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Planta Med 2013; 79(06): 437-446
DOI: 10.1055/s-0032-1328321
Reviews
Original Papers
Georg Thieme Verlag KG Stuttgart · New York

The Effects of Berberine on Blood Lipids: A Systemic Review and Meta-Analysis of Randomized Controlled Trials

Hui Dong   *
1   Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
,
Yan Zhao
2   Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
,
Li Zhao   *
1   Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
,
Fuer Lu
1   Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
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Publikationsverlauf

received 03. Juni 2012
revised 31. Januar 2013

accepted 13. Februar 2013

Publikationsdatum:
19. März 2013 (online)

   Lizenzen und Reprints

Abstract

Clinical trials have reported lipid-lowering effects of berberine intake, but the findings have been inconsistent. The aim of this meta-analysis was to assess the safety of berberine and its effects on blood lipid profiles. A systemic review was designed, undertaken and reported in accordance with the PRISMA statement. Randomized controlled trials of the effects of berberine on blood lipids in adults were included. Study population characteristics and the main results, including changes in the levels of total cholesterol, triglycerides, low-density and high-density lipoprotein cholesterol, were extracted. Weighted mean differences were calculated for net changes in blood lipid concentrations using fixed-effect or random-effects models. After filtering, eleven randomized controlled trials (including a total of 874 participants) were included in this study. The methodological quality of these studies was generally low. The final analysis showed that administration of berberine produced a significant reduction in total cholesterol (mean difference − 0.61 mmol/L; 95 % confidence interval − 0.83 to − 0.39), triglycerides (mean difference − 0.50 mmol/L; 95 % confidence interval − 0.69 to − 0.31), and low-density lipoprotein cholesterol (mean difference − 0.65 mmol/L; 95 % confidence interval − 0.76 to − 0.54) levels, with a remarkable increase in high-density lipoprotein (mean difference 0.05 mmol/L; 95 % confidence interval 0.02 to 0.09). No serious adverse effects of berberine have been reported. In conclusion, berberine may have beneficial effects in the control of blood lipid levels. However, the efficacy of berberine in treating hyperlipidemia should be further evaluated by more randomized controlled trials in a larger population of patients.

Key words

berberine - lipid - systematic review - meta-analysis - randomized controlled trials - clinical trials

* Equal contribution.


 

  • References

  • 1 Ford ES, Li C, Pearson WS, Zhao G, Mokdad AH. Trends in hypercholesterolemia, treatment and control among United States adults. Int J Cardiol 2010; 140: 226-235
    CrossrefPubMedGoogle Scholar
  • 2 Ross R, Harker L. Hyperlipidemia and atherosclerosis. Science 1976; 193: 1094-1100
    CrossrefPubMedGoogle Scholar
  • 3 Wang YR, Alexander GC, Meltzer DO. Screening and treatment of hypercholesterolemia for prevention of coronary heart disease. Manag Care Interface 2006; 19: 25-29
    PubMedGoogle Scholar
  • 4 Lewis A, Segal A. Hyperlipidemia and primary prevention of stroke: does risk factor identification and reduction really work?. Curr Atheroscler Rep 2010; 12: 225-229
    CrossrefPubMedGoogle Scholar
  • 5 Iughetti L, Bruzzi P, Predieri B. Evaluation and management of hyperlipidemia in children and adolescents. Curr Opin Pediatr 2010; 22: 485-493
    CrossrefPubMedGoogle Scholar
  • 6 Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001; 285: 2486-2497
    CrossrefPubMedGoogle Scholar
  • 7 Staels B, Schoonjans K, Fruchart JC, Auwerx J. The effects of fibrates and thiazolidinediones on plasma triglyceride metabolism are mediated by distinct peroxisome proliferator activated receptors (PPARs). Biochimie 1997; 79: 95-99
    CrossrefPubMedGoogle Scholar
  • 8 Fruchart JC, Brewer Jr. HB, Leitersdorf E. Consensus for the use of fibrates in the treatment of dyslipoproteinemia and coronary heart disease. Fibrate Consensus Group. Am J Cardiol 1998; 81: 912-917
    CrossrefPubMedGoogle Scholar
  • 9 Abourbih S, Filion KB, Joseph L, Schiffrin EL, Rinfret S, Poirier P, Pilote L, Genest J, Eisenberg MJ. Effect of fibrates on lipid profiles and cardiovascular outcomes: a systematic review. Am J Med 2009; 122: 962 e1–e8
    PubMedGoogle Scholar
  • 10 de Denus S, Spinler SA, Miller K, Peterson AM. Statins and liver toxicity: a meta-analysis. Pharmacotherapy 2004; 24: 584-591
    CrossrefPubMedGoogle Scholar
  • 11 Bates ER. Review: limited evidence suggests that statins are safe in patients with liver disease. Evid Based Med 2008; 13: 140
    CrossrefPubMedGoogle Scholar
  • 12 Matzno S, Tazuya-Murayama K, Tanaka H, Yasuda S, Mishima M, Uchida T, Nakabayashi T, Matsuyama K. Evaluation of the synergistic adverse effects of concomitant therapy with statins and fibrates on rhabdomyolysis. J Pharm Pharmacol 2003; 55: 795-802
    CrossrefPubMedGoogle Scholar
  • 13 Liu ZL, Liu JP, Zhang AL, Wu Q, Ruan Y, Lewith G, Visconte D. Chinese herbal medicines for hypercholesterolemia. Cochrane Database Syst Rev 2011; CD008305
    PubMedGoogle Scholar
  • 14 Kong W, Wei J, Abidi P, Lin M, Inaba S, Li C, Wang Y, Wang Z, Si S, Pan H, Wang S, Wu J, Wang Y, Li Z, Liu J, Jiang JD. Berberine is a novel cholesterol-lowering drug working through a unique mechanism distinct from statins. Nat Med 2004; 10: 1344-1351
    CrossrefPubMedGoogle Scholar
  • 15 Huang XS, Yang GF, Pan YC. Effect of berberine hydrochloride on blood concentration of cyclosporine A in cardiac transplanted recipients. Chin J Int Tradit West Med 2008; 28: 702-704
    PubMedGoogle Scholar
  • 16 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097
    CrossrefPubMedGoogle Scholar
  • 17 Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials 1996; 17: 1-12
    CrossrefPubMedGoogle Scholar
  • 18 Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions, Version 5.0.0 [updated February 2008]. Chichester: The Cochrane Collaboration; 2008
    CrossrefGoogle Scholar
  • 19 Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995; 273: 408-412
    CrossrefPubMedGoogle Scholar
  • 20 The Nordic Cochrane Centre. The Cochrane Collaboration, Review Manager (RevMan). 5.0. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration; 2008
    Google Scholar
  • 21 He JJ, Xu XG, Zheng S. Therapeutic effects of simvastatin and berberine hydrochloride in the treatment of hyperlipidemia and carotid artery arthrosclerosis. Tianjin Pharm 2007; 35: 539-541
    PubMedGoogle Scholar
  • 22 Yin SL, Li CH, Liu CM. The effects of berberine hydrochloride on blood glucose, insulin and lipids concentrations in newly diagnosed type 2 diabetic patients. Acta Acad Med Xuzhou 2011; 31: 40-41
    PubMedGoogle Scholar
  • 23 Kong WJ, Wei J, Zuo ZY, Wang YM, Song DQ, You XF, Zhao LX, Pan HN, Jiang JD. Combination of simvastatin with berberine improves the lipid-lowering efficacy. Metabolism 2008; 57: 1029-1037
    CrossrefPubMedGoogle Scholar
  • 24 Zhang Y, Li X, Zou D, Liu W, Yang J, Zhu N, Huo L, Wang M, Hong J, Wu P, Ren G, Ning G. Treatment of type 2 diabetes and dyslipidemia with the natural plant alkaloid berberine. J Clin Endocrinol Metab 2008; 93: 2559-2565
    CrossrefPubMedGoogle Scholar
  • 25 Wei W, Zhao H, Wang A, Sui M, Liang K, Deng H, Ma Y, Zhang Y, Zhang H, Guan Y. A clinical study on the short-term effect of berberine in comparison to metformin on the metabolic characteristics of women with polycystic ovary syndrome. Eur J Endocrinol 2012; 166: 99-105
    CrossrefPubMedGoogle Scholar
  • 26 Li Z, Liu LH. Therapeutic efficacy of combined berberine and glipizide on type 2 diabetes. J Clin Res 2007; 24: 61-64
    PubMedGoogle Scholar
  • 27 Cao Y. Clinical research on multiple factor intervention of improving the insulin resistance. Jinan: Shandong University of Traditional Chinese Medicine; 2007
    CrossrefGoogle Scholar
  • 28 Ju SB, Tan LR, Su W, Rong KW. The intervention of berberine hydrochloride liposomes on impaired glucose tolerance combining with hyperlipidemia. J Pract Tradit Chin Med 2007; 23: 490-491
    PubMedGoogle Scholar
  • 29 Wang W. Effect of berberine on blood glucose, blood lipid and serum adiponectin of primary type 2 diabetes mellitus patients. Taiyuan: Shanxi Medical University; 2008
    CrossrefGoogle Scholar
  • 30 Zheng BB, Wei J, Jiang JD, Zhang RS. The therapeutic effects of combination of simvastatin with berberine on the patients with hyperlipemia. Acta Univ Med Nanjing (Nat Sci) 2009; 29: 1493-1497
    PubMedGoogle Scholar
  • 31 Ye WP. Clinical efficacy of berberine treatment of diabetes. Mod Hosp 2010; 10: 9-10
    PubMedGoogle Scholar
  • 32 Zhou YF, Huang SJ. Clinical efficacy of berberine in the treatment of 60 patients with hyperlipidemia. Chin J Clin Rat Drug Use 2011; 4: 76-77
    PubMedGoogle Scholar
  • 33 OʼBrien KA. Alternative perspectives: how Chinese medicine understands hypercholesterolemia. Cholesterol 2010; 2010: 723289
    PubMedGoogle Scholar
  • 34 Xie W, Zhao Y, Du L. Emerging approaches of traditional Chinese medicine formulas for the treatment of hyperlipidemia. J Ethnopharmacol 2012; 140: 345-367
    CrossrefPubMedGoogle Scholar
  • 35 Grundy SM, Cleeman JI, Merz NB, Brewer B, Clark LT, Hunninghake DB, Pastemak RC, Smith jr. SC, Stone NJ. National Heart, Lung, and Blood Institute, American College of Cardiology Foundation, American Heart Association. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004; 110: 227-239
    CrossrefPubMedGoogle Scholar
  • 36 Hermann R, von Richter O. Clinical evidence of herbal drugs as perpetrators of pharmacokinetic drug interactions. Planta Med 2012; 78: 1458-1477
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 37 Guo Y, Pope C, Cheng X, Zhou H, Klaassen CD. Dose-response of berberine on hepatic cytochromes P450 mRNA expression and activities in mice. J Ethnopharmacol 2011; 138: 111-118
    CrossrefPubMedGoogle Scholar
  • 38 Guo Y, Chen Y, Tan ZR, Klaassen CD, Zhou HH. Repeated administration of berberine inhibits cytochromes P450 in humans. Eur J Clin Pharmacol 2012; 68: 213-217
    CrossrefPubMedGoogle Scholar
  • 39 Schulz KF, Grimes DA. Blinding in randomised trials: hiding who got what. Lancet 2002; 359: 696-700
    CrossrefPubMedGoogle Scholar
  • 40 Schulz KF, Grimes DA. Allocation concealment in randomised trials: defending against deciphering. Lancet 2002; 359: 614-618
    CrossrefPubMedGoogle Scholar