Medicinal Plant Research 2025, Vol.15, No.4, 188-196 http://hortherbpublisher.com/index.php/mpr 192 and inhibit vascular smooth muscle cell proliferation. Astragalus treatment in models of myocardial ischemia-reperfusion reduces infarct size, increases cardiac function, and inhibits cardiac remodeling and fibrosis (Zhang et al., 2022; Yang et al., 2023; Zhai et al., 2024). 4.4 Summary of meta-analysis findings in cardiovascular studies Systematic reviews and meta-analyses consistently show that Astragalus membranaceus and AS-IV provide multi-targeted cardioprotection in the form of anti-fibrotic, anti-inflammatory, antioxidant, and anti-apoptotic activities. These activities are translated into improved clinical efficacy in heart failure, coronary heart disease, angina, hypertension, and myocardial ischemia. Even if mostly preclinical data, clinical trials and meta-analyses are a testament to the safety and efficacy of Astragalus in controlling cardiovascular diseases, with further high-quality clinical trials to validate these findings and further outline therapeutic regimens (Tan et al., 2020; Yang et al., 2023). 5 Clinical Efficacy of Astragalus in Metabolic Diseases 5.1 Type 2 diabetes mellitus Astragalus, especially its polysaccharides (APS), has shown very good efficacy as an adjuvant therapy of type 2 diabetes mellitus (T2DM). Meta-analysis of randomized controlled trials reveals that drugs containing Astragalus markedly reduce fasting plasma glucose, postprandial glucose, HbA1c, and improve insulin sensitivity compared to standard therapy alone with an acceptable safety profile (Hong et al., 2023; Qiu et al., 2025). Mechanistically, APS enhances insulin resistance, protects islet cells, regulates gut microbiota, and regulates key metabolic pathways (Zheng et al., 2020; Su et al., 2023). 5.2 Diabetic complications Astragalus and its active ingredients, such as astragaloside IV, have demonstrated renoprotective effects in diabetic nephropathy (DN). Meta-analysis and clinical trials show that Astragalus improves renal function, reduces albuminuria, and slows the decline in kidney function in animal models and patients with diabetic kidney disease (Wang et al., 2020; Chan et al., 2021; Shen et al., 2023; Liang et al., 2025). The mechanisms are anti-inflammatory, antioxidant, anti-fibrotic, and modulation of the gut-kidney axis. Efficacy in diabetic neuropathy and cardiovascular complications is also apparent, but further clinical evidence is needed (Liu et al., 2024; Li et al., 2025). 5.3 Hyperlipidemia and metabolic syndrome Astragalus membranaceus extracts increase lipid profiles in animal models of hyperlipidemia and metabolic syndrome through a decrease in triglycerides, total cholesterol, and LDL, and an increase in HDL. The action is through mediation by modulation of lipid metabolism pathways like AKT1, VEGFA, and ESR1 and through the activation of lipid β-oxidation and inhibition of lipogenesis (Wang et al., 2022). APS also prevents obesity, hepatic steatosis, and insulin resistance in metabolically stressed models (Huang et al., 2017; Liu et al., 2024). 5.4 Summary of meta-analysis findings in metabolic studies Meta-analyses and systematic reviews consistently confirm the efficacy of Astragalus and its polysaccharides on glycemic control, lipid metabolism, and renal function in metabolic diseases. The strongest evidence is for adjunctive therapy of T2DM and diabetic nephropathy but also includes benefits for hyperlipidemia and metabolic syndrome. While most studies report adequate safety, further well-conducted clinical trials are needed to determine long-term efficacy and optimal dosing (Hong et al., 2023; Liang et al., 2025; Qiu et al., 2025). 6 Integrated Interpretation of Meta-analysis Results 6.1 Overall effects of Astragalus on primary clinical outcomes Meta-analyses are more accurate and have greater statistical power through aggregation of data to determine the effect of Astragalus membranaceus on endpoints like glycemic control, cardiac function, and renal function easily. Provided that the studies included are sufficiently similar, their collective results can actually represent the effect of the intervention. However, the quality of evidence should be evaluated utilizing frameworks such as GRADE considering effect size, risk of bias, consistency, directness, and precision (Brush et al., 2023).
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