Effectiveness and safety of Breviscapine in the treatment of coronary heart disease: a meta-analysis of randomized controlled trials

Background Coronary heart disease is a leading cause of cardiovascular mortality. Residual angina pectoris often persists despite long-term treatment. Breviscapine, a plant-derived flavonoid, exhibits multi-target cardiovascular effects; however, its clinical role requires systematic evaluation. Objective This meta-analysis aims to comprehensively assess the efficacy and safety of Breviscapine for angina pectoris in coronary heart disease. Methods Databases were systematically searched for relevant randomized controlled trials (RCTs) up to December 2024. Two researchers independently performed study selection, data extraction, and risk-of-bias assessment. Data were analyzed using RevMan 5.4, employing a random-effects model for all meta-analyses. Results A total of 29 RCTs were included. Breviscapine (alone or add-on) demonstrated significant benefits over conventional therapy in: (1) Total effective rate (13 studies, RR = 1.20, 95% CI 1.14–1.26, p < 0.00001). (2) Angina symptom improvement rate (11 studies, RR = 1.23, 95% CI 1.16–1.30, p < 0.00001). (3) Electrocardiogram improvement rate (13 studies, RR = 1.23, 95% CI 1.16–1.30, p < 0.00001). (4) TCM syndrome score (2 studies, RR = 1.32, 95% CI 1.07–1.61, p = 0.008). In addition, Breviscapine showed exploratory trends toward improvement in lipid profiles, with reductions in TG, TC, and LDL-C reported across the included studies, although high heterogeneity and the limited number of studies precluded quantitative pooling. For HDL-C, only two studies reported this outcome, with one showing an increase and the other showing no significant change. The incidence of adverse reaction did not differ significantly between groups (5 studies, p = 0.39). Data on acute cardiovascular events and all-cause mortality were insufficient or unreported. Conclusion Breviscapine, alone or as add-on therapy, significantly improves angina symptoms and electrocardiographic findings, with exploratory trends toward favorable lipid profile changes observed in the included studies, indicating promising efficacy and short-term clinical tolerability. However, the evidence is limited by methodological concerns in the included studies and substantial heterogeneity in lipid outcomes. The safety of Breviscapine requires further investigation. Higher-quality RCTs are warranted to strengthen these conclusions. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251055996 , PROSPERO CRD420251055996.