Efficacy and safety of berberine for several cardiovascular diseases: A systematic review and meta-analysis of randomized controlled trials

Phytomedicine. 2023 Apr:112:154716. doi: 10.1016/j.phymed.2023.154716. Epub 2023 Feb 12.

Abstract

Background: Berberine has been widely used for the adjuvant therapy of several cardiovascular diseases (CVDs). However, evidence for its efficacy remains controversial.

Purpose: This study aimed to evaluate the efficacy and safety of berberine in CVDs.

Study design: A systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods: We searched ten electronic databases for articles from inception to December 23, 2022. RCTs comparing berberine alone or combined with statins versus statins or routine for CVDs were included. Meta-analysis was performed according to the Cochrane Handbook.

Results: Forty-four RCTs were included with 4606 patients. There were no differences between berberine alone and routine or statins in improving total cholesterol (TC) (SMD, 0.43; 95% CI, -0.39 to 1.24; p = 0.30; I2 = 95%), triglyceride (TG) (SMD, -0.14; 95% CI, -0.49 to 0.21; p = 0.44; I2 = 76%), low-density lipoprotein cholesterol (LDL-C) (SMD, 0.69; 95% CI, -0.23 to 1.60; p = 0.14; I2 = 96%), high-density lipoprotein cholesterol (HDL-C) (SMD, 0.55; 95% CI, -0.48 to 1.57; p = 0.30; I2 = 96%), and Crouse score levels. Berberine alone significantly reduced National Institute of Health Stroke Scale (NIHSS) score, high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and intima-media thickness (IMT) levels than routine therapy. Berberine plus statins significantly reduced TC, TG, LDL-C, NIHSS score, hs-CRP, TNF-α, IMT, Crouse score, and number of unstable plaques levels than routine or statins. However, no differences were found between groups in improving HDL-C and IL-6 levels. There were no significant differences between groups in the incidence of adverse reactions.

Conclusion: This study suggests that berberine may be a promising alternative for CVDs with no serious adverse reactions. However, our results may be limited by the quality of existing research. High-quality RCTs are needed to provide more convinced evidence.

Keywords: Berberine; Cardiovascular diseases; Meta-analysis; Randomized controlled trial; Systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Berberine* / adverse effects
  • C-Reactive Protein
  • Cardiovascular Diseases* / drug therapy
  • Cholesterol, HDL
  • Cholesterol, LDL
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors* / adverse effects
  • Interleukin-6
  • Randomized Controlled Trials as Topic
  • Triglycerides
  • Tumor Necrosis Factor-alpha

Substances

  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Berberine
  • Cholesterol, LDL
  • C-Reactive Protein
  • Tumor Necrosis Factor-alpha
  • Interleukin-6
  • Triglycerides
  • Cholesterol, HDL