Affiliation:
1. Office of Academic Affairs, Shandong University of Traditional Chinese Medicine, Jinan, China
2. College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.
Abstract
Background:
Coronary heart disease (CHD) is a type of cardiovascular disease (CVD) caused by coronary atherosclerosis. It is a main cause of medical burden and cardiovascular related death. Zhishi Xiebai Guizhi Decoction (ZXGD) is a representative prescription of traditional Chinese medicine (TCM) in the treatment of CHD, but there is poor systemically evidence-based appraisal.
Objective:
To evaluate the efficacy and safety of ZXGD for CHD.
Methods:
Eight databases were retrieved for randomized controlled trials (RCTs). Data was extracted independently by 2 reviewers. The quality of the included studies was assessed by Cochrane Collaboration risk of bias tool. Clinical efficacy, blood lipid, vascular endothelial function, inflammatory factor and homocysteine (Hcy) were prespecified outcome measures.
Results:
Twenty-four studies (2272 patients) were included. Meta-analysis showed that compared with conventional western medicine (WM) alone, ZXGD was associated with a greater symptom improvement rate with a relative risk (RR) of 1.21 [95% CI (1.16, 1.26), P < .00001] and a greater electrocardiogram (ECG) improvement rate with a RR of 1.27 [95% CI (1.16, 1.40), P < .00001]. In terms of blood lipid, ZXGD reduced total cholesterol (TC) with a mean difference (MD) of −1.15 [95%CI (−1.75, −0.55), P = .0002] and triglyceride (TG) [MD = −0.72, 95%CI (−0.99, −0.45), P < .00001], reduced low-density lipoprotein cholesterol (LDL-C) [MD = −0.93, 95% CI (−1.17, −0.69), P < .00001], and increased high-density lipoprotein cholesterol (HDL-C) [MD = 0.31, 95%CI (0.20, 0.42), P < .00001]. In terms of vascular endothelial function, ZXGD decreased the level of endothelin-1 (ET-1) [MD = −7.81, 95%CI (−9.51, −6.10), P < .00001], and increased nitric oxide (NO) [MD = 8.90, 95%CI (7.86, 9.93), P < .00001]. ZXGD also reduced high-sensitivity C-reactive protein (hs-CRP) [MD = −1.73, 95% CI (−2.63, −0.83), P < .00001] and Hcy [MD = −2.03, 95%CI (−2.78, −1.28), P < .00001]. No significant differences were found in adverse event rate between the 2 groups with a RR of 0.77 [95% CI (0.44, 1.34), P = .36].
Conclusion:
ZXGD is effective and safe in the treatment of CHD. However, more rigorous and high-quality RCTs are needed to verify the conclusion.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Reference42 articles.
1. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study [published correction appears in J Am Coll Cardiol 2021 Apr 20;77(15):1958-1959].;Roth;J Am Coll Cardiol,2020
2. Coronary heart disease mortality trends during 50 years as explained by risk factor changes: the European cohorts of the seven countries study.;Menotti;Eur J Prev Cardiol,2020
3. The COVID-19 pandemic and coronary heart disease: the next surge [published online ahead of print, 2023 Aug 2].;Shaikh;Curr Atheroscler Rep,2023
4. 2021 ACC/AHA/SCAI Guideline for coronary artery revascularization: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines [published correction appears in Circulation 2022 Mar 15;145(11):e772].;Lawton;Circulation,2022
5. Medical therapy versus percutaneous coronary intervention or coronary artery bypass graft in stable coronary artery disease; a systematic review and meta-analysis of randomized clinical trials.;Davari;ARYA Atheroscler,2022