Comparative efficacy and safety of oral Chinese patent medicines combined with conventional therapy for coronary heart disease complicated by diabetes: a systematic review and network meta-analysis.

BACKGROUND: Coronary heart disease (CHD) frequently coexists with diabetes mellitus (DM), resulting in a complex metabolic-vascular disorder with poor cardiovascular prognosis. Oral Chinese patent medicines (OCPMs) are widely used as adjunctive therapies in China. However, their comparative efficacy and safety remain unclear.

METHODS: We systematically searched Chinese and international databases for randomized controlled trials (RCTs) evaluating OCPMs combined with conventional Western therapy in patients with CHD complicated by DM. We conducted a network meta-analysis using R and Stata software. The evaluated outcomes included glycemic control, lipid profiles, cardiac function, angina-related measures, inflammatory markers, endothelial function, hemorheological parameters, major adverse cardiovascular events (MACEs), and adverse reactions. We assessed treatment rankings using the surface under the cumulative ranking curve.

RESULTS: A total of 71 RCT articles were included, with a total sample size of 7,988 patients, involving 14 types of OCPMs. The NMA revealed the following results: Shexiang Baoxin Pills combined with conventional Western medicine exhibited optimal efficacy in reducing triglycerides (TG), improving high-density lipoprotein cholesterol (HDL-C) and left ventricular end-systolic diameter (LVESD), decreasing the weekly frequency and duration of angina pectoris episodes, and lowering levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein (hs-CRP), endothelin-1 (ET-1), and fibrinogen (FIB). Tongxinluo Capsules combined with conventional Western medicine achieved the best outcomes in clinical efficacy, reducing 2-h postprandial blood glucose (2 h PBG), improving left ventricular end-diastolic diameter (LVEDD), increasing nitric oxide (NO), and improving malondialdehyde (MDA). Yindan Xinnaotong Soft Capsules combined with conventional Western medicine showed the most prominent effects in enhancing left ventricular ejection fraction (LVEF), reducing whole blood high-shear viscosity and low-shear viscosity, and improving superoxide dismutase (SOD). Guanxinning Tablets combined with conventional Western medicine demonstrated optimal efficacy in lowering glycated hemoglobin (HbA1c). Jinlida Granules combined with conventional Western medicine yielded the best results in reducing fasting blood glucose (FBG) and low-density lipoprotein cholesterol (LDL-C). Liuwei Dihuang Pills combined with conventional Western medicine achieved optimal efficacy in reducing the incidence of MACE. Yangxinshi Tablets combined with conventional Western medicine exhibited the most significant decrease in N-terminal pro-B-type natriuretic peptide (NT-proBNP). Finally, Danzhi Jiangtang Capsules combined with conventional Western medicine achieved the best outcomes in reducing total cholesterol (TC).

CONCLUSIONS: OCPMs combined with conventional therapy provide multidimensional benefits for patients with CHD complicated by diabetes. However, the findings should be interpreted with caution due to heterogeneity and variable study quality, highlighting the need for high-quality, large-scale, multicenter RCTs to confirm these results.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024626573.