Meta-analysis comparing the effect of combined acupuncture plus statin therapy versus statin therapy alone on lipid levels of patients with angina pectoris of coronary heart disease

ABSTRACT Objectives Establish clinical evidence regarding acupuncture combined with statin for blood lipid control in patients with angina pectoris (AP) of coronary heart disease (CHD) by systematically analyzing data from all available studies. Design A systematic review and meta-analysis. Data sources The literature search involved eight databases (China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang, VIP Database for Chinese Technical Periodicals, PubMed, Embase, Web of Science, and Cochrane Library) and was finished on February 1, 2024. Eligibility criteria Random controlled trials (RCTs) investigating the efficacy of acupuncture combined with statin on lipid levels in patients with AP of CHD were eligible. The outcomes assessed were the lipid metabolism indicators, including TC, TG, LDL-C, and HDL-C, as well as the safety of the treatment. Data extraction and synthesis Data extraction and quality evaluation were conducted by two independent reviewers, with any discrepancies discussed by a third researcher. Pooled mean differences (MD) with 95% confidence intervals (CIs) were calculated for each outcome. Sensitivity and subgroup analyses were carried out to explore the heterogeneity. Publication bias was assessed using a funnel plot. The quality of the evidence was evaluated using the GRADE system. Results The final meta-analysis included nine eligible studies involving 754 patients. When comparing statin group, the acupuncture plus statin group showed lower levels of TC (MD=-0.48, 95% CI: −0.61 to −0.35, P <0.00001), TG (MD=-0.59, 95% CI: −0.86 to −0.32, P <0.00001), LDL-C (MD=-0.66, 95% CI: −0.99 to −0.33, P =0.0001), and higher levels of HDL-C (MD=0.16, 95% CI: 0.06 to 0.26, P =0.001). Each study included in the analysis exhibited some degree of bias. Significant publication bias was detected for the primary outcomes. Evidence quality for the primary outcomes was graded as very low. Conclusions Acupuncture as an adjunctive treatment can further improve lipid profile in individuals diagnosed with AP of CHD based on statin therapy. However, the clinical significance of this effect remains unclear; it is necessary to confirm the findings through more high-quality RCTs in the future. Trial registration number PROSPERO CRD42023465292. STRENGTHS AND LIMITATIONS OF THIS STUDY This comprehensive systematic review will collect data regarding the combined therapy (acupuncture + statin) on lipid profiles in patients with AP of CHD to provide new evidence supporting the use of acupuncture treatment for AP of CHD. Subgroup analysis based on the duration of intervention and types of acupuncture will provide a more detailed evaluation of the effectiveness of the combined therapy. A thorough evaluation of the quality of the evidence for the primary outcomes was conducted using the Grading of Recommendation Assessment, Development, and Evaluations (GRADE) system. This review has limited ability to draw clear conclusions due to poor quality of evidence. We restricted the literature search to eight electronic databases and ignored a search for gray literature, which may miss important literature and could introduce publication bias.