Exploring Astragaloside IV in Ischemic Heart Disease: A Comprehensive Systematic Review and Meta-Analysis of Preclinical Cardiotoxicity Models

This systematic review and meta-analysis were conducted to evaluate the therapeutic efficacy of Astragaloside IV (As-IV) in ischemic heart disease based on the preclinical evidence and to correlate the cardioprotective effect with various available mechanisms. This systematic review and meta-analysis were conducted based on the results of a thorough literature search in databases of published papers, such as PubMed, Embase, and Google Scholar. A total of 18 studies that met the inclusion/exclusion criteria were included. The meta-analysis has shown the significant therapeutic efficacy of As-IV on ischemic heart disease. As-IV has decreased the myocardial infarction size, the left ventricular weight indices, the left ventricular internal diameter in systole, and the left ventricular internal diameter in diastole. As-IV has decreased the level of the third type of collagen and the decreased activity of creatine kinase and lactate dehydrogenase. Also, As-IV has markedly decreased the rate of apoptosis and the expression of the proapoptotic markers such as caspase-3 and Bax. The left ventricular systolic pressure, as well as the arterial shortening edge and the ejection fraction, has increased. The levels of the antiapoptotic protein Bcl-2 increased. In addition, As-IV has a powerful anti-inflammatory influence by inhibiting the main markers of inflammation, such as TLR4, IL-1, TNF-α, and TGF-β. As-IV has also caused an effect on angiogenesis by increasing the VEGF level. The results have revealed the As-IV, as a decent universal medicine for ischemic heart disease because of its variety of actions and effectiveness.