Cardiovascular disease (CVD) is the leading cause of death in the world and our approach to the control and management of CVD mortality is limited. Nattokinase (NK), the most active ingredient of natto, possesses a variety of favourable cardiovascular effects and the consumption of Natto has been linked to a reduction in CVD mortality. Recent research has demonstrated that NK has potent fibrinolytic activity, antihypertensive, anti-atherosclerotic, and lipid-lowering, antiplatelet, and neuroprotective effects. This review covers the major pharmacologic effects of NK with a focus on its clinical relevance to CVD. It outlines the advantages of NK and the outstanding issues pertaining to NK pharmacokinetics. Available evidence suggests that NK is a unique natural compound that possesses several key cardiovascular beneficial effects for patients with CVD and is therefore an ideal drug candidate for the prevention and treatment of CVD. Nattokinase is a promising alternative in the management of CVD.

No abstract

No abstract

No abstract

BackgroundChina has low seasonal influenza vaccination rates among children and older adults. This quasi-experimental pragmatic trial examined the effectiveness of a pay-it-forward intervention on influenza vaccine uptake among children and older adults compared to standard of care (user-paid vaccination) and free vaccination strategies in China. Pay-it-forward is a community-engaged social innovation in which people receive a free influenza vaccination from a local group and are then asked if they would like to donate financially and/or create a postcard message to promote vaccination among future individuals.MethodsWe iteratively co-created the pay-it-forward intervention with the community through public engagement and a participatory hackathon. We implemented the three study arms in three clinics (rural, suburban, urban) in Guangdong Province, China. A total of 225 children aged between six months and eight years old and 225 older adults (60 years old or above) were recruited into the study. Regression methods were used to compare influenza vaccine uptake (administrative records) and vaccine confidence (self-report) between the three arms.ResultsAmong all participants, 55/150 (36.7%) in the standard of care arm received an influenza vaccine. 111/150 (74.0%) of people in the pay-it-forward arm received an influenza vaccine. 114/150 (76.0%) of people offered free vaccination received an influenza vaccination. Similar trends were observed among children and older adults. The pay-it-forward arm had significantly higher vaccine confidence when compared to the standard of care arm. In the pay-it-forward arm, 107/111 (96.4%) of participants donated money for subsequent vaccinations and 19 of 60 invited (31.7%) created postcard messages.ConclusionsPay-it-forward was effective in improving influenza vaccine uptake and engagement among children and older adults. Our data have implications for pro-social interventions to enhance influenza uptake in the many countries where influenza vaccines are available for a fee.Trial registrationChiCTR2000040048