Medicinal Plant Research 2025, Vol.15, No.4, 188-196 http://hortherbpublisher.com/index.php/mpr 189 randomized controlled trials and observational studies, meta-analyses have the ability to define therapeutic potential, quantify consistency or heterogeneity of results, and guide evidence-based clinical decisions (Xu et al., 2023). This study will assess the therapeutic effectiveness of Astragalus in cardiovascular and metabolic disease using a meta-analytical approach. By summarizing the available evidence, we seek to outline the therapeutic prospects of Astragalus for improving clinical outcomes, such as cardiac function, glycemic and lipid control, and quality of life. Moreover, this book points to the promising role Astragalus may play in integrative medicine, with an eye towards clinical use as an adjunct treatment. The study is expected to function as a theoretical and practical reference for the modernization of TCM and promotion of holistic strategies in prevention and therapy of cardiometabolic disorders. 2 Pharmacological Effects and Potential Mechanisms of Astragalus 2.1 Cardioprotective effects Astragalus and its major saponin, astragaloside IV (AS-IV), have potent cardioprotective activities. These include antioxidative stress, anti-inflammatory effects, and improvement of cardiac function. AS-IV possesses protective actions against myocardial ischemia and hypoxia, suppresses myocardial hypertrophy and fibrosis, enhances contractility, and reverses diastolic dysfunction. Mechanistically, all these activities are mediated via the inhibition of ROS generation, blockade of the NLRP3/caspase-1/GSDMD pathway, and inhibition of pro-inflammatory cytokines such as TNF-α and IL-6 (Su et al., 2021; Zhang et al., 2022; Chen et al., 2024; 2025). Astragalus polysaccharides (APS) also inhibit cardiomyocytes against apoptosis and oxidative stress and preserve cardiac function (Liu et al., 2018; Sun et al., 2019). 2.2 Metabolic regulation Astragalus and its constituents regulate glucose and lipid metabolism to increase insulin sensitivity and reduce risk of metabolic syndrome. APS and AS-IV reduce fasting blood glucose, improve insulin resistance, and correct lipid profiles by lowering total cholesterol and LDL-C and raising triglyceride with a rise in HDL-C. These effects are ascribed to modulation of key metabolic pathways, including PI3K-AKT signaling, AMPK/mTOR-autophagy, and control of adipogenesis and fatty acid metabolism (Tan et al., 2020; Xu et al., 2023; Liu et al., 2024). Animal models support Astragalus extracts treat hyperlipidemia and decrease metabolic indexes in diabetes and high-fat diet disorder models (Zheng et al., 2020; Wang et al., 2022). 2.3 Immunomodulation and multi-target synergistic actions Astragalus has immunomodulatory actions on immune cell activation regulation, cytokine release, and inflammatory responses. It modulates T and B cells, inhibits immune cell infiltration into heart tissue, and balances pro- and anti-inflammatory cytokines. These multi-targeting actions explain its efficacy against multifactorial conditions like dilated cardiomyopathy and viral myocarditis, where immune dysregulation plays a role (Chen et al., 2021; Dong et al., 2023). 2.4 Bioactive components as the pharmacological basis The pharmacological actions of Astragalus are primarily attributable to its polysaccharides (APS), flavonoids (e.g., quercetin, kaempferol, isorhamnetin), and saponins (particularly astragaloside IV). The molecules demonstrate synergistic antioxidant, anti-inflammatory, metabolic, and immunomodulatory properties. Their biosynthetic pathways and structural diversity underlie the broad therapeutic promise of Astragalus in cardiometabolic diseases (Su et al., 2021; Chen et al., 2024; Liu et al., 2024) (Figure 1). 3 Meta-Analysis Methodology 3.1 Literature search and inclusion criteria Literature searching was in line with PRISMA and PROSPERO registered for transparency. Systematic multiple database searches, including PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, CBM, and VIP, were conducted across English and Chinese literature to October 31, 2023. Search strategy combined the keywords "Astragalus membranaceus", "Radix astragali", "Huangqi", "heart failure", and "left ventricular
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