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Effectiveness of Shuxuening injection in coronary heart disease: a systematic review and meta-analysis
Menglong Shi1,2, Tianye Sun3, Zhaochen Ji1,2
1State Key Laboratory of Component-Based Chinese Medicine, College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
Insights
Shuxuening injection (SXNI) combination therapy effectively treats coronary heart disease (CHD) by improving angina symptoms, cardiac function, and lipid profiles. Further large-scale studies are needed to confirm safety and efficacy.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Evidence-Based Medicine
Background:
- Coronary heart disease (CHD) presents significant public health challenges with unmet medical needs.
- Shuxuening injection (SXNI) is widely used in China for CHD, but robust evidence of its efficacy is limited.
- Current treatments for CHD face ongoing challenges, necessitating exploration of novel therapeutic strategies.
Purpose of the Study:
- To systematically evaluate the efficacy of Shuxuening injection (SXNI) as a combination therapy for treating coronary heart disease (CHD).
- To synthesize evidence from randomized controlled trials (RCTs) to assess SXNI's impact on clinical outcomes in CHD patients.
Main Methods:
- A systematic literature search was performed across eight databases up to June 2023, identifying relevant randomized controlled trials (RCTs).
- Quality assessment of included studies was conducted using ROB 2.0, with data analysis performed using RevMan 5.4 and Stata 15.1.
- The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was employed to assess the overall quality of evidence.
Main Results:
- The meta-analysis included 39 studies with 3,779 participants, demonstrating that SXNI combination therapy significantly improved clinical efficacy and reduced angina frequency and duration.
- SXNI therapy enhanced cardiac function by decreasing left ventricular end-diastolic diameter (LVEDD) and increasing cardiac index (CI), cardiac output (CO), and left ventricular ejection fraction (LVEF).
- Improvements were observed in blood lipid profiles (increased HDL, decreased TC, TG, LDL), thrombosis factors (decreased FIB, PV, HCT, HS), C-reactive protein (CRP) levels, electrocardiogram (ECG) efficacy, and B-type natriuretic peptide (BNP).
Conclusions:
- Shuxuening injection (SXNI) combination therapy demonstrates significant efficacy in improving angina symptoms, clinical outcomes, cardiac function, blood lipids, and thrombosis markers in patients with coronary heart disease (CHD).
- Limited safety data precludes definitive conclusions on SXNI's safety profile.
- The evidence quality ranges from very low to moderate, underscoring the need for more high-quality, multi-center, large-sample studies to validate these findings.
Abstract:
Background: Coronary heart disease (CHD) poses a serious threat to public health, and the current medical management still faces significant challenges. Reliable evidence on the efficacy of Shuxuening injection (SXNI) in CHD is still lacking, even though it is widely used in China. Purpose: To evaluate the efficacy of SXNI combination therapy in treating CHD. Methods: A systematic search of eight databases was conducted to identify relevant randomized controlled trials (RCTs) from the inception of each database until June 2023. ROB 2.0, RevMan 5.4, and Stata 15.1 were used for quality evaluation and data analysis. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the quality of evidence. Results: A total of 3,779 participants from 39 studies were included. The results showed SXNI combination therapy increased the clinical efficacy and decreased the frequency and duration of angina. Furthermore, SXNI combination therapy improved cardiac function of patients by decreasing LVEDD, and increased CI, CO, and LVEF. It also improved blood lipid profiles by increasing HDL, decreasing TC, TG, and LDL. The thrombosis factors of patients were also improved by decreasing FIB, PV, HCT, and HS. Moreover, SXNI combination therapy was superior to the conventional treatment in improving CRP levels, increasing ECG efficacy and BNP. However, due to the limited safety information, reliable safety conclusions could not be drawn. Furthermore, the levels of evidence ranged from very low to moderate due to publication bias and heterogeneity. Conclusion: SXNI can effectively improve angina symptoms, clinical efficacy, cardiac function, blood lipid indicators, and thrombosis factors of patients with CHD. However, more multi-center and large-sample studies are needed to confirm the conclusions due to the limitations of this study. Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=399606; Identifier: CRD42023433292.
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