Yuan Rong, Yuan Yahui, Wang Lidan, Xin Qiqi, Wang Ya, Shi Weili, Miao Yu, Leng Sean Xiao, Chen Keji, Cong Weihong
Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Front Pharmacol. 2022 Feb 21;13:744928. doi: 10.3389/fphar.2022.744928. eCollection 2022.
Metabolic syndrome (MetS) is characterized by the cooccurrence of obesity, insulin resistance, dyslipidaemia, and hypertension. Red yeast rice (RYR) preparations might be beneficial for the prevention and treatment of MetS. To implement a systematic review and meta-analysis to determine whether RYR preparations improve clinical endpoints and reduce risk factors for MetS. The PubMed, Cochrane Library, EMBASE, Scopus, China National Knowledge Infrastructure, Chinese VIP Information, and WanFang databases were searched for randomized controlled trials (published up to September 2020), and a meta-analysis was performed using fixed- or random-effects models. The primary outcome measures were mortality and major adverse cardiovascular events (MACEs), and the secondary outcome measures were biochemical parameters of blood glucose, blood lipids, and blood pressure. The registration number is CRD42020209186. A total of 921 articles were identified, of which 30 articles were included in this article. RYR preparations group demonstrated significant improvements in MetS compared with control group. RYR preparations reduced the mortality and MACEs (RR = 0.62, 95% CI [0.49, 0.78]; RR = 0.54, 95% CI [0.43, 0.66]). In terms of blood glucose metabolism, fasting plasma glucose (FPG) (MD = -0.46 mmol/L, 95% CI [-0.71, -0.22]), haemoglobin A1c (HbA1c) (MD = -0.49, 95% CI [-0.71, -0.26]) and the homeostasis model assessment of insulin resistance (HOMA-IR) (MD = -0.93, 95% CI [-1.64, -0.21]) were decreased. Regarding the lipid metabolism, total cholesterol (TC) (MD = -0.74 mmol/L, 95% CI [-1.02, -0.46]), triglycerides (TG) (MD = -0.45 mmol/L, 95% CI [-0.70, -0.21]), and low-density lipoprotein cholesterol (LDL) (MD = -0.42 mmol/L, 95% CI [-0.78, -0.06]) were decreased, while high-density lipoprotein cholesterol (HDL) (MD = 0.14 mmol/L, 95% CI [0.09, 0.20]) was increased. Regarding blood pressure, the mean arterial pressure (MAP) (MD = -3.79 mmHg, 95% CI [-5.01, -2.57]) was decreased. In addition, RYR preparations did not increase the incidence of adverse reactions (RR = 1.00, 95% CI [0.69, 1.43]). RYR preparations reduce mortality, MACEs, and multiple risk factors for MetS without compromising safety, which supports its application for the prevention and treatment of MetS. However, additional high-quality studies are needed to provide more evidence for the effect of RYR on MetS due to the heterogeneity in this study. : www.crd.york.ac.uk/PROSPERO, identifier CRD42020209186.
代谢综合征（MetS）的特征是肥胖、胰岛素抵抗、血脂异常和高血压同时存在。红曲米（RYR）制剂可能对代谢综合征的预防和治疗有益。开展一项系统评价和荟萃分析，以确定RYR制剂是否能改善临床终点并降低代谢综合征的危险因素。检索了PubMed、Cochrane图书馆、EMBASE、Scopus、中国知网、中文科技期刊数据库和万方数据库中截至2020年9月发表的随机对照试验，并使用固定效应或随机效应模型进行荟萃分析。主要结局指标为死亡率和主要不良心血管事件（MACE），次要结局指标为血糖、血脂和血压的生化参数。注册号为CRD42020209186。共识别出921篇文章，其中30篇纳入本文。与对照组相比，RYR制剂组在代谢综合征方面有显著改善。RYR制剂降低了死亡率和MACE（RR = 0.62，95%CI [0.49，0.78]；RR = 0.54，95%CI [0.43，0.66]）。在血糖代谢方面，空腹血糖（FPG）（MD = -0.46 mmol/L，95%CI [-0.71，-0.22]）、糖化血红蛋白（HbA1c）（MD = -0.49，95%CI [-0.71，-0.26]）和胰岛素抵抗稳态模型评估（HOMA-IR）（MD = -0.93，95%CI [-1.64，-0.21]）均降低。在脂质代谢方面，总胆固醇（TC）（MD = -0.74 mmol/L，95%CI [-1.02，-0.46]）、甘油三酯（TG）（MD = -0.45 mmol/L，95%CI [-0.70，-0.21]）和低密度脂蛋白胆固醇（LDL）（MD = -0.42 mmol/L，95%CI [-0.78，-0.06]）降低，而高密度脂蛋白胆固醇（HDL）（MD = 0.14 mmol/L，95%CI [0.09，0.20]）升高。在血压方面，平均动脉压（MAP）（MD = -3.79 mmHg，95%CI [-5.01，-2.57]）降低。此外，RYR制剂未增加不良反应的发生率（RR = 1.00，95%CI [0.69，1.43]）。RYR制剂可降低死亡率、MACE和代谢综合征的多种危险因素，且不影响安全性，这支持其在代谢综合征预防和治疗中的应用。然而，由于本研究存在异质性，需要更多高质量的研究来为RYR对代谢综合征的影响提供更多证据。：www.crd.york.ac.uk/PROSPERO，标识符CRD42020209186。
