Impact of Berberine or Berberine Combination Products on Lipoprotein, Triglyceride and Biological Safety Marker Concentrations in Patients with Hyperlipidemia: A Systematic Review and Meta-Analysis

Abstract

Monoclonal antibody Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) inhibitors reduce total cholesterol (TC), low density lipoproteins (LDL), high density lipoproteins (HDL), and triglycerides (TG). We assessed the ability of berberine, a natural PCSK9 inhibitor, to reduce lipid concentrations either alone or combined with other nutraceuticals. We searched PubMed, Scopus and EMBASE from inception to September 30^th, 2022 for randomized controlled trials (RCTs) assessing 8-18 wk of berberine therapy on. A total of 41 RCTs with 4,838 patients met our inclusion criteria. Berberine containing products significantly reduced TC (MD −17.42 mg/dL [95%CI: −22.91 to −11.93]), LDL (MD −14.98 mg/dL [95%CI: −20.67 to −9.28]), and TG (MD −18.67 mg/dL [95%CI: −25.82 to −11.51]) while raising HDL (MD 1.97 mg/dL [95%CI: 1.16 to 2.78]) versus control (I² > 72% for all analyses). Products with berberine alone had less robust effects on TC (MD −12.08 mg/dL [95%CI: −21.79 to −2.37]), LDL (MD −9.26 mg/dL [95%CI: −20.31 to 1.78]), and HDL (MD 1.38 mg/dL [95%CI: −1.27 to 4.03]) but TG effects were similar (MD −17.40 mg/dL [95%CI: −32.57 to −2.23]). Berberine along with red yeast rice reduced TC (MD −19.62 mg/dL [95%CI: −28.56 to −10.68]) and LDL (MD −18.79 mg/dL [95%CI: −28.03 to −9.54]) as did combination therapy with Silybum maranium for TC (MD −31.81 mg/dL [95%CI: −59.88 to −3.73]) and LDL (MD −30.82 mg/dL [95%CI: −56.48 to −5.16]). Berberine, alone or with other nutraceuticals, can provide a modest positive impact on lipid concentrations.

Keywords:

• Berberine
• cholesterol
• LDL
• LFTs
• lipids
• nutraceutical
• triglycerides

Acknowledgements

None.

Disclosure statement

This was an unfunded project, and the authors and investigators have no financial or nonfinancial conflicts of interest to report.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Adrian V. Hernandez

Adrian V. Hernandez, MD, PhD is an Associate Professor at the University of Connecticut School of Pharmacy, Storrs, CT and a Systematic Reviewer at UConn and the Universidad San Ignacio de Loyola in Lima, Peru with expertise in cardiovascular medicine.

Jennifer Hwang

Jennifer Hwang, Pharm.D. and Iram Nasreen, Pharm.D. were pharmacy students at the University of Connecticut at the time of writing but are now both pursuing post-graduate residency training.

Iram Nasreen

Jennifer Hwang, Pharm.D. and Iram Nasreen, Pharm.D. were pharmacy students at the University of Connecticut at the time of writing but are now both pursuing post-graduate residency training.

Dakota Sicignano

Dakota Sicignano, BS Pharm is a University of Connecticut pharmacy student entering his third professional year at the school.

Vinay Pasupuleti

Vinay Pasupuleti, MD, PhD is a researcher at Lumanity North America and Yardley, PA with expertise in systematic review and meta-analysis.

Kimberly Snow-Caroti

Kimberly Snow-Caroti, Pharm.D. is finishing the second year of her post-graduate outcomes research fellowship at Hartford Hospital and the University of Connecticut.

C. Michael White

C. Michael White, Pharm.D. is a Distinguished Professor and Head of Pharmacy Practice at the University of Connecticut and is Co-Director of the Helth Outcomes, Policy, and Evidence Synthesis (HOPES) group at UConn and Hartford Hospital with expertise in cardiovascular therapy and natural products.