4.7 Review

Efficacy and safety of Shexiang Baoxin Pill for stable coronary artery disease: A systematic review and meta-analysis of 42 randomized controlled trials

Journal

FRONTIERS IN PHARMACOLOGY
Volume 13, Issue -, Pages -

Publisher

FRONTIERS MEDIA SA
DOI: 10.3389/fphar.2022.1002713

Keywords

Shexiang Baoxin Pill; stable coronary artery disease; randomized controlled trials; meta-analysis; grade

Funding

  1. Ministry of Science and Technology of the People's Republic of China's Key Projects during the 13th Five-Year Plan Period
  2. National Natural Science Foundation of China
  3. Chinese Medicine Evidence-Based Capacity Building Project of State Administration of Traditional Chinese Medicine
  4. [2019YFC1710003]
  5. [82074226]
  6. [82030120]
  7. [2019XZZX-XXG003]

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This study conducted a meta-analysis to verify the therapeutic effect and safety of Shexiang Baoxin Pill (SBP) on stable coronary artery disease (SCAD). The results demonstrated that the combination therapy of SBP with conventional western medicine (CWM) was more effective in reducing major adverse cardiovascular events and improving symptoms and indicators related to angina. The evidence also showed improvements in blood lipid level and left ventricular ejection fraction after SBP treatment.
Objective: Patients with stable coronary artery disease (SCAD) still have a higher risk of adverse cardiovascular events. Shexiang Baoxin Pill (SBP) is widely used as a complementary and alternative treatment for SCAD. This study aimed to further verify the therapeutic effect and safety of SBP on SCAD. Methods: Seven databases were involved in this meta-analysis as of 1 June 2022. Data was collected from all the randomized controlled trials (RCTs) of the combination of SBP and conventional western medicine (CWM) in treating SCAD which was conducted by two independent authors. Risk of bias was assessed using the Cochrane risk-of-bias 2.0 (RoB2.0) tool, and the meta-analysis was accomplished with Review Manager 5.3. Furthermore, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) profiler 3.2.2 software was selected to grade the current evidence in our findings. Results: 42 articles, involving 6,694 patients were screened among all the 1,374 records in the analysis. The results demonstrated that the combination therapy was more efficient than CWM alone in lowering the incidence of major adverse cardiovascular events (MACE, RR = 0.50, 95% CI: 0.37 to 0.68, p < 0.00001) and ameliorating the total effective rate of angina symptom improvement (RR = 1.23, 95% CI: 1.19 to 1.28, p < 0.00001), the effective rate of electrocardiogram improvement (RR = 1.34, 95% CI: 1.26 to 1.43, p < 0.00001), the frequency of angina pectoris (MD = -2.83, 95% CI: -3.62 to -2.05, p < 0.00001), and the duration of angina pectoris (MD = -1.32, 95% CI: -2.04 to -0.61, p = 0.0003). We also found that, after SBP treatment, a more positive blood lipid level and left ventricular ejection fraction without the increase in adverse cases were calculated in our meta-analysis. What's more, Subgroup analysis indicated that treatment duration may be the source of heterogeneity. The certainty of the evidence for MACE, and electrocardiogram improvement exhibited moderate certainty, and the certainty of the evidence for the remaining outcomes was judged as low certainty. The trial sequential analysis further affirmed the clinical efficacy of SBP. Conclusion: The available evidence indicates that SBP may be an effective therapeutic option in patients with SCAD. However, considering the inferior quality and inconsistent results in the included trials, further rigorous RCTs are required.

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