Efficacy, safety, and pharmacological mechanism of Suxiao Jiuxin Pill in acute coronary syndrome: A systematic review and network pharmacology analysis

Abstract

Introduction

Suxiao Jiuxin Pill (SJP), a patented Chinese medicine, is used to treat various cardiovascular diseases, including acute coronary syndrome (ACS). Nonetheless, substantial evidence validating the efficacy and safety of SJP, as well as elucidating its underlying mechanisms in ACS treatment, is lacking. In this study, a systematic review and network pharmacology approach were employed to evaluate the efficacy and safety of combining SJP with conventional treatment (CT) for ACS and to explore the potential mechanisms.

Methods

A systematic search of eight electronic databases was conducted to retrieve relevant randomized controlled trials (RCTs) which evaluated the efficacy and safety of SJP combined with CT for treating ACS. The Cochrane risk-of-bias tool for RCTs version 2.0 was used to assess the risk of bias. The fixed-effects model or the random-effects model was determined based on the significance of the statistical heterogeneity and clinical heterogeneity. Risk ratios and mean differences were calculated for binary variables and continuous variables, respectively, based on a 95 % confidence interval. Finally, network pharmacology analysis was used to explore the underlying mechanisms of action of SJP in ACS treatment.

Results

A total of 39 RCTs involving 4265 patients were included. The intervention group showed significant improvements, including a lower incidence of myocardial infarction, left heart failure, and sudden death, compared to the control group. The intervention group also demonstrated enhanced clinical efficacy, improved electrocardiogram results, fewer angina attacks, and shorter duration of angina. No significant differences in the incidence of adverse events were found between the intervention and control groups. Network pharmacology identified ferulic acid, caffeic acid, and scopoletin as the active ingredients responsible for the observed therapeutic effects of SJP. Additionally, potential therapeutic targets such as GSK3B, PRKCA, and EGFR, as well as other pathways related to the HIF-1, IL-17, and TNF signaling pathways, were identified as potential mechanisms regulated by SJP.

Conclusion

This study indicates that a combination therapy of SJP and CT may provide benefits for patients with ACS by reducing cardiovascular events, improving myocardial ischemia, and alleviating cardiac symptoms with favorable safety. These findings also suggest that the effects of SJP on ACS involve a multi-target, multi-component, and multi-pathway mechanism.