Gynostemma pentaphyllum for dyslipidemia: A systematic review of randomized controlled trials

Systematic review of 22 randomized controlled trials including 2,407 adults with dyslipidemia. Participants had hyperlipidemia with some comorbidities such as hypertension, coronary heart disease, or diabetes, and most trials were conducted in China with one trial in Thailand.

Gynostemma pentaphyllum was tested in multiple forms across trials, including gypenosides tablets or capsules, Gynostemma tea, and one adjunctive regimen combined with fenofibrate. Reported doses ranged from 40 mg three times daily to 80 mg twice daily for tablets, 3 g tea preparations twice daily, and 30 g tea with 0.5 g n-3 fatty acids three times daily in one study; durations ranged from 4 weeks to 12 months.

Very low certainty evidence suggests Gynostemma pentaphyllum can improve lipid outcomes, but the size and reliability of the effect are uncertain. As a stand-alone treatment, it appeared comparable to lipid-lowering agents for total cholesterol, triglycerides, and HDL-C, but inferior to red yeast rice for total cholesterol, triglycerides, and HDL-C. As an add-on to lipid-lowering therapy, it may produce greater improvements in triglycerides, LDL-C, and HDL-C than lipid-lowering therapy alone. Safety data favored Gynostemma pentaphyllum, with fewer adverse events than lipid-lowering drugs and no serious adverse events reported.

The certainty of evidence was very low to low, limiting confidence in the findings. Trials were heterogeneous in formulation, dose, comparator, and duration, and most were conducted in China, which limits generalizability. Many studies were small and short, and reporting of safety and other outcomes was limited.