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

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.