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Review
. 2024 Feb 13:11:1229299.
doi: 10.3389/fcvm.2024.1229299. eCollection 2024.

Efficacy and safety of tongxinluo capsule for angina pectoris of coronary heart disease: an overview of systematic reviews and meta-analysis

Liuying Li #  1 , Peimin Feng #  1 , Wenhua Zhou  2 , Biao Luo  2 , Lvyu Deng  2 , Daohui Gan  2 , Xiaohan Wu  2 , Fengya Zhu  2 , Xia Zhou  2
Affiliations
Review

Efficacy and safety of tongxinluo capsule for angina pectoris of coronary heart disease: an overview of systematic reviews and meta-analysis

Liuying Li et al. Front Cardiovasc Med. .

Abstract

Background: Tongxinluo capsule (TXLC) is a common drug for treating angina pectoris of coronary heart disease (CHD). In recent years, many systematic reviews (SRs) and meta-analyses (MAs) have reported the efficacy and safety of TXLC for improving angina symptoms in patients with CHD. We aimed to comprehensively evaluate the existing SRs and MAs of TXLC in treating angina pectoris of CHD, summarize the evidence quality, and provide scientific evidence and recommendations.

Methods: We searched seven databases for relevant SRs/MAs published up to 1 June 2023. Two reviewers independently completed the literature retrieval, screening, and data extraction. We used A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) to evaluate the methodological quality, the Risk of Bias in Systematic Reviews (ROBIS) to assess the risk of bias, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to determine the strength of the evidence. RevMan 5.3 was used to synthesize data.

Results: We identified 15 SRs/MAs, including 329 RCTs and 33,417 patients. According to the evaluation results of AMSTAR-2, only one SR was of high methodological quality, the others were very low. ROBIS assessment showed that one SR (6.67%) had a low risk, 3 SRs (20%) had an unclear risk, and 11 SRs (73.33%) had a high risk. We assessed 42 outcomes by the GRADE, 10 (23.81%) for moderate-quality evidence, 17 (40.48%) for low-quality evidence, and 15 (35.71%) for very-low-quality evidence. Mate-analysis showed that TXLC combined with conventional western medications improved electrocardiogram efficacy (RR = 1.38, 95% CI: 1.23-1.43, P < 0.001) and angina efficacy (OR = 3.58, 95% CI: 3.02-4.24, P < 0.001), reduced angina attack frequency (SMD = -0.54, 95% CI: -0.64 to -0.44, P < 0.001) and angina duration (SMD = -0.42, 95% CI: -0.57 to -0.28, P < 0.001), with general heterogeneity. The pooled results showed that TXLC appears to have some efficacy in improving cardiac function and relieving angina symptoms, but there is limited evidence that it improves cardiovascular event rates, hemorheology, lipids, or hs-CRP. In the assessment of drug safety, TXLC was associated with different degrees of adverse drug reactions.

Conclusion: Based on the evidence, TXLC may be effective as an adjuvant treatment for angina pectoris of CHD. However, the quality of the evidence is low, and the drug's safety must be carefully interpreted. In future studies, high-quality randomized controlled trials are needed to confirm the effectiveness and safety of TXLC.

Systematic review registration: http://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42022365372).

Keywords: angina pectoris; coronary heart disease; overview; tongxinluo capsule; traditional Chinese medicine.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The detailed flow chart.
Figure 2
Figure 2
The detailed results of RoB.
Figure 3
Figure 3
Forest plot of electrocardiography efficacy.
Figure 4
Figure 4
Forest plot of angina pectoris efficacy.
Figure 5
Figure 5
Forest plot of angina attack frequency.
Figure 6
Figure 6
Forest plot of angina duration.
Figure 7
Figure 7
Funnel plot of electrocardiography efficacy.
Figure 8
Figure 8
Funnel plot of angina pectoris efficacy.
Figure 9
Figure 9
Funnel plot of angina attack frequency.
Figure 10
Figure 10
Funnel plot of angina duration.
See this image and copyright information in PMC

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