Table 2_Efficacy and safety of selected Chinese herbal medicine preparations in treating carotid atherosclerosis: a systematic review and meta-analyses.xlsx

Sources of heterogeneity were investigated through meta-regression and subgroup analyses. Network analysis reveals herbal medication patterns across 21 studies.</p>Results<p>Twenty-one RCTs involving 3,078 patients were included. Compared with conventional therapy alone, adjunctive CHM significantly reduced carotid plaque area (MD = 4.94, 95% CI: 3.13 to 6.76, p < 0.01), intima-media thickness (IMT) (MD = 0.12, 95% CI: 0.07 to 0.17, p < 0.05), total cholesterol (TC) (MD = 0.32, 95% CI: 0.22 to 0.42, p < 0.01), triglycerides (TG) (MD = 0.24, 95% CI: 0.11 to 0.37, p < 0.01), and low-density lipoprotein cholesterol (LDL-C) (MD = 0.37, 95% CI: 0.21 to 0.53, p < 0.01), while greatly increasing high-density lipoprotein cholesterol (HDL-C) (MD = −0.20, 95% CI: −0.29 to −0.10, p < 0.01).

CHM did not significantly increase the risk of adverse events (RR = 0.84, 95% CI: 0.64 to 1.10, p = 0.20) or impair liver/kidney function. Network analysis identified core actions as clearing phlegm and removing blood stasis, with Danshen (Salvia miltiorrhiza Bge.) and Banxia [Pinellia ternata (Thunb.) Breit.] as pivotal botanical drugs exerting anti-stasis and lipid-regulating effects.</p>Conclusion<p>As an adjunct to conventional therapy, CHM may further reduce carotid IMT and plaque burden, improve lipid metabolism, and demonstrate a favorable safety profile.

However, the overall quality and heterogeneity of the included studies limit the strength of the evidence, highlighting the need for well-designed, high-quality RCTs to confirm these findings.</p>Systematic Review Registration<p>crd.york.ac.uk/PROSPERO/view/CRD420261285381, identifier CRD420261285381.</p>