{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T11:59:24Z","timestamp":1777982364064,"version":"3.51.4"},"reference-count":40,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardio\u2010cerebrovascular events continue to pose major life\u2010threatening risks worldwide. Though approved for treatment of angina pectoris and ischemic stroke, the effects of tongxinluo, as a traditional Chinese medicine, on stroke and major adverse cardiovascular events (MACE) after atherosclerotic cardiovascular disease (ASCVD) remain controversial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to assess the efficacy of tongxinluo in the secondary prevention of ASCVD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The present systematic review was conducted following PRISMA guidelines and the\n                      <jats:italic>Cochrane Handbook for Systematic Reviews of Interventions<\/jats:italic>\n                      . In this study\u2010level meta\u2010analysis, we conducted a comprehensive search of medical libraries and clinical trial registries, spanning from their inception until November 20, 2024, and randomized controlled trials (RCTs) comparing tongxinluo versus no tongxinluo in a secondary prevention. The ASCVD population was included. The primary outcome was stroke and MACE. The secondary outcome was MACE and myocardial infarction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results and conclusion<\/jats:title>\n                    <jats:p>\n                      Four RCTs, including 7087 patients with known coronary artery disease, ischemic stroke, or carotid artery plaque, were included in the analysis. Compared to placebo, tongxinluo numerically decreased the risk of stroke with a RR of 0.84 (95% CI: 0.61\u20131.17,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.31). For the outcome of MACE, tongxinluo reduced the risk by 28% (RR: 0.72, 95% CI: 0.59\u20130.88,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001). Patients randomized to tongxinluo had a RR of 0.70 (95% CI: 0.54\u20130.92,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.01) for cardiovascular mortality and 0.74 (95% CI: 0.56\u20130.92,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.01) for all\u2010cause mortality. In summary, in patients with ASCVD, tongxinluo tended to decrease the incidence of stroke, and reduced the composite of stroke, myocardial infarction, and cardiovascular mortality by 28%.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.71232","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T05:05:36Z","timestamp":1773378336000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tongxinluo for the Secondary Prevention of Atherosclerotic Disease: A Systematic Review and Meta\u2010Analysis of Randomized Clinical Trials"],"prefix":"10.1002","volume":"16","author":[{"given":"Yanyan","family":"Feng","sequence":"first","affiliation":[{"name":"Department of Neurology The People's Hospital of Zhengzhou University &amp; Henan Provincial People's Hospital  Zhengzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhaobo","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Neurology Kaifeng Central Hospital  Kaifeng China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiewen","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology The People's Hospital of Zhengzhou University &amp; Henan Provincial People's Hospital  Zhengzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiejie","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology Beijing Tiantan Hospital Capital Medical University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2023.08.019"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2022.04.004"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jep.2009.04.009"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2021.673366"},{"issue":"05","key":"e_1_2_10_6_1","first-page":"481","article-title":"Expert Recommendations on the Clinical Application of Tongxinluo Capsules in Atherosclerotic Cerebrovascular Disease","volume":"30","author":"Dan D. 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