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Peer-reviewedCC BYFrontiers in pharmacology

Efficacy and safety of selected Chinese herbal medicine preparations in treating carotid atherosclerosis: a systematic review and meta-analyses

  • Yuemeng Sun1
  • Menghan Feng1
  • Haoran Zhang1
  • Jiayi Liu1
  • Qian Li1
  • Shujing Zhang2
  • Chunjie Ma1
  • Hao Wu1
  1. 1College of Traditional Chinese Medicine, Inner Mongolia Medical University , ,
  2. 2School of Traditional Chinese Medicine, Beijing University of Chinese Medicine , ,
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Abstract

Background: Although conventional therapies for Carotid atherosclerosis (CAS) remain the standard treatment, their effectiveness is often limited and accompanied by adverse effects. Chinese herbal medicine (CHM) is a promising adjunctive therapy for CAS; however, robust clinical evidence supporting its efficacy and safety remains limited.

Objective: This systematic review and meta-analysis evaluates the efficacy and safety of CHM for CAS treatment and characterizes its medication patterns.

Methods: Five databases were searched from inception to December 2025. Randomized controlled trials (RCTs) evaluating oral CHM for CAS were included. Study quality was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Data were extracted and analyzed using RevMan v5.3 and R software. Sources of heterogeneity were investigated through meta-regression and subgroup analyses. Network analysis reveals herbal medication patterns across 21 studies.

Results: Twenty-one RCTs involving 3,078 patients were included. Compared with conventional therapy alone, adjunctive CHM significantly reduced carotid plaque area (MD = 4.94, 95% CI: 3.13 to 6.76, p < 0.01), intima-media thickness (IMT) (MD = 0.12, 95% CI: 0.07 to 0.17, p < 0.05), total cholesterol (TC) (MD = 0.32, 95% CI: 0.22 to 0.42, p < 0.01), triglycerides (TG) (MD = 0.24, 95% CI: 0.11 to 0.37, p < 0.01), and low-density lipoprotein cholesterol (LDL-C) (MD = 0.37, 95% CI: 0.21 to 0.53, p < 0.01), while greatly increasing high-density lipoprotein cholesterol (HDL-C) (MD = −0.20, 95% CI: −0.29 to −0.10, p < 0.01). CHM did not significantly increase the risk of adverse events (RR = 0.84, 95% CI: 0.64 to 1.10, p = 0.20) or impair liver/kidney function. Network analysis identified core actions as clearing phlegm and removing blood stasis, with Danshen (Salvia miltiorrhiza Bge.) and Banxia [Pinellia ternata (Thunb.) Breit.] as pivotal botanical drugs exerting anti-stasis and lipid-regulating effects.

Conclusion: As an adjunct to conventional therapy, CHM may further reduce carotid IMT and plaque burden, improve lipid metabolism, and demonstrate a favorable safety profile. However, the overall quality and heterogeneity of the included studies limit the strength of the evidence, highlighting the need for well-designed, high-quality RCTs to confirm these findings.

Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261285381 , identifier CRD420261285381.

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Cite

BibTeXRIS
BibTeX
@article{sun2026efficacy,
  title = {{Efficacy and safety of selected Chinese herbal medicine preparations in treating carotid atherosclerosis: a systematic review and meta-analyses}},
  author = {Yuemeng Sun and Menghan Feng and Haoran Zhang and Jiayi Liu and Qian Li and Shujing Zhang and Chunjie Ma and Hao Wu},
  journal = {Frontiers in pharmacology},
  year = {2026},
  month = oct,
  doi = {10.3389/fphar.2026.1903096},
  url = {https://europepmc.org/article/PMC/PMC13672559},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Efficacy and safety of selected Chinese herbal medicine preparations in treating carotid atherosclerosis: a systematic review and meta-analyses
AU  - Yuemeng Sun
AU  - Menghan Feng
AU  - Haoran Zhang
AU  - Jiayi Liu
AU  - Qian Li
AU  - Shujing Zhang
AU  - Chunjie Ma
AU  - Hao Wu
PY  - 2026
DA  - 2026/10/02
JO  - Frontiers in pharmacology
DO  - 10.3389/fphar.2026.1903096
UR  - https://europepmc.org/article/PMC/PMC13672559
AB  - Background: Although conventional therapies for Carotid atherosclerosis (CAS) remain the standard treatment, their effectiveness is often limited and accompanied by adverse effects. Chinese herbal medicine (CHM) is a promising adjunctive therapy for CAS; however, robust clinical evidence supporting its efficacy and safety remains limited.  Objective: This systematic review and meta-analysis evaluates the efficacy and safety of CHM for CAS treatment and characterizes its medication patterns.  Methods: Five databases were searched from inception to December 2025. Randomized controlled trials (RCTs) evaluating oral CHM for CAS were included. Study quality was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Data were extracted and analyzed using RevMan v5.3 and R software. Sources of heterogeneity were investigated through meta-regression and subgroup analyses. Network analysis reveals herbal medication patterns across 21 studies.  Results: Twenty-one RCTs involving 3,078 patients were included. Compared with conventional therapy alone, adjunctive CHM significantly reduced carotid plaque area (MD = 4.94, 95% CI: 3.13 to 6.76, p < 0.01), intima-media thickness (IMT) (MD = 0.12, 95% CI: 0.07 to 0.17, p < 0.05), total cholesterol (TC) (MD = 0.32, 95% CI: 0.22 to 0.42, p < 0.01), triglycerides (TG) (MD = 0.24, 95% CI: 0.11 to 0.37, p < 0.01), and low-density lipoprotein cholesterol (LDL-C) (MD = 0.37, 95% CI: 0.21 to 0.53, p < 0.01), while greatly increasing high-density lipoprotein cholesterol (HDL-C) (MD = −0.20, 95% CI: −0.29 to −0.10, p < 0.01). CHM did not significantly increase the risk of adverse events (RR = 0.84, 95% CI: 0.64 to 1.10, p = 0.20) or impair liver/kidney function. Network analysis identified core actions as clearing phlegm and removing blood stasis, with Danshen (Salvia miltiorrhiza Bge.) and Banxia [Pinellia ternata (Thunb.) Breit.] as pivotal botanical drugs exerting anti-stasis and lipid-regulating effects.  Conclusion: As an adjunct to conventional therapy, CHM may further reduce carotid IMT and plaque burden, improve lipid metabolism, and demonstrate a favorable safety profile. However, the overall quality and heterogeneity of the included studies limit the strength of the evidence, highlighting the need for well-designed, high-quality RCTs to confirm these findings.  Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261285381 , identifier CRD420261285381.
SN  - 1663-9812
ER  -