title: Could ginseng-based medicines be better than nitrates in treating ischemic heart disease? A systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Ginseng-based medicines and nitrates are commonly used in treating ischemic heart disease (IHD) angina pectoris in China. Hundreds of randomized controlled trials (RCTs) reported in Chinese language claimed that ginseng-based medicines can relieve the symptoms of IHD. This study provides the first PRISMA-compliant systematic review with sensitivity and subgroup analyses to evaluate the RCTs comparing the efficacies of ginseng-based medicines and nitrates in treating ischemic heart disease, particularly angina pectoris.
  
  
  METHODS
  Past RCTs published up to 2010 on ginseng versus nitrates in treating IHD for 14 or more days were retrieved from major English and Chinese databases, including PubMed, Science Direct, Cochrane Library, WangFang Data, and Chinese National Knowledge Infrastructure. The qualities of included RCTs were assessed with Jadad scale, a refined Jadad scale called M scale, CONSORT 2010 checklist, and Cochrane risk of bias tool. Meta-analysis was performed on the primary outcomes including the improvement of symptoms and electrocardiography (ECG). Subgroup analysis, sensitivity analysis, and meta-regression were performed to evaluate the effects of study characteristics of RCTs, including quality, follow-up periods, and efficacy definitions on the overall effect size of ginseng.
  
  
  RESULTS
  Eighteen RCTs with 1549 participants were included. Overall odds ratios for comparing ginseng-based medicines with nitrates were 3.00 (95% CI: 2.27-3.96) in symptom improvement (n=18) and 1.61 (95% CI: 1.20-2.15) in ECG improvement (n=10). Subgroup analysis, sensitivity analysis, and meta-regression found no significant difference in overall effects among all study characteristics, indicating that the overall effects were stable.
  
  
  CONCLUSIONS
  The meta-analysis of 18 eligible RCTs demonstrates moderate evidence that ginseng is more effective than nitrates for treating angina pectoris. However, further RCTs for higher quality, longer follow-up periods, lager sample size, multi-center/country, and are still required to verify the efficacy.
authors.affiliation: State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, Faculty of Social Sciences and Humanities, The University of Macau, Taipa, Macao SAR, China. gentrany@gmail.com
authors.forename: Yongliang
authors.initials: Y
authors.lastname: Jia
authors.forename: Shikai
authors.initials: S
authors.lastname: Zhang
authors.forename: Fangyi
authors.initials: F
authors.lastname: Huang
authors.forename: Siu-wai
authors.initials: SW
authors.lastname: Leung
mesh_terms: D004365:Drugs, Chinese Herbal / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D004562:Electrocardiography; D006321:Heart / Q000187:drug effects*; D006801:Humans; D017202:Myocardial Ischemia / Q000150:complications / Q000188:drug therapy*; D009566:Nitrates / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D017063:Outcome Assessment, Health Care; D008517:Phytotherapy
chemical_list: D004365:Drugs, Chinese Herbal; D009566:Nitrates