Chinese herbal medicine treatment and the association with long-term major adverse cardiac events in patients with chronic kidney disease: A propensity-score matched cohort study

Background: Cardiovascular disease (CVD) represents the leading cause of mortality among idividuals with chronic kidney disease (CKD). While Chinese herbal medicine (CHM) is commonly used by CKD patients in Taiwan, the impact of CHM use on cardiovascular outcomes in this population remains insufficiently understood. Aims: This study aimed to evaluate the association between CHM use and the long- term risk of major adverse cardiac events (MACEs) in patients with CKD. Methods: Data were obtained from the Taiwan National Health Insurance Research Database to identify patients aged over 20 years with newly diagnosed CKD. A 1:1 propensity score matching was performed based on age, sex, comorbidities, medication use, and CHM exposure, resulting in 6,351 matched pairs.. Participants were followed from 2000 to 2017 to assess the incidence of MACEs, including heart failure (HF), myocardial infarction (MI), ischemic stroke (IS), cardiovascular death, and all-cause mortality. Results: The CHM group comprised 56.4% females with a mean age of 49.4 ± 15.3 years. After matching, CHM use was associated with a statistically significant reduction of 23% to 31% in the adjusted hazard ratios for various cardiovascular outcomes and all-cause mortality (P < 0.001). The most commonly prescribed CHM formula and single herb were Ji-Sheng-Shen-Qi-Wan (JSSQW) and Danshen (Salviae Miltiorrhizae), respectively. Conclusions: The use of CHM as an adjunct therapy in CKD patients was associated with a significantly lower risk of MACEs and all-cause mortality. These findings support the potential of CHM in cardiovascular risk mitigation among CKD patients and highlight the need for future clinical and ethnopharmacological investigations.