Overall and Sex-Specific Effect of Berberine for the Treatment of Dyslipidemia in Adults: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized placebo-controlled trials
PubMed 36941490 · doi:10.1007/s40265-023-01841-4
What was done
A systematic review and meta-analysis (PROSPERO CRD42021293218) evaluated randomized placebo-controlled trials of berberine (900–1500 mg/day) in adults with dyslipidemia to assess efficacy, safety, and sex disparity. Six databases and trial registries were searched through December 13, 2022 without language restrictions. Mean differences (MD) were pooled using inverse-variance random-effects models, risk of bias was assessed with the Cochrane tool, and adverse events were synthesized narratively.
What was found
Eighteen trials (1788 participants, duration 4–24 weeks, 83% in mainland China and Hong Kong) were included. Berberine reduced LDL cholesterol (MD -0.46 mmol/L, 95% CI -0.62 to -0.30; 14 studies, n = 1447), total cholesterol (MD -0.48 mmol/L, 95% CI -0.63 to -0.33; 17 studies, n = 1637), triglycerides (MD -0.34 mmol/L, 95% CI -0.46 to -0.23; 18 studies, n = 1661), and apolipoprotein B (MD -0.25 g/L, 95% CI -0.40 to -0.11; 2 studies, n = 127). Overall HDL cholesterol increased slightly (MD 0.06 mmol/L, 95% CI 0.00 to 0.11; 15 studies, n = 1471), with an increase in women (MD 0.11 mmol/L, 95% CI 0.09 to 0.13) and no significant change in men (MD -0.07 mmol/L, 95% CI -0.16 to 0.02). No serious adverse events occurred across 16 reporting studies; gastrointestinal adverse events were more frequent with berberine than placebo (2–23% vs 2–15%).
Why it matters
This review shows that berberine produces modest improvements in atherogenic lipid profiles and suggests that its effect on HDL cholesterol may differ by sex.
Limits
Most studies (15 of 18) were conducted in China/Hong Kong, limiting ethnic and geographic generalizability. Interventions were short-term (maximum 24 weeks) and measured surrogate circulating lipids rather than clinical cardiovascular outcomes. Apolipoprotein B was assessed in only two studies (n = 127).
Cited by
- context Studies indicate that long-term use of berberine is not advised.