Chinese patent medicine tongxinluo capsule as a supplement to treat chronic coronary syndromes: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials

Shi-Bing Liang; Yi-Fei Wang; Zhen-Chao Niu; Yu-Fei Li; Hui-Min Zheng; Jia-Ming Huan; Jie Yuan; Nicola Robinson; Jian-Ping Liu; Yun-Lun Li

doi:10.3389/fcvm.2024.1499585

Chinese patent medicine tongxinluo capsule as a supplement to treat chronic coronary syndromes: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials

Front Cardiovasc Med. 2025 Jan 7:11:1499585. doi: 10.3389/fcvm.2024.1499585. eCollection 2024.

Authors

Shi-Bing Liang^{1

2

3}, Yi-Fei Wang^{1

2

4}, Zhen-Chao Niu^{2

4}, Yu-Fei Li⁵, Hui-Min Zheng^{1

2}, Jia-Ming Huan⁶, Jie Yuan⁴, Nicola Robinson^{5

7}, Jian-Ping Liu⁵, Yun-Lun Li^{4

6

8}

Affiliations

¹ Clinical Study Center, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
² Centre for Evidence-Based Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.
³ Postdoctoral Research Station, Shandong University of Traditional Chinese Medicine, Jinan, China.
⁴ Cardiovascular Disease Center, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
⁵ Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
⁶ The First School of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.
⁷ Institute of Health and Social Care, London South Bank University, London, United Kingdom.
⁸ Shandong Engineering Laboratory of Traditional Chinese Medicine Precision Therapy for Cardiovascular Diseases, Shandong University of Traditional Chinese Medicine, Jinan, China.

Abstract

Background: Chronic coronary syndromes (CCS) is a common clinical condition that increases the risk of cardiovascular events at any time. Tongxinluo capsules (TXL) are widely used in China for treating CCS.

Objectives: To systematically evaluate the therapeutic effects and safety of adding TXL to Western medical treatment (WM) for CCS.

Methods: We searched PubMed, Cochrane Library, CNKI, VIP, and Wanfang databases up to August 2024 for randomized controlled trials (RCTs) investigating the therapeutic effects and safety of combining TXL with WM compared to WM alone for CCS. Data analyses were conducted using RevMan 5.4 software.

Results: Twenty studies involving 2091 participants were identified. Evidence supports the use of TXL plus WM for reducing angina frequency [SMD -2.50, 95% CI (-3.53, -1.48)], improving seattle angina questionnaire scores (P < 0.05), decreasing nitroglycerin dose [SMD -1.63, 95% CI (-2.26, -1.00)], and shortening angina duration [MD -1.50 min/once, 95% CI (-1.98, -1.02)]. Adding TXL to WM showed a non-significant trend toward reducing myocardial infarction [RR 0.34, 95% CI (0.05, 2.12); NNT = 41] and sudden cardiac death [RR 0.34, 95% CI (0.01, 8.28); NNT = 65]. No increase in adverse events was observed when TXL was added to WM [RR 1.02, 95% CI (0.70, 1.49); NNT = 149].

Conclusions: Our review suggests that TXL may offer additional therapeutic benefits for CCS patients and appears to be safe when combined with WM. Further investigations are warranted to confirm the potential impact of adding TXL to WM for CCS.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024499031, PROSPERO (CRD42024499031).

Keywords: Chinese herbal medicine; cardiovascular disease; chronic coronary syndromes; clinical evidence; meta-analysis; systematic review; tongxinluo.

Publication types

Systematic Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was supported by the National Natural Science Foundation of China (No. 82274471) and the Science Project for Medicine and Health of Shandong Province (No. 202303010788). NR is the guest professor at Beijing University of Chinese Medicine, Centre of Evidence-Based Chinese Medicine (certification number 20210017).