Chinese herbal medicine and risk of coronary heart disease in patients with hyperlipidemia: A target trial emulation

ETHNOPHARMACOLOGICAL RELEVANCE: Chinese herbal medicine (CHM) has served as a class of preventive and therapeutic interventions for hyperlipidemia and CHD over several thousand years. However, research evaluating CHM's potential to prevent incident CHD in hyperlipidemic populations is limited. AIM OF THE REVIEW: To explore the effects of CHM on CHD risk in a Chinese population. MATERIALS AND METHODS: Based on the Yinzhou Regional Health Care Database (YRHCD), a population-based cohort study with an active-comparator new-user framework was carried out to emulate a hypothetical randomized trial. A propensity score matched Cox analysis was adopted to appraise the hazard ratio (HR) for CHD risk attributed to CHM exposure. A broad set of subgroup analyses and various sensitivity analyses were conducted to validate results' reliability and stability. RESULTS: A total of 112,282 hyperlipidemia-diagnosed individuals were included in the YRHCD database covering the period from 2009 to 2024, with 65,389 CHM users and 45,893 statins users. The CHD incidence reached 29.14 and 48.77 per 1000 person-years for CHM users and statins users, respectively. CHM users conferred a 42% relative-risk reduction for CHD, compared with statin users (HR 0.58 [95%CI 0.55, 0.61]). Additionally, CHM users had better safety than statins users in liver function (HR 0.90 [95%CI 0.82 - 0.98]) and kidney function (HR 0.58 [95%CI 0.50 - 0.68]). This protective effect remained consistent across subgroup and sensitivity analyses. CONCLUSION: CHM can decrease the risk of CHD incidence among hyperlipidaemic patients in the study population of YRHCD.