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. 2025 Aug 5:16:1614767.
doi: 10.3389/fphar.2025.1614767. eCollection 2025.

Comparative efficacy of eight traditional Chinese medicines combined with statins in the treatment of hyperlipidemia: a Bayesian network meta-analysis

Ling Jiang #  1 , Wen Fan #  1 , Fangyu Zhou  1 , Lihan Liu  2 , Maoxing Pan  1   3 , Qinhe Yang  1   3 , Yupei Zhang  1   3
Affiliations

Comparative efficacy of eight traditional Chinese medicines combined with statins in the treatment of hyperlipidemia: a Bayesian network meta-analysis

Ling Jiang et al. Front Pharmacol. .

Abstract

Background: Hyperlipidemia drives global cardiovascular mortality by elevating risks of atherosclerosis and stroke. While statins are foundational, traditional Chinese medicines (TCMs) are widely combined with statins to boost efficacy. However, diverse TCM formulations lack comparative evidence in combination regimens, necessitating urgent evidence-based optimization.

Methods: Based on preliminary literature review and component usage frequency analysis, 8 TCMs were included firstly. Then, we conducted a systematic search for RCTs that assessed 8 TCMs with traditional statin drugs (TT) for the treatment of hyperlipidemia. The search was conducted through September 30, 2024, and encompassed China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Database of Chinese Sci-Tech Periodicals (VIP), Wanfang Database, PubMed, Web of Science, and Cochrane Library. Outcomes included clinical total effective rate, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Risk of bias in RCTs was evaluated using Cochrane's bias risk tool. Evidence synthesis was performed utilizing both direct and Bayesian network meta-analyses (NMA). Meta-regression analysis, subgroup analysis, publication bias analysis, and sensitivity analysis were employed to evaluate heterogeneity sources and efficacy robustness. Ranking analysis was implemented to comparatively assess clinical efficacy among eight TCMs. Evidence quality for each outcome was assessed using Grading of Recommendations, Assessment, Development, and Evaluation approach (GRADE). Overall, the proposed structured framework integrated high-frequency TCM screening, NMA-driven efficacy ranking, methodological validation, and mechanistic investigation to holistically evaluate therapeutic interventions for the first time.

Results: 67 RCTs involving 7327 individuals and 8 TCMs were encompassed. Related analyses indicated TT + TCMs were more efficacious than TT monotherapy. Among 8 TCMs + TT, TT combined with Jiangzhi Tongmai Capsule (TT + JZTM) demonstrated the highest clinical total effective rate, TT combined with Dantian Jiangzhi Pill (TT + DTJZ) was the most effective in reducing TC, TT combined with Pushen Capsule (TT + PS) was the most effective in reducing TG, and TT combined with Jiangzhiling Tablet (TT + JZL) was the most effective in increasing HDL-C and reducing LDL-C.

Conclusion: NMA revealed the overall clinical efficacy of TT + JZL, TT + DTJZ, and TT + JZTM were ranked at the forefront in treating hyperlipidemia. These findings provide evidence-based guidance for tailoring TCM-statin combinations to target individualized lipid profiles.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024603979, identifier [CRD42024603979].

Keywords: clinical efficacy; hyperlipidemia; network meta-analysis; safety outcome; traditional Chinese medicines.

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
Literature screening protocol.
FIGURE 2
FIGURE 2
Risk assessment of bias for include studies.
FIGURE 3
FIGURE 3
Network evidence plots of (A) clinical total effective rate, (B) TC, (C) TG, (D) HDL-C and (E) LDL-C.
FIGURE 4
FIGURE 4
SUCRA rank of (A) clinical total effective rate, (B) TC, (C) TG, (D) HDL-C and (E) LDL-C.
See this image and copyright information in PMC

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References

    1. Balshem H., Helfand M., Schünemann H. J., Oxman A. D., Kunz R., Brozek J., et al. (2011). GRADE guidelines: 3. Rating the quality of evidence. J. Clin. Epidemiol. 64 (4), 401–406. 10.1016/j.jclinepi.2010.07.015 - DOI - PubMed
    1. Begg C. B., Mazumdar M. (1994). Operating characteristics of a rank correlation test for publication bias. Biometrics 50 (4), 1088–1101. 10.2307/2533446 - DOI - PubMed
    1. Canfora I., Pierno S. (2024). Hypertriglyceridemia therapy: past, present and future perspectives. Int. J. Mol. Sci. 25 (17), 9727. 10.3390/ijms25179727 - DOI - PMC - PubMed
    1. Chen C. Y., Li H., Yuan Y. N., Dai H. Q., Yang B. (2013). Antioxidant activity and components of a traditional Chinese medicine formula consisting of Crataegus pinnatifida and Salvia miltiorrhiza. BMC Complement. Altern. Med. 13, 99. 10.1186/1472-6882-13-99 - DOI - PMC - PubMed
    1. Cieza A., Causey K., Kamenov K., Hanson S. W., Chatterji S., Vos T. (2021). Global estimates of the need for rehabilitation based on the global burden of disease study 2019: a systematic analysis for the global burden of disease study 2019. Lancet 396 (10267), 2006–2017. 10.1016/S0140-6736(20)32340-0 - DOI - PMC - PubMed

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