4 DP Placebo Table 2: Within-groups analysis: CAMs (ICAM 1, VCAM and E-selectin). Mean P (two-tailed t-test) N = 19 Mean P (two-tailed t-test) Visit 1 ICAM-1 37.1 ± 26.1 30.1 ± 20.6 Visit 2 ICAM-1 33.8 ± 25.8 0.03 27.4 ± 21.2 0.36a Visit 1 VCAM-1 14.2 ± 10.1 12.0 ± 8.1 Visit 2 VCAM-1 14.0 ± 9.9 0.79 11.5 ± 6.8 0.97a Visit 1 E-SEL 33.0 ± 25.3 27.9 ± 16.2 Visit 2 E-SEL 28.0 ± 25.7 0.004a 24.8 ± 19.1 0.37a N = 20 E-SEL = E-selectin; aWilcoxon Signed Ranks Test; Visit 1—baseline measurements; Visit 2—measurements taken after 12 weeks of study medication. Evidence-Based Complementary and Alternative Medicine of these facts, it has been argued that adhesion molecules and their interactions may be useful therapeutic targets for the reduction of cardiovascular risk and management of CVD [23, 24]. These CAMs are produced chieﬂy by endothelial cells, although modest expression of ICAM-1 and VCAM-1 has also been shown by bone marrow stromal cells and some other cells under speciﬁc conditions [25]. Circulating levels of CAMs increase leukocyte binding that can be accurately quantiﬁed by FACScan analysis [1, 2]. Our results show clearly that ICAM-1, VCAM-1 and E-selectin are detectable on the surface of leukocytes and that treatment with DP for 12 weeks reduces expression of E-selectin and ICAM-1. Several eﬀects of Radix Salviae Miltiorrhizae on the cardiovascular system have been demonstrated, including reduction of cholesterol and triglyceride levels and enhanced recovery following myocardial ischemia [26, 27] and reduced adhesion molecule expression [28, 29]. Radix Salviae Mil- tiorrhizae contains multiple active chemical constituents, of which nearly 100 have been identiﬁed. Among the most important of these are lipophilic tanshinones such as tanshinone IIA and hydrophilic phenolic acids, particularly danshensu, protocatechuic aldehyde and salvianolic acid [30]. Radix Notoginseng has been used traditionally for its haemostatic eﬀect for internal and external bleeding [31], is said to increase coronary blood ﬂow and reduce myocar- dial oxygen consumption [32] and dilate coronary arteries [26]. The active constituents of Radix Notoginseng include arasaponin A, arasaponin B, dencichine and trilinolein [31]. Saponins have been found to lower blood lipids [33], limit atherosclerosis by inhibiting the proliferation of aortic smooth muscle cells [34, 35] and reduce inﬂammation [36]. Trilinolein has antioxidant eﬀects, reduces thrombo- genicity and suppresses cardiac arrhythmias during oxygen- deprivation ischemia in a rat model [37]. The major chemical constituents of Borneoleum Syntheticum are sesquiterpenes: racemic borneol, isoborneol and camphor [38]. In the present study, the eﬀect of the mixture of herbs contained in the DP appears speciﬁcally to reduce circulating levels of the adhesion molecules ICAM-1 and E-selectin. Taken together with the eﬀect previously demonstrated in an animal model of reduced atherogenesis this suggests that this product may provide a useful model for the further investigation of the underlying mechanisms of CVD. It is also possible that it may also contribute to the development of novel strategies for preventing CVD and limiting the development of existing atherosclerotic lesions. Further research is necessary to identify the constituents of this herbal preparation, which are responsible for these actions. It is important, however, to note the limitations of this study, which comprised small numbers, focused on a population of basically healthy individuals not taking conventional medications and relied on surrogate rather than clinical endpoints. It is possible that the eﬀects of the herbal product are diﬀerent in other clinical settings and in particular, in subjects with active CVD. The signiﬁcance of changes in circulating adhesions molecules of this magnitude is uncertain. It is known that physical exercise can reduce adhesion molecule expression while psychological stress can increase it [39]. In our study physical exercise did not change. While there is no reason to believe that there were diﬀerences in levels of psychological stress between the groups nor changes in stress levels over the study period, we did not measure these directly so stress should be recognized as a potential confounding factor. In summary, in human subjects with mild to moderately elevated lipid levels the mixture of herbs contained in the DP appears to have a speciﬁc eﬀect on reducing the CAMs ICAM-1 and E-selectin. This product may contribute to the further investigation of the mechanisms of CVD and to the development of novel strategies for both its prevention and management. Funding Australian Commonwealth Department of Education, Sci- ence and Technology, and the Chinese Ministry of Science and Technology (Australia-China Fund grant); Tianjin Tasly Pharmaceutical Corporation, China (research grant). Dr Ling was supported by an Industry Fellowship from the National Health and Medical Research Council of Australia. Acknowledgments The authors would like to thank Ms. Jacqueline Whitehead for dietary analysis. Dr. K. A. O’Brien was and Professor P. A. Komesaroﬀ is an employee of Monash University and received compensation for their time from the grant from