Cardioprotective effects of Salviae Miltiorrhizae Radix et Rhizoma on myocardial ischemia-reperfusion injury in animal models: A systematic review and meta-analysis

ETHNOPHARMACOLOGICAL RELEVANCE: Salviae Miltiorrhizae Radix et Rhizoma (Danshen, DS) is the dried root and rhizome of the plant Salvia miltiorrhiza Bunge. Traditional Chinese Medicine practitioners use it in the treatment of cardiovascular diseases such as atherosclerosis or acute myocardial infarction because it demonstrates cardioprotective effects. However, the specific mechanism still requires further investigation and evaluation. AIM OF THE REVIEW: To synthesise data on cardiovascular outcomes and evaluate the effects of DS in animal model of myocardial ischemia-reperfusion injury (MIRI). MATERIAL AND METHODS: We searched the following databases from inception to Aug. 2025: CNKI, Wanfang database, Chinese Science and Technology Journals Database, China Biology Medicine disc (CBMdisc), PubMed, Embase, Web of Science, and Cochrane Library. SYRCLE's risk of bias tool was utilised to assess risk of bias. Standardized mean difference (SMD) or mean difference (MD) was used to estimate effect size of lactate dehydrogenase (LDH), creatine kinase (CK), myocardial infarct size, creatine kinase MB (CK-MB), superoxide dismutase (SOD), malondialdehyde (MDA) and cardiomyocyte apoptosis rate. Statistical analysis, sensitivity analysis, subgroup analysis, network meta-analysis, meta-regression and publication bias analysis were performed with R software (ver 4.3.1). RESULTS: A total of 26 studies with 4 sub-studies from 2 studies involving 691 animals were included in the analysis. DS significantly reduced LDH (SMD, -3.93; 95% CI [-6.27; -1.59]), CK (SMD, -2.28; 95% CI [-3.04; -1.52]), myocardial infarct size (MD, -10.05, 95% CI [-13.04; -7.05]), CK-MB (SMD, -2.77, 95% CI [-4.29; -1.25]), MDA (SMD, -1.85; 95% CI [-2.52; -1.19]), cardiomyocyte apoptosis rate (MD, -2.87; 95% CI [-5.41; -0.33]) and increased SOD (SMD, 2.01; 95% CI [1.34; 2.68]) compared with the model group. CONCLUSION: DS may exert cardioprotective effects through multiple mechanisms simultaneously. However, given the limited number of studies included, further large-scale, high-quality research is needed to validate this conclusion.