The Improvement of Cardiac and Endothelial Functions of Xue-Fu-Zhu-Yu Decoction for Patients with Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background. Xue-Fu-Zhu-Yu decoction (XFZYD) is a traditional Chinese prescription that has been used to treat patients with blood stasis in China for many years. The present study aimed to evaluate the improvement of cardiac and endothelial functions of XFZYD for patients with acute coronary syndrome (ACS) through a systematic review and meta-analysis. Methods. Six databases were searched to collect RCTs related to the treatment of XFZYD for ACS. The primary outcomes were cardiac and endothelial functions, including the levels of left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD) in echocardiography, as well as the changes in the levels of nitric oxide (NO), endothelin-1 (ET-1), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) in the serum. The secondary outcomes were the blood levels of oxidative damage markers (including superoxide dismutase (SOD) and malondialdehyde (MDA)), C-reactive protein (CRP), brain natriuretic peptide (BNP), creatine kinase-MB (CK-MB), and cardiac troponin I (cTnI) as well as the incidence of adverse drug reactions (ADRs). Weighted mean difference (WMD) was estimated for all the outcomes with the random effects model. This type of analysis was conducted in the subgroups of the ACS subtypes, and the methodological quality was assessed using the handbook of Cochrane Collaboration. Results. A total of 1,658 records were identified, and 16 randomized controlled trials (1,171 patients) were included. The primary outcomes suggested that XFZYD combined with routine treatment improved LVEF, reduced LVEDD and LVESD, and also improved the serum levels of NO, and reduced the levels of ET-1 and ICAM-1. XFZYD combination therapy significantly ameliorated the blood levels of SOD, MDA, BNP, CK-MB, and cTnI. However, the results indicated no significant difference between XFZYD plus routine treatment and routine treatment for the levels of VCAM-1 and CRP. Moreover, all the ADRs reported in the included studies were slight and the patients recovered soon. Conclusions. The present study suggested that XFZYD may improve the cardiac and endothelial functions of ACS patients without serious ADRs. However, based on the mediocre methodological quality, the aforementioned conclusion should be confirmed in a multicenter, large-scale, and accurately designed clinical trial.

The Effect and Safety of Xuefu Zhuoyue Prescription for Coronary Heart Disease: An Overview of Systematic Reviews and Meta-Analyses

“…Two SRs/MAs [ 29 , 38 ] reported that XFZY was effective in reducing LDL-C (1 low-quality piece of evidence and 1 extremely low quality piece of evidence), TC (1 low-quality piece of evidence and 1 extremely low-quality piece of evidence), and one SR/MA [ 29 ] reported that XFZY was effective in increasing HDL-C (low-quality evidence). One SR/MA [ 30 ] reported that XFZY was effective in treating LVEF (low-quality evidence), LVESD (low-quality evidence), NO (extremely low-quality evidence), ET-1 (extremely low-quality evidence), ICAM-1 (extremely low-quality evidence), SOD (extremely low-quality evidence), MDA (extremely low-quality evidence), BNP (extremely low-quality evidence), and CK-MB (extremely low-quality evidence) in patients with CHD. In addition, the results of one SR/MA [ 27 ] showed significant efficacy of XFZY in the treatment of AF (low-quality evidence), DAP (low-quality evidence), WBV (low-quality evidence), PV (extremely low-quality evidence), FB (extremely low-quality evidence), NO (low-quality evidence), and ET-1 (low-quality evidence).…”

“…One SR/MA [ 31 ] quantified the adverse events associated with XFZY for CHD treatment and showed no difference in the incidence of AEs (low-quality evidence) in XFZY compared to controls. In addition, nine SRs/MAs [ 29 , 30 , 32 – 36 , 38 , 39 ] gave a narrative description on the low incidence of adverse events in the XFZY group.…”

“…A total of 78 publications were obtained from seven electronic databases after the search; among those, 45 were excluded after duplicates removal, 17 were excluded by screening the titles and abstracts, and 7 [22][23][24][25][26][27][28] were further excluded after the full text was read due to their failure to meet the intervention criteria. Finally, 11 publications [29][30][31][32][33][34][35][36][37][38][39] were included for the study. Te fow chart of literature screening is shown in Figure 1.…”

“…Te characteristics of the 11 SRs/MAs used for qualitative analysis in this overview were summarized in Table 2. All SRs/MAs were published between 2014 and 2022, with 6 (6/11, 54.5%) [30,31,34,35,37,38] of them being published within the last 5 years. All the included SRs/MAs were published by Chinese scholars, fve [29][30][31][32][33] of which were in English and six [34][35][36][37][38][39] in Chinese.…”

Efficacy and safety of acupuncture combined with Xuefu Zhuyu Decoction on major adverse cardiovascular events after percutaneous coronary intervention: A protocol for systematic review and meta-analysis

“…Xuefu Zhuyu Decoction (XFZYD) has the effects of promoting blood circulation, eliminating blood stasis, activating vital energy to stop pain, and reinforcing functional activities of the heart, so it can greatly relieve angina pectoris after PCI. [ 18 , 19 ] XFZYD is a traditional classic soup for the treatment of chest paralysis, originated from the book “Yilin Gaicuo.” [ 20 ] Modern pharmacological analysis suggests that XFZYD can improve myocardial microcirculation perfusion and myocardial contractility, effectively inhibit platelet aggregation, dilate coronary arteries and peripheral vessels, prevent the formation of atherosclerosis, and ameliorate myocardial ischemia and hypoxia. [ 21 ]…”