SYSTEMATIC REVIEW article
Front. Cardiovasc. Med.
Sec. Cardiovascular Pharmacology and Drug Discovery
Efficacy and Safety of Guanxinshutong Capsule as Adjunctive Therapy for Unstable Angina: An Integrated Systematic Review, Meta-Analysis, and Network Pharmacology Study
Ya Li 1
Liyuan Yu 1
Lulu Wu 1
Weihang Peng 1
Peiying Huang 2
Xiaohui Chen 1
Ye Ye 1
Bojun Chen 1
Qingmin Li 3
Li Chen 1
1. The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
2. The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
3. The First People's Hospital of Chenzhou, Chenzhou, China
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Abstract
Background: Unstable angina (UA), characterized by worsening chest pain and 2 increased risk of acute myocardial infarction or sudden death, is a major clinical condition necessitating urgent and effective intervention. Although guanxinshutong capsule (GXST) has demonstrated preliminary therapeutic potential in alleviating angina symptoms, it lacks sufficient and robust clinical evidence to confirm its efficacy and safety in UA treatment. Therefore, further clinical research is urgently needed to validate the practical value of GXST in managing UA. Objective: To determine the efficacy and safety of GXST as an adjunctive therapy for UA and to elucidate its potential pharmacological mechanisms. Methods: Relevant RCTs were included to investigate the effectiveness of GXST in combination with WM for UA. ROB 2 was applied to assess their methodological quality. The data integration, evidence quality assessment, and trial sequence analysis were performed using R software, the GRADE framework, and TSA software, respectively. Concurrently, the network pharmacology was employed to identify disease-relevant targets, active components, and core targets of GXST. Crucially, bioinformatics analysis was conducted to explore the potential regulatory mechanisms. Results: Fifteen RCTs were included. Compared with WM monotherapy, GXST combined with WM exhibited significantly superior efficacy across multiple indicators: clinical effective rate( RR = 1.19, 95% CI = 1.13-1.25), ECG effective rate (RR = 1.20, 95% CI = 1.07-1.34), angina frequency (SMD= -2.20, 95% CI = -3.36 to -1.04), angina duration (SMD = -1.54, 95% CI = -2.14 to -0.94), PV levels(SMD = -0.82, 95% CI = - 1.23 to -0.41), FIB levels(SMD = -1.18, 95% CI = -1.50 to -0.86), and TCM syndrome scores (SMD = -1.68, 95% CI = -2.18 to -1.18). However, no significant intergroup differences were detected in CK-MB, cTnI, or ARDI. KEGG enrichment analysis highlighted the PI3K-Akt and MAPK signaling pathways as central to the underlying mechanism. Molecular docking further demonstrated pronounced binding affinities of kaempferol, miltirone, and asiatic acid toward core targets AKT1, MAPK3, and PIK3CA, corroborating their therapeutic potential. 3 Conclusion: The combination therapy of GXST and WM significantly boosted clinical efficacy in patients with UA. Its mechanism of action involves regulating the PIK3CA/AKT1 and MAPK3 signaling pathways.
Summary
Keywords
efficacy and safety, Guanxinshutong capsule, Meta-analysis, network pharmacology analysis, Unstable angina
Received
12 November 2025
Accepted
03 February 2026
Copyright
© 2026 Li, Yu, Wu, Peng, Huang, Chen, Ye, Chen, Li and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Qingmin Li; Li Chen
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