monocyte adhesion | \n\t\t[30] | \n\t
\n\t\t | Tanshinone IIA | \n\t\tReduce ROS, Bax/Bcl-2, caspase-3, LOX-1, NF-κB, ox-LDL, monocyte adhesion, VSMC migration and proliferation, macrophage, cholesterol accumulation, CD 40, TNF-α MMP-2, MMP-9, and platelet aggregation | \n\t\t[34,35,36,43,49] | \n\t
\n\t\t | \n\t\t\tSalvianolic acid B\n\t\t | \n\t\tReduce ICAM-1, E-selectin, NF-κB, ox-LDL, MMP-2, and MMP-9 | \n\t\t[31-33] | \n\t
\n\t\t\tPanax notoginseng\n\t\t | \n\t\t\n\t\t\tPanax notoginseng\n\t\t\t \n\t\t\tSaponins\n\t\t | \n\t\tReduce ICAM-1, VCAM-1, ox-LDL, IL-1β, MMP-9, MMP-2, NF-κB, CD40, and MCP-1 | \n\t\t[4,21,38] | \n\t
\n\t\t\tGinkgo biloba\n\t\t | \n\t\t\n\t\t\tGinkgo biloba\n\t\t\t Extract | \n\t\tIncrease eNOS/NO; Reduce LDL, VCAM-1, ICAM-1, E-selectin, MMP-2, and NF-κB | \n\t\t[5,14,22,39,40] | \n\t
\n\t\t\tCurcuma longa\n\t\t | \n\t\tCurcumin | \n\t\tReduce LDL, VCAM-1, ICAM-1, MMP-2, MMP-9, TNF-α, and NF-κB | \n\t\t[6,19,23,41] | \n\t
\n\t\t\tCrataegus pinnatifida\n\t\t | \n\t\t\n\t\t\tCrataegus pinnatifida extract | \n\t\tReduce LDL, VCAM-1, ICAM-1, and MMP-9 | \n\t\t[7,24] | \n\t
\n\t\t\tPaeonia lactiflora\n\t\t | \n\t\tPaeonol | \n\t\tReduce VCAM-1, ICAM-1, and TNF-α | \n\t\t[42,43] | \n\t
\n\t\t | Total glucosides of peony | \n\t\tReduce LDL and TNF-α | \n\t\t[8] | \n\t
\n\t\t\tPrunella vulgaris\n\t\t | \n\t\t\n\t\t\tPrunella vulgaris extract | \n\t\tIncrease eNOS/NO; reduce LDL, VCAM-1, ICAM-1, and NF-κB | \n\t\t[9,38,44] | \n\t
\n\t\t\tPolygonum multiflorum\n\t\t | \n\t\t2,3,5,4\'-tetrahydroxystilbene-2-O-beta-D-glucoside (TSG) | \n\t\tIncrease eNOS/NO; reduce LDL, VCAM-1, and ICAM-1 | \n\t\t[10,15,39,45] | \n\t
\n\t\t\tCoptis chinensis\n\t\t | \n\t\tBerberine | \n\t\tReduce LDL, ox-LDL, VCAM-1, ICAM-1, MMP-9, MCP-1, NF-κB, and TNF-α | \n\t\t[11,12,18,25,40,46] | \n\t
Red yeast rice | \n\t\t\n\t\t\tMonascus purpureus-fermented rice extract | \n\t\tIncrease eNOS/NO; reduce LDL, VCAM-1, ICAM-1, MMP-9, MMP-2, and NF-κB | \n\t\t[13,16,26,41,42,47,48] | \n\t
The target activity of herbal extracts or compounds in atherosclerosis
eNOS, endothelial nitric oxide synthase; ICAM-1, intercellular adhesion molecule; IL-1β, interleukin 1β; LDL, low-density lipoprotein; LOX1, lectin-like oxidized low-density lipoprotein receptor-1; MCP-1, macrophage chemoattractant protein; MMP, matrix metalloproteinase; NF-κB, nuclear factor-kappaB; NO, nitric oxide; ox-LDL, oxidized low-density lipoprotein; ROS, reactive oxygen species; TNF-α, tumor necrosis factor alpha; VCAM-1, vascular cell adhesion molecule-1; VSMC, vascular smooth muscle cells.
Salvia miltiorrhiza has been widely used in the Chinese population for treating cardiovascular and cerebrovascular diseases. Its specific clinical use is for angina pectoris, hyperlipidemia, and acute ischemic stroke [27], which are all closely associated with atherosclerosis. According to TCM theory, Salvia miltiorrhiza promotes blood circulation, removes blood stasis, and relieves pain. Several compounds derived from Salvia miltiorrhiza have been well studied in the treatment of atherosclerosis. Protocatechuic aldehyde derived from Salvia miltiorrhiza inhibits lipopolysaccharide-induced human umbilical vein EC apoptosis via the regulation of caspase-3, the migration and proliferation of VSMC, and intravascular thrombosis [28,29]. Cryptotanshinone derived from Salvia miltiorrhiza suppresses the increase in endothelial permeability, which is likely because of the restoration of NO bioavailability in EC. Cryptotanshinone also can attenuate monocyte adhesion to EC through inhibiting the expression of adhesion molecules. Salvianolic acid B, a water-soluble antioxidant obtained from Salvia miltiorrhiza, can reduce oxidative stress, inhibit LDL oxidation, and reduce oxidized LDL-induced cytotoxicity [31]. Salvianolic acid B also inhibits VCAM-1 and ICAM-1 expression in TNF-α-treated human aortic EC, and attenuates MMP-2 and MMP-9 expression in vivo in apolipoprotein E-deficient mouse aorta and in vitro in LPS-treated human aortic smooth muscle cells [32,33].
Tanshinone IIA, another compound derived from Salvia miltiorrhiza, markedly inhibits the elevation of ROS evoked by hydrogen peroxide. Tanshinone IIA significantly decreases the hydrogen peroxide-induced expression of proapoptotic proteins Bax and caspase-3 and significantly increases the expression of antiapoptotic protein Bcl-2 in EA.hy926 cells [34]. Tanshinone IIA inhibits oxidized LDL-induced lectin-like oxidized low-density lipoprotein receptor-1 (LOX1) expression in macrophages by reducing intracellular superoxide radical generation and NF-κB activation [35]. Tanshinine IIA also reduces the expression of CD 40, TNF-α, MMP-2, MMP-9, and suppresses VSMC migration and proliferation, macrophage cholesterol accumulation, and platelet aggregation [36].
Hung et al. [37] report that a low dose (0.015 mg/mL) of Salvia miltiorrhiza aqueous extract significantly inhibited the growth of a rat smooth muscle cell line (i.e., A10) under Homocysteine(Hcy) stimulation, and Salvia miltiorrhiza aqueous extract treatment decreased the intracellular reactive oxygen species (ROS) concentration in terms of reducing p47 (phox) translocation and increasing catalase activity. The signaling profile suggests that Salvia miltiorrhiza aqueous extract inhibits Hcy-induced A10 cell growth via the protein kinase C/mitogen-activated protein kinase (PKC/MAPK)-dependent pathway [37].
In addition to herbal medicine, acupuncture has been used for a long time in the treatment of cardiovascular disease in Asia. Acupuncture is applied in the treatment of hypertension and hyperlipidemia, which are risk factors leading to atherosclerosis. Kim et al. [50] demonstrated that electroacupuncture on the Zusanli (ST36) (Figure 2) point reduces hypertension by activating nitric oxide synthase signaling mechanisms [50]. Tian et al. [51] report that electroacupuncture on the Fenglong (ST40) point downregulates the effect of plasma total cholesterol, LDL, MCP-1, and ICAM-1 in hyperlipidemic rats. Another study by Xiao et al. [52] showed that electroacupuncture on the Fenglong (ST40) point effectively lowers serum total cholesterol, LDL, and macrophage TNF-α and IL-6 levels in hyperlipemia rats. Li et al. [53] showed that electroacupuncture of the Neiguan (PC6) and Xinshu (BL15) points can suppress the increased expression of CD 40 L and MMP-9 proteins of coronary artery tissue in rats with coronary atherosclerotic heart disease.
The World Health Organization (WHO) standard acupuncture point locations of ST36, ST40, PC6, and BL15 [54].
Tai chi chuan (tai chi) is a Chinese traditional mind–body exercise with low to moderate exercise intensity. Previous studies have shown that it offers benefits for aerobic capacity, muscular strength, balance, and cardiovascular risk factors such as hypertension, diabetes mellitus, and dyslipidemia. Furthermore, tai chi appears to be safe and effective for patients with acute myocardial infarction, coronary artery bypass grafting surgery, congestive heart failure, and stroke [55]. A study conducted in India shows that regular yogic practices can significantly reduce blood pressure, heart rate, body fat, total cholesterol, triglycerides, and LDL.These reactions are beneficial for cardiac and hypertensive patients [56].
Certain mental disorders and stress are conducive to atherosclerosis. Kroenke et al. [57] revealed that a negative mood is predictive of a greater progression of calcified atherosclerosis, compared to a positive mood. Everson-Rose et al. [58] found that high levels of stress, hostility, and depressive symptoms are associated with a significantly increased risk of incident stroke or transient ischemic attacks in middle-aged and older adults. Stillman et al. [59] and Wang et al. [60] also noted that anxiety can potentially predict a worse outcome through worsening of vascular function in patients with coronary atherosclerotic disease.
Meditation is an alternative medicine practice for mental and physical health. It has salutary effects on patients with anxiety [61, 62], depression [61, 63], and stress [64, 65]. Some articles report that meditation can calm the emotions and produce beneficial effects on the cardiovascular system, particularly with regard to vascular aspects [66-68]. Walton et al. [68] advocate meditation to reduce traditional and novel risk factors for cardiovascular diseases; for example, meditation (1) decreases blood pressure; (2) reduces the use of tobacco and alcohol; (3) lowers the cholesterol level and lipid oxidation; and (4) decreases psychosocial stress.
The mechanism and neurobiological effects of mindfulness meditation involve (1) deactivation of the default mode network, which generates spontaneous thoughts, contributes to the maintenance of the autobiographical self, and is associated with anxiety and depression; (2) the anterior cingulate cortex, which underpins attention functions; (3) the anterior insula, which is associated with the perception of visceral sensation, the detection of the heartbeat and respiratory rate, and the affective response to pain; (4) the posterior cingulate cortex, which helps one to understand the context from which a stimulus emerges; (5) the temporoparietal junction, which assumes a central role in empathy and compassion; and (6) the amygdala, which is implicated in fear responses [69].
There are few studies on formulas or single herbal drugs interaction in the treatment of atherosclerosis. In accordance with evidence-based medicine, well-designed and conducted clinical studies such as randomized control clinical trials will be necessary in the future.
Atherosclerosis-related diseases are the primary causes of death. In addition to standard treatment, complementary therapy needs to be face up. Traditional Chinese medicine is a popular complementary and alternative medicine (CAM) in East Asia and throughout the world. There is increasing scientific evidence demonstrating that TCM has potential for treating atherosclerosis and its associated conditions. Acupuncture, tai chi, and meditation have beneficial effects for atherosclerosis-related cardiovascular diseases. Extracts or compounds of single herbs of some Chinese herbs such as Salvia miltiorrhiza, Panax notoginseng, Ginkgo biloba, Curcuma longa, Crataegus pinnatifida, Paeonia lactiflora, Prunella vulgaris, Polygonum multiflorum, Coptis chinensis, and red yeast rice through their endothelial protective, antioxidative, anti-inflammatory, and lipid-lowering effects may act on multiple mechanisms involved in the pathogenesis of atherosclerosis.
The spiral formed tube which has been used in water transmission pipelines [1, 2] is the most common structural application of a cylindrical shell. Spiral formed pipes were initially constructed by riveting together appropriately bent plates [3] until advances in welding technology allowed for efficient tandem arc welding [1]. Recently, increasing attention has been devoted to the study of spiral welded tubes due to its many applications in water, gas and oil pipelines under both low and high pressure [4] as well as for foundation piles and primary load-bearing members in Combi-walls [5]. Spiral welded tubes provide certain benefits over traditional longitudinal and butt-welded tubes. In particular, continuous or very long tubular members may be constructed efficiently from compact coils of metal strip, eliminating the need for costly transport of long tubular members. The coil material is usually manufactured to very tight tolerances which results in a tube with consistent wall thickness [6]. Further, they exhibit a superior fatigue performance compared to longitudinal seam welded tubes [7]. They also exhibit a comparable resistance to crack growth propagation in ductile materials [8]. However, spiral welded tubes are not suitable for offshore and deep-water applications, because their diameter and wall thickness are limited to nearly 3 m and 30 mm, respectively [9] which generally makes them unsuitable for offshore and deep-water applications [10].
\nIn recent years, great attention has been directed towards the study of generalized thermoelastic interactions in anisotropic thermoelastic models due to its many applications in physics, geophysics, astronautics, aeronautics, earthquake engineering, military technologies, plasma, robotics, mining engineering, accelerators, nuclear reactors, nuclear plants, soil dynamics, automobile industries, high-energy particle accelerators and other science and engineering applications. The main notion of photons, which are particles of light energy, has been introduced by Albert Einstein in 1905. It is difficult to interpret why temperature depends on the specific heat of the crystalline solids. So, the original notion of phonons, which are particles of heat, has also introduced by Albert Einstein in 1907 to explain this phenomenon. Our three-temperature study is essential for a wide range of low-temperature applications, such as pool and basin heating, unglazed and uninsulated flat-plate organic collectors, cold storage warehouses, outdoor applications in extreme low temperatures, cryogenic gas processing plants and frozen food processing facilities. Also, our three-temperature study is very important high temperature applications such as turbine blades, piston engine valves, turbo charger components, microwave devices, laser diodes, RF power amplifiers, tubes of steam power plant, recuperators in the metallurgical and glass industries. The proposed boundary element method (BEM) can be easily implemented for solving nonlinear generalized thermoelasticity problems. Through the present paper, the three-temperature concept introduced for the first time in the field of nonlinear generalized thermoelasticity. Duhamel [11] and Neumann [12] developed the classical thermo-elasticity (CTE) theory and obtained the strain-temperature gradients equations in an elastic body, but their theory has the following two shortcomings: First, the heat conduction equation is predicting infinite speeds of propagation. Second, the heat conduction equation does not contain elastic terms. Biot [13] developed the classical coupled thermo-elasticity (CCTE) theory to overcome the first shortcoming in CTE. Then, several generalized theories based on a modified Fourier’s law predict finite propagation speed of thermal waves such as extended thermo-elasticity (ETE) theory of Lord and Shulman (L-S) [14], temperature-rate-dependent thermo-elasticity (TRDTE) theory of Green and Lindsay (G-L) [15] and three linear generalized thermoelasticity models of Green and Naghdi (G-N) [16, 17], where Type I discusses the heat conduction theory based on Fourier’s law, type II describes the thermoelasticity theory without energy dissipation (TEWOED), and type III discusses the thermoelasticity theory with energy dissipation (TEWED). Due to the computational difficulties, inherent in solving nonlinear generalized thermoelastic problems [18], for such problems, it is very difficult to obtain the analytical solution in a general case. Instead of analytical methods, many numerical methods were developed for solving such problems approximately including the finite difference method (FDM) [19, 20], discontinuous Galerkin method (DGM) [21], finite element method (FEM) [22, 23] and boundary element method (BEM) [24, 25, 26]. The boundary element method (BEM) has been performed successfully for solving various engineering, scientific and mathematical applications due to its simplicity, efficiency, and ease of implementation [27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46].
\nThe main aim of the present chapter is to propose a new theory called nonlinear generalized thermoelasticity involving three-temperature. A new boundary element model was proposed for solving nonlinear generalized thermoelastic problems in anisotropic circular cylindrical plate structures which are associated with the proposed theory, where we used two-dimensional three-temperature (2D-3T) nonlinear time-dependent radiative heat conduction equations coupled with electron, ion and photon temperatures in the formulation of such problems. The numerical results are presented graphically to show the effects of electron, ion and photon temperatures on the thermal stress components. The validity and accuracy of our proposed BEM model were confirmed by comparing our BEM obtained results with the corresponding results of finite element method (FEM).
\nA brief summary of the chapter is as follows: Section 1 outlines the background and provides the readers with the necessary information to books and articles for a better understanding of mechanical behaviour of anisotropic circular cylindrical plate structures and their applications. Section 2 describes the formulation of the new theory and its related problems. Section 3 discusses the implementation of the new BEM for solving the three-temperature heat conduction equations, to obtain the temperature fields. Section 4 studies the development of new BEM and its implementation for solving the equilibrium equation based on the three-temperature fields. Section 5 presents the new numerical results that describe the temperatures effects on the thermal stresses generated in anisotropic circular cylindrical plate structures.
\nWe consider a cylindrical coordinate system \n
Geometry of circular cylindrical plate structure.
Pressure distribution over the structure’s entire surface.
Geometry of meridional cross section of considered structure.
The equilibrium equations for anisotropic plate structures can be written as follows
\nwhere
\nThree radiative heat conduction equations coupled with electron, ion and phonon temperatures can be written as follows
\nwhere \n
The total temperature
\nThe nonlinear time-dependent two dimensions three temperature (2D-3T) radiative heat conduction Eqs. (3)–(5) coupled by electron, ion and phonon temperatures can be written as
\nwhere
\nThe total energy can be written as follows
\nBy applying the following conditions
\nBy using the fundamental solution that satisfies the following Eq. [46]
\nwhere \n
The corresponding dual reciprocity boundary integral equation can be written as [46]
\nwhich can be expressed as
\nIn order to transform the domain integral into the boundary, we assume that
\nwhere \n
We assume that \n
Thus, from (17) we can write the following boundary integral equation
\nwhere
\nBy using (20) and (22), we obtain
\nwhere
\nand
\nFor solving (24) numerically, the functions \n
By substituting from Eqs. (28)–(30) into Eq. (24), we obtain
\nBy applying the initial and boundary conditions, we obtain
\nThis system yields the temperature in terms of the displacement field.
\nThe equilibrium Eqs. (1) for anisotropic plate structures can be written as follows [47]
\nwhere
\nBy using (34) and (35), we can write (33) in the following form
\nwhere
\nBy using Eqs. (37) and (38), we can write (36) as follows
\nwhere
\nThe general solution of (39) can be obtained as
\nwhere
\nand the particular solution can be determined as \n
Thus, Eq. (41) can be written as
\nBy implementing the following boundary conditions.
\nwe can write the unknown \n
where
\nIf we neglected the longitudinal forces influence on the bending of the circular cylindrical shell, we can write (39) in the following form
\nNow, the approximate solution has been reduced for solving problem of bending single span beam with the following compliance
\nThe deflection of the considered shell in the cross section and reference section, respectively, is as follows
\nAlso, the bending moment in the cross section and reference section, respectively, is as follows
\nThe Cauchy model with two-bed scheme can be described as follows
\nwhere the characteristic equation of (58) can be defined as
\nwhich roots
\nThe systems (32) and (58) can be solved by using the algorithm of Fahmy [35] to obtain the three temperatures and displacements components. Then we can compute thermal stresses distributions along radial distance r. we refer the reader to recent references [48, 49, 50, 51] for details of boundary element technique.
\nThe BEM that has been used in the current chapter can be applicable to a wide variety of plate structures problems associated with the proposed theory of three temperatures nonlinear generalized thermoelasticity. In order to evaluate temperatures effects on the thermal stresses, the numerical results are carried out and depicted graphically for electron, ion and phonon temperatures.
\n\n\nFigure 4\n shows the distributions of the three temperatures \n
Variation of the temperatures Te, Ti, Tp and T along the radial distance r.
\n\nFigures 5\n\n–\n\n7\n show the distributions of the thermal stresses \n
Variation of the thermal stress σ11 with radial distance r.
Variation of the thermal stress σ12 with radial distance r.
Variation of the thermal stress σ22 with radial distance r.
\n\nFigure 8\n shows the distributions of the thermal stresses \n
Thermal stresses and total temperature variations with r.
The main objective of this chapter is to propose a new theory called nonlinear generalized thermoelasticity involving three-temperature and new BEM model for the solution of problems which are associated with the proposed nonlinear theory, where we used the three-temperature radiative heat conduction equations coupled with electron, ion and phonon temperatures to describe the thermal stresses in anisotropic circular cylindrical plate structures. It can be concluded from numerical results of our proposed model that the generalized theories of thermoelasticity can be connected with the three-temperature radiative heat conduction to describe the deformation of anisotropic circular cylindrical plate structures. The validity and accuracy of the proposed model was examined and confirmed by comparing the obtained results with those known previously. Because there are no available data to confirm the validity and accuracy of our results, we replace the three-temperature radiative heat conduction results with one-temperature heat conduction results as a special case from results of our current general model for circular cylindrical plate structures. In the special case under consideration, the results obtained with the BEM have been compared graphically with the FEM results of COMSOL Multiphysics software version 5.4. Excellent agreement is obtained between BEM results and FEM results. Understanding the behaviour of the three-temperature thermal stresses in anisotropic circular cylindrical plate structures should be a key for extending the application of these behaviors to a wide range of structures. The numerical results for our general model which is associated with our proposed theory may provide interesting information for computer scientists and engineers, geotechnical and geothermal engineers, researchers who will industrialize the thermoelastic devices using additive manufacturing and the materials designers and developers, etc. stress-temperature coefficients Kronecker delta \n strain tensor thermodynamic temperature tractions magnetic permeability viscoelastic relaxation time weights of control points density force stress tensor specific heat capacity constant elastic moduli piezoelectric tensor mass force vector conductive coefficients bending moment total energy of unit mass temperature functions displacement vector general solution electron-ion energy coefficient electron-photon energy coefficientNomenclature
\n
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