Choto-san was administered to 6-week-old spontaneously hypertensive rats (SHR) at the usual dose used for humans and at a 10-times higher dose, and its effects on blood pressure and the autonomic nervous system were examined. Significant blood pressure elevation was noted in the SHRs administered with the 10-fold dose, but no such changes were observed in the SHRs that were administered the usual human dose. Since the urinary levels of adrenaline and noradrenaline and the granulocyte count significantly increased in the 10-fold dose group, the elevation in blood pressure in this group appears to be attributable to stimulation of the sympathetic nervous system. Accelerated sympathetic nervous activity is noted in SHRs during the growing stage, and the excessively high dose of Choto-san probably further stimulated the sympathetic nervous activity.

Cardio-oncology is an emerging multi-disciplinary field, which aims to reduce morbidity and mortality of cancer patients by preventing and managing cancer treatment-related cardiovascular toxicities. With the exponential growth in cancer and cardiovascular diseases in Asia, there is an emerging need for cardio-oncology awareness among physicians and country-specific cardio-oncology initiatives. In this state-of-the-art review, we sought to describe the burden of cancer and cardiovascular disease in Asia, a region with rich cultural and socio-economic diversity. From describing the uniqueness and challenges (such as socio-economic disparity, ethnical and racial diversity, and limited training opportunities) in establishing cardio-oncology in Asia, and outlining ways to overcome any barriers, this article aims to help advance the field of cardio-oncology in Asia.