Evidence-based construction of clinical decision optimization for Xue-Fu-Zhu-Yu decoction to treat chronic stable angina: a meta-analysis and systematic review

Background Xue-fu-Zhu-yu Decoction (XFZYD) is commonly used to treat chronic stable angina pectoris (CSA), and there is still a lack of evidence-based medical evidence for clinical decision optimization. Objective Exploring the efficacy and safety of XFZYD and metoprolol in the treatment of chronic stable angina pectoris by meta-analysis. Methods We searched PubMed, Embase database, Web of Science, Cochrane Library, WanFang database (WangFang), China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), and Wikipedia (VIP). Detailed inclusion and exclusion criteria were established, and the primary endpoints included ER, AR, LVEF, LVSP, SV, 6MWD, TC, TG, LDL-C, HDL-C, WBV, PV, EPV, and FB. Two reviewers independently assessed trial quality and extracted data. Included studies were analyzed using R software Setting Review Manager version code. Results 17 studies were included, with 1387 patients, 695 in the control group and 692 in the experimental group, 799 males and 588 females. In the experimental group, the treatment of CSA with XFZYD combined with metoprolol can improve many indicators: (1). Key outcome indicators:① The experimental group could improve cardiac function, including: increasing LVEF [MD = 5.49, 95% CI (3.86,7.12), P < 0.01], increasing LVSP [MD = 4.32, 95% CI (3.59,5.04), P < 0.01], increasing SV [ MD = 6.50, 95% CI (5.89,7.11), P < 0.01], and increased 6MWD [MD = 49.86, 95% CI (47.62,52.10), P = 0], and the difference was statistically significant; ②The experimental group could regulate blood lipids, including: decreasing TC [MD = -1.09, 95%CI (-1.40,-0.79), P <0.01], decreasing TG [MD = -0.52, 95% CI (-0.65,-0.39), P < 0.01], decreasing LDL-C [MD = -0.59, 95% CI (-0.90,-0.28), P < 0.01], increasing HDL-C [MD = 0.27, 95% CI (0.09,0.45), P < 0.01], the difference was statistically significant; ③ The experimental group could reduce blood viscosity, including: reducing WBV [MD = -0.96, 95% CI (-1.34,-0.59), P < 0.01], reducing PV [MD = -0.56, 95% CI (-0.84,-0.28), P < 0.01]. Reduction of EPV [MD = -3.79, 95% CI (-5.70, -1.88), P < 0.01] and FB [MD = -1.10, 95% CI (-1.63, -0.56), P < 0.01], the differences were statistically significant. ④The experimental group could significantly increase ER [RR = 1.23, 95% CI (1.16,1.30), P < 0.01] and decrease AE [RR = 0.29, 95% CI (0.15,0.58), P < 0.01], the difference was statistically significant. (2). Secondary outcome indicators: The experimental group could significantly reduce AF [SMD = -1.81, 95% CI (-3.07,-0.56), P < 0.05] and HCY [MD = -5.83, 95% CI (-8.59,-3.08), P <0.05], the difference was statistically significant. Conclusion XFZYD combined with metoprolol is more suitable for CSA patients with hyperlipidemia, hyperviscosity, and poor cardiac function, and it is an effective and safe drug combination. XFZYD combined with metoprolol in the treatment of CSA has a combination of preventive and therapeutic effects, which can improve the risk factors of CSA, reduce the incidence of metoprolol adverse effects and adverse cardiovascular events, and significantly improve the efficacy of treating CSA. However, more high-quality studies are needed to provide evidence.