Effects and safety of acupuncture on inflammatory biomarkers in patients with coronary heart disease: a systematic review and meta-analysis

Background Inflammation contributes to the development and progression of coronary heart disease (CHD), and residual inflammatory risk remains an important clinical concern despite advances in standard cardiovascular therapy. Acupuncture interventions have been increasingly used as adjunctive therapies for CHD, but their effects on inflammatory biomarkers have not been systematically evaluated. This systematic review and meta-analysis aimed to assess the effects of acupuncture interventions on inflammatory biomarkers and to evaluate their safety in patients with CHD. Methods PubMed, Embase, the Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and SinoMed were searched from inception to 12 March 2026. Randomized controlled trials evaluating acupuncture interventions in patients with CHD were included. The co-primary outcomes were high-sensitivity C-reactive protein (hs-CRP) and C-reactive protein (CRP). Secondary inflammatory outcomes included interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). Meta-analyses were performed using Review Manager 5.4 and Stata 18.0. Random-effects 95% prediction intervals were calculated for heterogeneous inflammatory outcomes with at least three studies. Subgroup analyses were conducted by clinical setting, and a post hoc exploratory analysis by comparator type was undertaken for CRP, with a formal test for interaction. The certainty of evidence was assessed using GRADE. Results Thirteen randomized controlled trials involving 927 patients were included. The pooled estimates were lower for CRP standardized mean difference (SMD) = −0.87, 95% confidence interval (CI) −1.43 to −0.30; 95% prediction interval (PI) −2.15 to 0.42; low-certainty evidence] and IL-6 (SMD = −0.74, 95% CI −1.31 to −0.17; 95% PI −1.93 to 0.45; low-certainty evidence), but heterogeneity was substantial and both prediction intervals included no effect. For hs-CRP, the pooled estimate was not statistically significant (SMD = −0.79, 95% CI −1.65 to 0.07; 95% PI −2.99 to 1.42), and the evidence remained inconclusive. TNF-α also favored acupuncture, but heterogeneity and imprecision were substantial. Total cholesterol (TC) and triglycerides (TG) decreased, whereas low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) did not differ significantly. Reported adverse events did not differ significantly between groups, but safety reporting was sparse. Conclusion The pooled data yielded lower average CRP and IL-6 estimates, but low-certainty evidence, substantial heterogeneity, and prediction intervals including no effect preclude inference of a consistent anti-inflammatory benefit. Findings for hs-CRP and TNF-α were inconclusive. Current studies cannot distinguish acupuncture-specific effects from non-specific or contextual effects, and evidence on cardiovascular events and safety remains limited. Further well-designed trials are needed. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261279145 .