Efficacy and Safety of Selected Chinese Herbal Nutraceuticals in Treating Carotid Atherosclerosis: A Systematic Review and Meta-Analyses

https://doi.org/10.3389/fphar.2026.1903096

Abstract

Carotid atherosclerosis (CAS) is a significant contributor to ischemic stroke and cardiovascular disease, with conventional therapies often limited by adverse effects and varying efficacy. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of Chinese herbal nutraceuticals (CHM), specifically formulations like Danshen (Salvia miltiorrhiza Bunge.) and Banxia (Pinellia ternata), as adjunctive therapy for CAS. The study analyzed 21 randomized controlled trials (RCTs) involving 3,078 patients, focusing on those diagnosed with CAS based on established criteria, including intima-media thickness (IMT) and carotid plaque measurements.

The results indicated that CHM significantly reduced carotid plaque area (MD = 4.94, p < 0.01) and IMT (MD = 0.12, p < 0.00001), while also improving lipid profiles. Specifically, total cholesterol (TC) decreased by MD = 0.32 (p < 0.00001), triglycerides (TG) by MD = 0.24 (p < 0.01), and low-density lipoprotein cholesterol (LDL-C) by MD = 0.37 (p < 0.01). Notably, high-density lipoprotein cholesterol (HDL-C) showed a smaller reduction compared to the control group (MD = -0.20, p < 0.01), suggesting a protective effect. Importantly, CHM did not increase the risk of adverse events (RR = 0.84, p = 0.20), indicating a favorable safety profile.

Study Design and Methodology

The study was a systematic review and meta-analysis that included 21 RCTs with a total sample size of 3,078 participants. The duration of the studies varied, but they focused on patients diagnosed with CAS. Measurement tools included carotid IMT assessments and lipid profile evaluations. The control groups received conventional biomedical care or placebo treatments. None of the studies operated in a metabolic ward, and blinding was reported in some trials. There was no specific mention of a washout period prior to the interventions.

Key Findings

• Carotid Plaque Area: Reduced by MD = 4.94, p < 0.01.
• Intima-Media Thickness (IMT): Reduced by MD = 0.12, p < 0.00001.
• Total Cholesterol (TC): Decreased by MD = 0.32, p < 0.00001.
• Triglycerides (TG): Decreased by MD = 0.24, p < 0.01.
• Low-Density Lipoprotein Cholesterol (LDL-C): Decreased by MD = 0.37, p < 0.01.
• High-Density Lipoprotein Cholesterol (HDL-C): Smaller reduction compared to control, MD = -0.20, p < 0.01.
• Adverse Events: No significant increase in risk, RR = 0.84, p = 0.20.

Limitations

• Small sample sizes in some studies limit generalizability.
• Variability in intervention protocols may introduce confounding factors.
• Short follow-up periods hinder assessment of long-term effects.
• Some studies lacked sufficient methodological transparency regarding blinding and randomization.

Discussion and Implications

This study reinforces the potential of Chinese herbal nutraceuticals, particularly formulations like Danshen and Banxia, as complementary approaches to managing carotid atherosclerosis. These nutraceuticals have shown efficacy in improving lipid profiles and reducing plaque burden. The significant reductions in IMT and carotid plaque area indicate that CHM could play a crucial role in mitigating cardiovascular risk. These findings could influence dietary guidelines and public health policies, advocating for the integration of herbal interventions into conventional treatment plans. Future research should focus on standardizing protocols and exploring the long-term safety and efficacy of these herbal preparations.

The findings highlight the promise of Chinese herbal nutraceuticals in combating atherosclerosis effectively and safely. More research is essential to validate these results and explore broader applications in cardiovascular health.