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2000
Volume 26, Issue 6
  • ISSN: 1389-2002
  • E-ISSN: 1875-5453

Abstract

Introduction

Shenlian formula (SL) has been widely used to treat various diseases, including type 2 diabetes mellitus and atherosclerosis (AS). Pathological states can significantly alter drug pharmacokinetics (PK) compared to normal physiology, primarily by modulating biological membrane permeability and metabolic enzyme activity, thereby affecting drug absorption, distribution, metabolism, and excretion. However, the specific influence of AS on the PK profile of SL remains uncharacterized.

Objective

To investigate the plasma PK of five components (Salvianolic acid A (SAA), Danshensu (DSS), Andrographolide (AND), Neoandrographolide (NAND), and Dehydrated andrographolide (DDAND),) which were the ingredients of SL, in physiological and AS rats administered SL intragastrically.

Methods

The AS SD rat model was induced with a high-fat diet, carotid balloon injury, and VD injections. A validated LC-MS/MS method quantified plasma concentrations to assess PK parameters.

Results and Discussion

The validation parameters were all in accordance with the current standards. Comparative PK analysis revealed significant intergroup disparities between the AS and normal groups. The value of C and AUC for DSS was significantly decreased (<0.05) in the AS group, which indicated that the absorptive amount was remarkably attenuated in the pathological state. Additionally, the variation trend of AND under C and AUC values were consistent with the alteration trend of DSS. Furthermore, the T of NAND in the AS group was significantly reduced (<0.05), confirming that the pathological state accelerated the absorption rate of NAND, thereby shortening the time required for NAND to reach its maximum concentration in the body.

Conclusion

We established and validated a sensitive LC-MS/MS method for the simultaneous quantification of five bioactive components of SL in rat plasma. This method is applicable to both physiological and pathological states. Comparative pharmacokinetic analysis revealed significant differences in the systemic exposure of all five analytes between AS and normal rats. These findings provide critical PK evidence for optimizing SL dosage regimens in AS patients, underscoring the imperative to consider the disease’ status when determining therapeutic strategies for traditional Chinese medicine formulations.

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2025-09-02
2026-02-02
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References

  1. LibbyP. BuringJ.E. BadimonL. HanssonG.K. DeanfieldJ. BittencourtM.S. TokgözoğluL. LewisE.F. Atherosclerosis.Nat. Rev. Dis. Primers2019515610.1038/s41572‑019‑0106‑z31420554
    [Google Scholar]
  2. RaiV. High-fat diet, epigenetics, and atherosclerosis: A narrative review.Nutrients202417112710.3390/nu1701012739796562
    [Google Scholar]
  3. SinghH. RaiV. AgrawalD.K. LPS and oxLDL-induced S100A12 and RAGE expression in carotid arteries of atherosclerotic Yucatan microswine.Mol. Biol. Rep.20224998663867210.1007/s11033‑022‑07703‑835771356
    [Google Scholar]
  4. BekbossynovaM. SalievT. Ivanova-RazumovaT. AndossovaS. KaliA. MyrzakhmetovaG. Beyond cholesterol: Emerging risk factors in atherosclerosis.J. Clin. Med.2025147235210.3390/jcm1407235240217801
    [Google Scholar]
  5. WangX. XieZ. ZhangJ. ChenY. LiQ. YangQ. ChenX. LiuB. XuS. DongY. Interaction between lipid metabolism and macrophage polarization in atherosclerosis.iScience202528411216810.1016/j.isci.2025.11216840201117
    [Google Scholar]
  6. FanJ. ChenY. YanH. LiuB. WangY. ZhangJ. ChenY. LiuE. LiangJ. Genomic and transcriptomic analysis of hypercholesterolemic rabbits: Progress and perspectives.Int. J. Mol. Sci.20181911351210.3390/ijms1911351230413026
    [Google Scholar]
  7. FracassiA. QiaoH. LowellA.N. CaoJ. BodeJ.W. MasaiH. Yoshizawa-SugataN. ZhouR. YamakoshiY. Natural and synthetic LDL-based imaging probes for the detection of atherosclerotic plaques.ACS Pharmacol. Transl. Sci.20258257859110.1021/acsptsci.4c0066739974638
    [Google Scholar]
  8. AcostaS. FatemiS. ZarroukM. GottsäterA. Novel plasma biomarkers associated with future peripheral atherosclerotic disease and abdominal aortic aneurysm—Insights from contemporary prospective studies from the Malmö diet and cancer study.Biomolecules202414784410.3390/biom1407084439062558
    [Google Scholar]
  9. XueY. PengY. JinL. LiuL. LiuQ. YuanX. WangJ. ZhaoM. ZhangW. LuoS. LiY. LuoM. HuangL. Macrophage KDM2A promotes atherosclerosis via regulating FYN and inducing inflammatory response.Int. J. Biol. Sci.20252162780280510.7150/ijbs.10267540303308
    [Google Scholar]
  10. WangY. ChenT. PengF. WangS. ZhaoF. WangX. XieL. Activating TRPV1 by evodiamine attenuates atherosclerosis by inhibiting endothelial microparticle release.Int. Immunopharmacol.202515511465710.1016/j.intimp.2025.11465740239331
    [Google Scholar]
  11. MagniP. MitićT. DevauxY. Deciphering immune dynamics in atherosclerosis: Inflammatory mediators as biomarkers and therapeutic target.Eur. J. Clin. Invest.2025556e7004310.1111/eci.7004340192118
    [Google Scholar]
  12. QianT. GuoD. SunL. ChiM. MaX. JinJ. Crosstalk between lipid metabolism and macrophages in atherosclerosis: Therapeutic potential of natural products.Front. Cardiovasc. Med.202512152992410.3389/fcvm.2025.152992440099271
    [Google Scholar]
  13. HermannS. KuhlmannM.T. StarsichovaA. EligehausenS. SchäfersK. StypmannJ. TiemannK. LevkauB. SchäfersM. Imaging reveals the connection between spontaneous coronary plaque ruptures, atherothrombosis, and myocardial infarctions in HypoE/SRBI −/− Mice.J. Nucl. Med.20165791420142710.2967/jnumed.115.17113227127225
    [Google Scholar]
  14. TsaoC.W. AdayA.W. AlmarzooqZ.I. AlonsoA. BeatonA.Z. BittencourtM.S. BoehmeA.K. BuxtonA.E. CarsonA.P. Commodore-MensahY. ElkindM.S.V. EvensonK.R. Eze-NliamC. FergusonJ.F. GenerosoG. HoJ.E. KalaniR. KhanS.S. KisselaB.M. KnutsonK.L. LevineD.A. LewisT.T. LiuJ. LoopM.S. MaJ. MussolinoM.E. NavaneethanS.D. PerakA.M. PoudelR. Rezk-HannaM. RothG.A. SchroederE.B. ShahS.H. ThackerE.L. VanWagnerL.B. ViraniS.S. VoecksJ.H. WangN.Y. YaffeK. MartinS.S. Heart disease and stroke statistics—2022 Update: A report from the American Heart Association.Circulation20221458e153e63910.1161/CIR.000000000000105235078371
    [Google Scholar]
  15. BrauerM. RothG.A. AravkinA.Y. ZhengP. AbateK.H. AbateY.H. AbbafatiC. AbbasgholizadehR. AbbasiM.A. AbbasianM. AbbasifardM. Abbasi-KangevariM. Abd ElHafeezS. Abd-ElsalamS. AbdiP. AbdollahiM. AbdounM. AbdulahD.M. AbdullahiA. AbebeM. AbediA. AbediA. AbegazT.M. Abeldaño ZuñigaR.A. AbiodunO. AbisoT.L. AboagyeR.G. AbolhassaniH. AbouzidM. AboyeG.B. AbreuL.G. AbualruzH. AbubakarB. Abu-GharbiehE. AbukhadijahH.J.J. AburuzS. Abu-ZaidA. AdaneM.M. AddoI.Y. AddoloratoG. AdedoyinR.A. AdekanmbiV. AdenB. AdetunjiJ.B. AdeyeoluwaT.E. AdhaR. AdibiA. AdnaniQ.E.S. AdzigbliL.A. AfolabiA.A. AfolabiR.F. AfshinA. AfyouniS. AfzalM.S. AfzalS. AgampodiS.B. AgbozoF. AghamiriS. AgodiA. AgrawalA. Agyemang-DuahW. AhinkorahB.O. AhmadA. AhmadD. AhmadF. AhmadN. AhmadS. AhmadT. AhmedA. AhmedA. AhmedA. AhmedL.A. AhmedM.B. AhmedS. AhmedS.A. AjamiM. AkaluG.T. AkaraE.M. AkbarialiabadH. AkhlaghiS. AkinosoglouK. AkinyemijuT. AkkaifM.A. AkkalaS. Akombi-InyangB. Al AwaidyS. Al HasanS.M. AlahdabF. AL-Ahdal, T.M.A.; Alalalmeh, S.O.; Alalwan, T.A.; Al-Aly, Z.; Alam, K.; Alam, N.; Alanezi, F.M.; Alanzi, T.M.; Albakri, A.; AlBataineh, M.T.; Aldhaleei, W.A.; Aldridge, R.W.; Alemayohu, M.A.; Alemu, Y.M.; Al-Fatly, B.; Al-Gheethi, A.A.S.; Al-Habbal, K.; Alhabib, K.F.; Alhassan, R.K.; Ali, A.; Ali, A.; Ali, B.A.; Ali, I.; Ali, L.; Ali, M.U.; Ali, R.; Ali, S.S.S.; Ali, W.; Alicandro, G.; Alif, S.M.; Aljunid, S.M.; Alla, F.; Al-Marwani, S.; Al-Mekhlafi, H.M.; Almustanyir, S.; Alomari, M.A.; Alonso, J.; Alqahtani, J.S.; Alqutaibi, A.Y.; Al-Raddadi, R.M.; Alrawashdeh, A.; Al-Rifai, R.H.; Alrousan, S.M.; Al-Sabah, S.K.; Alshahrani, N.Z.; Altaany, Z.; Altaf, A.; Al-Tawfiq, J.A.; Altirkawi, K.A.; Aluh, D.O.; Alvis-Guzman, N.; Alvis-Zakzuk, N.J.; Alwafi, H.; Al-Wardat, M.S.; Al-Worafi, Y.M.; Aly, H.; Aly, S.; Alzoubi, K.H.; Al-Zyoud, W.; Amaechi, U.A.; Aman Mohammadi, M.; Amani, R.; Amiri, S.; Amirzade-Iranaq, M.H.; Ammirati, E.; Amu, H.; Amugsi, D.A.; Amusa, G.A.; Ancuceanu, R.; Anderlini, D.; Anderson, J.A.; Andrade, P.P.; Andrei, C.L.; Andrei, T.; Anenberg, S.C.; Angappan, D.; Angus, C.; Anil, A.; Anil, S.; Anjum, A.; Anoushiravani, A.; Antonazzo, I.C.; Antony, C.M.; Antriyandarti, E.; Anuoluwa, B.S.; Anvari, D.; Anvari, S.; Anwar, S.; Anwar, S.L.; Anwer, R.; Anyabolo, E.E.; Anyasodor, A.E.; Apostol, G.L.C.; Arabloo, J.; Arabzadeh Bahri, R.; Arafat, M.; Areda, D.; Aregawi, B.B.; Aremu, A.; Armocida, B.; Arndt, M.B.; Ärnlöv, J.; Arooj, M.; Artamonov, A.A.; Artanti, K.D.; Aruleba, I.T.; Arumugam, A.; Asbeutah, A.M.; Asgary, S.; Asgedom, A.A.; Ashbaugh, C.; Ashemo, M.Y.; Ashraf, T.; Askarinejad, A.; Assmus, M.; Astell-Burt, T.; Athar, M.; Athari, S.S.; Atorkey, P.; Atreya, A.; Aujayeb, A.; Ausloos, M.; Avila-Burgos, L.; Awoke, A.A.; Ayala Quintanilla, B.P.; Ayatollahi, H.; Ayestas Portugal, C.; Ayuso-Mateos, J.L.; Azadnajafabad, S.; Azevedo, R.M.S.; Azhar, G.S.; Azizi, H.; Azzam, A.Y.; Backhaus, I.L.; Badar, M.; Badiye, A.D.; Bagga, A.; Baghdadi, S.; Bagheri, N.; Bagherieh, S.; Bahrami Taghanaki, P.; Bai, R.; Baig, A.A.; Baker, J.L.; Bakkannavar, S.M.; Balasubramanian, M.; Baltatu, O.C.; Bam, K.; Bandyopadhyay, S.; Banik, B.; Banik, P.C.; Banke-Thomas, A.; Bansal, H.; Barchitta, M.; Bardhan, M.; Bardideh, E.; Barker-Collo, S.L.; Bärnighausen, T.W.; Barone-Adesi, F.; Barqawi, H.J.; Barrero, L.H.; Barrow, A.; Barteit, S.; Basharat, Z.; Basiru, A.; Basso, J.D.; Bastan, M-M.; Basu, S.; Batchu, S.; Batra, K.; Batra, R.; Baune, B.T.; Bayati, M.; Bayileyegn, N.S.; Beaney, T.; Behnoush, A.H.; Beiranvand, M.; Béjot, Y.; Bekele, A.; Belgaumi, U.I.; Bell, A.W.; Bell, M.L.; Bello, M.B.; Bello, O.O.; Belo, L.; Beloukas, A.; Bendak, S.; Bennett, D.A.; Bennitt, F.B.; Bensenor, I.M.; Benzian, H.; Beran, A.; Berezvai, Z.; Bernabe, E.; Bernstein, R.S.; Bettencourt, P.J.G.; Bhagavathula, A.S.; Bhala, N.; Bhandari, D.; Bhardwaj, N.; Bhardwaj, P.; Bhaskar, S.; Bhat, A.N.; Bhat, V.; Bhatti, G.K.; Bhatti, J.S.; Bhatti, M.S.; Bhatti, R.; Bhuiyan, M.A.; Bhutta, Z.A.; Bikbov, B.; Bishai, J.D.; Bisignano, C.; Biswas, A.; Biswas, B.; Biswas, R.K.; Bjørge, T.; Boachie, M.K.; Boakye, H.; Bockarie, M.J.; Bodolica, V.; Bodunrin, A.O.; Bogale, E.K.; Bolla, S.R.; Boloor, A.; Bonakdar Hashemi, M.; Boppana, S.H.; Bora Basara, B.; Borhany, H.; Botero Carvajal, A.; Bouaoud, S.; Boufous, S.; Bourne, R.; Boxe, C.; Braithwaite, D.; Brant, L.C.; Brar, A.; Breitborde, N.J.K.; Breitner, S.; Brenner, H.; Briko, A.N.; Britton, G.; Brown, C.S.; Browne, A.J.; Brunoni, A.R.; Bryazka, D.; Bulamu, N.B.; Bulto, L.N.; Buonsenso, D.; Burkart, K.; Burns, R.A.; Busse, R.; Bustanji, Y.; Butt, N.S.; Butt, Z.A.; Caetano dos Santos, F.L.; Cagney, J.; Cahuana-Hurtado, L.; Calina, D.; Cámera, L.A.; Campos, L.A.; Campos-Nonato, I.R.; Cao, C.; Cao, F.; Cao, Y.; Capodici, A.; Cárdenas, R.; Carr, S.; Carreras, G.; Carrero, J.J.; Carugno, A.; Carvalho, F.; Carvalho, M.; Castaldelli-Maia, J.M.; Castañeda-Orjuela, C.A.; Castelpietra, G.; Catalá-López, F.; Catapano, A.L.; Cattaruzza, M.S.; Caye, A.; Cederroth, C.R.; Cegolon, L.; Cenderadewi, M.; Cercy, K.M.; Cerin, E.; Chadwick, J.; Chakraborty, C.; Chakraborty, P.A.; Chakraborty, S.; Chan, J.S.K.; Chan, R.N.C.; Chandan, J.S.; Chandika, R.M.; Chaturvedi, P.; Chen, A-T.; Chen, C.S.; Chen, H.; Chen, M.X.; Chen, M.; Chen, S.; Cheng, C-Y.; Cheng, E.T.W.; Cherbuin, N.; Chi, G.; Chichagi, F.; Chimed-Ochir, O.; Chimoriya, R.; Ching, P.R.; Chirinos-Caceres, J.L.; Chitheer, A.; Cho, W.C.S.; Chong, B.; Chopra, H.; Chowdhury, R.; Christopher, D.J.; Chu, D-T.; Chukwu, I.S.; Chung, E.; Chung, S-C.; Chutiyami, M.; Cioffi, I.; Cogen, R.M.; Cohen, A.J.; Columbus, A.; Conde, J.; Corlateanu, A.; Cortese, S.; Cortesi, P.A.; Costa, V.M.; Costanzo, S.; Criqui, M.H.; Cruz, J.A.; Cruz-Martins, N.; Culbreth, G.T.; da Silva, A.G.; Dadras, O.; Dai, X.; Dai, Z.; Daikwo, P.U.; Dalli, L.L.; Damiani, G.; D’Amico, E.; D’Anna, L.; Darwesh, A.M.; Das, J.K.; Das, S.; Dash, N.R.; Dashti, M.; Dávila-Cervantes, C.A.; Davis Weaver, N.; Davitoiu, D.V.; De la Hoz, F.P.; de la Torre-Luque, A.; De Leo, D.; Debopadhaya, S.; Degenhardt, L.; Del Bo’, C.; Delgado-Enciso, I.; Delgado-Saborit, J.M.; Demoze, C.K.; Denova-Gutiérrez, E.; Dervenis, N.; Dervišević, E.; Desai, H.D.; Desai, R.; Devanbu, V.G.C.; Dewan, S.M.R.; Dhali, A.; Dhama, K.; Dhane, A.S.; Dhimal, M.L.; Dhimal, M.; Dhingra, S.; Dhulipala, V.R.; Dhungana, R.R.; Dias da Silva, D.; Diaz, D.; Diaz, L.A.; Diaz, M.J.; Dima, A.; Ding, D.D.; Dinu, M.; Djalalinia, S.; Do, T.C.; Do, T.H.P.; do Prado, C.B.; Dodangeh, M.; Dohare, S.; Dokova, K.G.; Dong, W.; Dongarwar, D.; D’Oria, M.; Dorostkar, F.; Dorsey, E.R.; Doshi, R.; Doshmangir, L.; Dowou, R.K.; Driscoll, T.R.; Dsouza, A.C.; Dsouza, H.L.; Dumith, S.C.; Duncan, B.B.; Duraes, A.R.; Duraisamy, S.; Dushpanova, A.; Dzianach, P.A.; Dziedzic, A.M.; Ebrahimi, A.; Echieh, C.P.; Ed-Dra, A.; Edinur, H.A.; Edvardsson, D.; Edvardsson, K.; Efendi, F.; Eftekharimehrabad, A.; Eini, E.; Ekholuenetale, M.; Ekundayo, T.C.; El Arab, R.A.; El Sayed Zaki, M.; El-Dahiyat, F.; Elemam, N.M.; Elgar, F.J.; ElGohary, G.M.T.; Elhabashy, H.R.; Elhadi, M.; Elmehrath, A.O.; Elmeligy, O.A.A.; Elshaer, M.; Elsohaby, I.; Emeto, T.I.; Esfandiari, N.; Eshrati, B.; Eslami, M.; Esmaeili, S.V.; Estep, K.; Etaee, F.; Fabin, N.; Fagbamigbe, A.F.; Fagbule, O.F.; Fahimi, S.; Falzone, L.; Fareed, M.; Farinha, C.S.S.; Faris, M.A.I.E.M.; Faris, P.S.; Faro, A.; Fasina, F.O.; Fatehizadeh, A.; Fauk, N.K.; Fazylov, T.; Feigin, V.L.; Feng, X.; Fereshtehnejad, S-M.; Feroze, A.H.; Ferrara, P.; Ferrari, A.J.; Ferreira, N.; Fetensa, G.; Feyisa, B.R.; Filip, I.; Fischer, F.; Fitriana, I.; Flavel, J.; Flohr, C.; Flood, D.; Flor, L.S.; Foigt, N.A.; Folayan, M.O.; Force, L.M.; Fortuna, D.; Foschi, M.; Franklin, R.C.; Freitas, A.; Friedman, S.D.; Fux, B.; G, S.; Gaal, P.A.; Gaihre, S.; Gajdács, M.; Galali, Y.; Gallus, S.; Gandhi, A.P.; Ganesan, B.; Ganiyani, M.A.; Garcia, V.; Gardner, W.M.; Garg, R.K.; Gautam, R.K.; Gebi, T.G.; Gebregergis, M.W.; Gebrehiwot, M.; Gebremariam, T.B.B.; Gebremeskel, T.G.; Gerema, U.; Getacher, L.; Getahun, G.K.; Getie, M.; Ghadirian, F.; Ghafarian, S.; Ghaffari Jolfayi, A.; Ghailan, K.Y.; Ghajar, A.; Ghasemi, M.R.; Ghasempour Dabaghi, G.; Ghasemzadeh, A.; Ghassemi, F.; Ghazy, R.M.; Gholami, A.; Gholamrezanezhad, A.; Gholizadeh, N.; Ghorbani, M.; Gil, A.U.; Gil, G.F.; Gilbertson, N.M.; Gill, P.S.; Gill, T.K.; Gindaba, E.Z.; Girmay, A.; Glasbey, J.C.; Gnedovskaya, E.V.; Göbölös, L.; Godinho, M.A.; Goel, A.; Golechha, M.; Goleij, P.; Golinelli, D.; Gomes, N.G.M.; Gopalani, S.V.; Gorini, G.; Goudarzi, H.; Goulart, A.C.; Gouravani, M.; Goyal, A.; Graham, S.M.; Grivna, M.; Grosso, G.; Guan, S-Y.; Guarducci, G.; Gubari, M.I.M.; Guha, A.; Guicciardi, S.; Gulati, S.; Gulisashvili, D.; Gunawardane, D.A.; Guo, C.; Gupta, A.K.; Gupta, B.; Gupta, M.; Gupta, R.; Gupta, R.D.; Gupta, R.; Gupta, S.; Gupta, V.B.; Gupta, V.K.; Gupta, V.K.; Habibzadeh, F.; Habibzadeh, P.; Hadaro, T.S.; Hadian, Z.; Haep, N.; Haghi-Aminjan, H.; Haghmorad, D.; Hagins, H.; Haile, D.; Hailu, A.; Hajj Ali, A.; Halboub, E.S.; Halimi, A.; Hall, B.J.; Haller, S.; Halwani, R.; Hamadeh, R.R.; Hamdy, N.M.; Hameed, S.; Hamidi, S.; Hammoud, A.; Hanif, A.; Hanifi, N.; Haq, Z.A.; Haque, M.R.; Harapan, H.; Hargono, A.; Haro, J.M.; Hasaballah, A.I.; Hasan, I.; Hasan, M.J.; Hasan, S.M.M.; Hasani, H.; Hasanian, M.; Hashmeh, N.; Hasnain, M.S.; Hassan, A.; Hassan, I.; Hassan Zadeh Tabatabaei, M.S.; Hassani, S.; Hassanipour, S.; Hassankhani, H.; Haubold, J.; Havmoeller, R.J.; Hay, S.I.; Hebert, J.J.; Hegazi, O.E.; Hegena, T.Y.; Heidari, G.; Heidari, M.; Helfer, B.; Hemmati, M.; Henson, C.A.; Herbert, M.E.; Herteliu, C.; Heuer, A.; Hezam, K.; Hinneh, T.K.; Hiraike, Y.; Hoan, N.Q.; Holla, R.; Hon, J.; Hoque, M.E.; Horita, N.; Hossain, S.; Hosseini, S.E.; Hosseinzadeh, H.; Hosseinzadeh, M.; Hostiuc, M.; Hostiuc, S.; Hoven, H.; Hsairi, M.; Hsu, J.M.; Hu, C.; Huang, J.; Huda, M.N.; Hulland, E.N.; Hultström, M.; Hushmandi, K.; Hussain, J.; Hussein, N.R.; Huynh, C.K.; Huynh, H-H.; Ibitoye, S.E.; Idowu, O.O.; Ihler, A.L.; Ikeda, N.; Ikuta, K.S.; Ilesanmi, O.S.; Ilic, I.M.; Ilic, M.D.; Imam, M.T.; Immurana, M.; Inbaraj, L.R.; Irham, L.M.; Isa, M.A.; Islam, M.R.; Ismail, F.; Ismail, N.E.; Iso, H.; Isola, G.; Iwagami, M.; Iwu, C.C.D.; Iwu-Jaja, C.J.; J, V.; Jaafari, J.; Jacob, L.; Jacobsen, K.H.; Jadidi-Niaragh, F.; Jahankhani, K.; Jahanmehr, N.; Jahrami, H.; Jain, A.; Jain, N.; Jairoun, A.A.; Jaiswal, A.; Jakovljevic, M.; Jalilzadeh Yengejeh, R.; Jamora, R.D.G.; Jatau, A.I.; Javadov, S.; Javaheri, T.; Jayaram, S.; Jeganathan, J.; Jeswani, B.M.; Jiang, H.; Johnson, C.O.; Jokar, M.; Jomehzadeh, N.; Jonas, J.B.; Joo, T.; Joseph, A.; Joseph, N.; Joshi, V.; Joshua, C.E.; Jozwiak, J.J.; Jürisson, M.; Kaambwa, B.; Kabir, A.; Kabir, Z.; Kadashetti, V.; Kahn, E.M.; Kalani, R.; Kaliyadan, F.; Kalra, S.; Kamath, R.; Kanagasabai, T.; Kanchan, T.; Kandel, H.; Kanmiki, E.W.; Kanmodi, K.K.; Kansal, S.K.; Kapner, D.J.; Kapoor, N.; Karagiannidis, E.; Karajizadeh, M.; Karakasis, P.; Karanth, S.D.; Karaye, I.M.; Karch, A.; Karim, A.; Karimi, H.; Karmakar, S.; Kashoo, F.Z.; Kasraei, H.; Kassahun, W.D.; Kassebaum, N.J.; Kassel, M.B.; Katikireddi, S.V.; Kauppila, J.H.; Kawakami, N.; Kaydi, N.; Kayode, G.A.; Kazemi, F.; Keiyoro, P.N.; Kemmer, L.; Kempen, J.H.; Kerr, J.A.; Kesse-Guyot, E.; Khader, Y.S.; Khafaie, M.A.; Khajuria, H.; Khalaji, A.; Khalil, M.; Khalilian, A.; Khamesipour, F.; Khan, A.; Khan, M.N.; Khan, M.; Khan, M.J.; Khan, M.A.B.; Khanmohammadi, S.; Khatab, K.; Khatatbeh, H.; Khatatbeh, M.M.; Khatib, M.N.; Khavandegar, A.; Khayat Kashani, H.R.; Khidri, F.F.; Khodadoust, E.; Khormali, M.; Khorrami, Z.; Khosla, A.A.; Khosrowjerdi, M.; Khreis, H.; Khusun, H.; Kifle, Z.D.; Kim, K.; Kim, M.S.; Kim, Y.J.; Kimokoti, R.W.; Kisa, A.; Kisa, S.; Knibbs, L.D.; Knudsen, A.K.S.; Koh, D.S.Q.; Kolahi, A-A.; Kompani, F.; Kong, J.; Koren, G.; Korja, M.; Korshunov, V.A.; Korzh, O.; Kosen, S.; Kothari, N.; Koul, P.A.; Koulmane Laxminarayana, S.L.; Krishan, K.; Krishnamoorthy, V.; Krishnamoorthy, Y.; Krishnan, B.; Krohn, K.J.; Kuate Defo, B.; Kucuk Bicer, B.; Kuddus, M.A.; Kuddus, M.; Kugbey, N.; Kuitunen, I.; Kulimbet, M.; Kulkarni, V.; Kumar, A.; Kumar, N.; Kumar, V.; Kundu, S.; Kurmi, O.P.; Kusnali, A.; Kusuma, D.; Kutluk, T.; La Vecchia, C.; Ladan, M.A.; Laflamme, L.; Lahariya, C.; Lai, D.T.C.; Lal, D.K.; Lallukka, T.; Lám, J.; Lan, Q.; Lan, T.; Landires, I.; Lanfranchi, F.; Langguth, B.; Lansingh, V.C.; Laplante-Lévesque, A.; Larijani, B.; Larsson, A.O.; Lasrado, S.; Lauriola, P.; Le, H-H.; Le, L.K.D.; Le, N.H.H.; Le, T.T.T.; Leasher, J.L.; Ledda, C.; Lee, M.; Lee, P.H.; Lee, S.W.; Lee, S.W.H.; Lee, Y.H.; LeGrand, K.E.; Leigh, J.; Leong, E.; Lerango, T.L.; Lescinsky, H.; Leung, J.; Li, M-C.; Li, W-Z.; Li, W.; Li, Y.; Li, Z.; Ligade, V.S.; Lim, L-L.; Lim, S.S.; Lin, R-T.; Lin, S.; Liu, C.; Liu, G.; Liu, J.; Liu, J.; Liu, R.T.; Liu, S.; Liu, W.; Liu, X.; Liu, X.; Livingstone, K.M.; Llanaj, E.; Lohiya, A.; López-Bueno, R.; Lopukhov, P.D.; Lorkowski, S.; Lotufo, P.A.; Lozano, R.; Lubinda, J.; Lucchetti, G.; Luo, L.; lv, H.; M Amin, H.I.; Ma, Z.F.; Maass, K.L.; Mabrok, M.; Machairas, N.; Machoy, M.; Mafhoumi, A.; Magdy Abd El Razek, M.; Maghazachi, A.A.; Mahadeshwara Prasad, D.R.; Maharaj, S.B.; Mahmoud, M.A.; Mahmoudi, E.; Majeed, A.; Makram, O.M.; Makris, K.C.; Malasala, S.; Maled, V.; Malhotra, K.; Malik, A.A.; Malik, I.; Malinga, L.A.; Malta, D.C.; Mamun, A.A.; Manda, A.L.; Manla, Y.; Mansour, A.; Mansouri, B.; Mansouri, P.; Mansourian, M.; Mansournia, M.A.; Mantovani, L.G.; Manu, E.; Marateb, H.R.; Maravilla, J.C.; Marsh, E.; Martinez, G.; Martinez-Piedra, R.; Martini, S.; Martins-Melo, F.R.; Martorell, M.; Marx, W.; Maryam, S.; Mathangasinghe, Y.; Mathioudakis, A.G.; Matozinhos, F.P.; Mattumpuram, J.; Maugeri, A.; Maulik, P.K.; Mayeli, M.; Mazidi, M.; Mazzotti, A.; McGrath, J.J.; McKee, M.; McKowen, A.L.W.; McLaughlin, S.A.; McPhail, M.A.; McPhail, S.M.; Mechili, E.A.; Mehmood, A.; Mehmood, K.; Mehrabani-Zeinabad, K.; Mehrabi Nasab, E.; Meier, T.; Mejia-Rodriguez, F.; Mekene Meto, T.; Mekonnen, B.D.; Menezes, R.G.; Mengist, B.; Mensah, G.A.; Mensah, L.G.; Mentis, A-F.A.; Meo, S.A.; Meretoja, A.; Meretoja, T.J.; Mersha, A.M.; Mesfin, B.A.; Mestrovic, T.; Mettananda, K.C.D.; Mettananda, S.; Miazgowski, T.; Micha, G.; Michalek, I.M.; Micheletti Gomide Nogueira de Sá, A.C.; Miller, T.R.; Mirarefin, M.; Mirghafourvand, M.; Mirica, A.; Mirijello, A.; Mirrakhimov, E.M.; Mirshahi, A.; Mirzaei, M.; Mishra, A.K.; Mishra, V.; Mitchell, P.B.; Mithra, P.; Mittal, C.; Moazen, B.; Moberg, M.E.; Mocciaro, G.; Mohamadkhani, A.; Mohamed, A.Z.; Mohamed, A.I.; Mohamed, J.; Mohamed, M.F.H.; Mohamed, N.S.; Mohammadi, E.; Mohammadi, S.; Mohammadian-Hafshejani, A.; Mohammadifard, N.; Mohammed, H.; Mohammed, M.; Mohammed, S.; Mohammed, S.; Mokdad, A.H.; Monasta, L.; Mondello, S.; Moni, M.A.; Moodi Ghalibaf, A.A.; Moore, C.E.; Moradi, M.; Moradi, Y.; Moraga, P.; Morawska, L.; Moreira, R.S.; Morovatdar, N.; Morrison, S.D.; Morze, J.; Mosaddeghi Heris, R.; Mossialos, E.; Motappa, R.; Mougin, V.; Mousavi, P.; Msherghi, A.; Mubarik, S.; Muccioli, L.; Mueller, U.O.; Mulita, F.; Mullany, E.C.; Munjal, K.; Murillo-Zamora, E.; Murlimanju, B.V.; Musina, A-M.; Mustafa, G.; Muthu, S.; Muthupandian, S.; Muthusamy, R.; Muzaffar, M.; Myung, W.; Nafei, A.; Nagarajan, A.J.; Nagaraju, S.P.; Nagel, G.; Naghavi, M.; Naghavi, P.; Naik, G.R.; Naik, G.; Nainu, F.; Nair, T.S.; Najdaghi, S.; Nakhostin Ansari, N.; Nanavaty, D.P.; Nangia, V.; Narasimha Swamy, S.; Narimani Davani, D.; Nascimento, B.R.; Nascimento, G.G.; Nashwan, A.J.; Natto, Z.S.; Nauman, J.; Navaratna, S.N.K.; Naveed, M.; Nayak, B.P.; Nayak, V.C.; Ndejjo, R.; Nduaguba, S.O.; Negash, H.; Negoi, I.; Negoi, R.I.; Nejadghaderi, S.A.; Nejjari, C.; Nematollahi, M.H.; Nepal, S.; Neupane, S.; Ng, M.; Nguefack-Tsague, G.; Ngunjiri, J.W.; Nguyen, D.H.; Nguyen, N.N.Y.; Nguyen, P.T.; Nguyen, P.T.; Nguyen, V.T.; Nguyen Tran Minh, D.; Niazi, R.K.; Nicholson, S.I.; Nie, J.; Nikoobar, A.; Nikpoor, A.R.; Ningrum, D.N.A.; Nnaji, C.A.; Noman, E.A.; Nomura, S.; Noroozi, N.; Norrving, B.; Noubiap, J.J.; Nri-Ezedi, C.A.; Ntaios, G.; Ntsekhe, M.; Nunemo, M.H.; Nurrika, D.; Nutor, J.J.; Oancea, B.; O’Connell, E.M.; Odetokun, I.A.; O’Donnell, M.J.; Oduro, M.S.; Ogunfowokan, A.A.; Ogunkoya, A.; Oh, I-H.; Okati-Aliabad, H.; Okeke, S.R.; Okekunle, A.P.; Okonji, O.C.; Olagunju, A.T.; Olasupo, O.O.; Olatubi, M.I.; Oliveira, A.B.; Oliveira, G.M.M.; Olorukooba, A.A.; Olufadewa, I.I.; Olusanya, B.O.; Olusanya, J.O.; Oluwafemi, Y.D.; Omar, H.A.; Omar Bali, A.; Omer, G.L.; Ong, K.L.; Ong, S.; Onwujekwe, O.E.; Onyedibe, K.I.; Oppong, A.F.; Ordak, M.; Orish, V.N.; Ornello, R.; Orpana, H.M.; Ortiz, A.; Ortiz-Prado, E.; Osman, W.M.S.; Ostroff, S.M.; Osuagwu, U.L.; Otoiu, A.; Otstavnov, N.; Otstavnov, S.S.; Ouyahia, A.; Owolabi, M.O.; Oyeyemi, I.T.; Oyeyemi, O.T.; P A, M.P.; Pacheco-Barrios, K.; Padron-Monedero, A.; Padubidri, J.R.; Pal, P.K.; Palicz, T.; Pan, F.; Pan, H-F.; Pana, A.; Panda, S.K.; Panda-Jonas, S.; Pandey, A.; Pandi-Perumal, S.R.; Pangaribuan, H.U.; Pantazopoulos, I.; Pantea Stoian, A.M.; Papadopoulou, P.; Parent, M.C.; Parija, P.P.; Parikh, R.R.; Park, S.; Park, S.; Parsons, N.; Pashaei, A.; Pasovic, M.; Passera, R.; Patil, S.; Patoulias, D.; Patthipati, V.S.; Paudel, U.; Pawar, S.; Pazoki Toroudi, H.; Peden, A.E.; Pedersini, P.; Peng, M.; Pensato, U.; Pepito, V.C.F.; Peprah, E.K.; Peprah, P.; Peres, M.F.P.; Perianayagam, A.; Perico, N.; Perna, S.; Pesudovs, K.; Petcu, I-R.; Petermann-Rocha, F.E.; Pham, H.T.; Philip, A.K.; Phillips, M.R.; Pickering, B.V.; Pierannunzio, D.; Pigeolet, M.; Pigott, D.M.; Piracha, Z.Z.; Piradov, M.A.; Pisoni, E.; Piyasena, M.P.; Plass, D.; Plotnikov, E.; Poddighe, D.; Polkinghorne, K.R.; Poluru, R.; Pond, C.D.; Popovic, D.S.; Porru, F.; Postma, M.J.; Poudel, G.R.; Pour-Rashidi, A.; Pourshams, A.; Pourtaheri, N.; Prabhu, D.; Prada, S.I.; Pradhan, J.; Pradhan, P.M.S.; Prasad, M.; Prates, E.J.S.; Purnobasuki, H.; Purohit, B.M.; Puvvula, J.; Qasim, N.H.; Qattea, I.; Qazi, A.S.; Qian, G.; Qiu, S.; Rabiee Rad, M.; Radfar, A.; Radhakrishnan, R.A.; Radhakrishnan, V.; Raeisi Shahraki, H.; Rafferty, Q.; Rafiei, A.; Raggi, A.; Raghav, P.R.; Raheem, N.; Rahim, F.; Rahim, M.J.; Rahimifard, M.; Rahimi-Movaghar, V.; Rahman, M.O.; Rahman, M.A.; Rahmani, A.M.; Rahmani, B.; Rahmanian, M.; Rahmanian, N.; Rahmanian, V.; Rahmati, M.; Rahmawaty, S.; Raimondo, D.; Rajaa, S.; Rajendran, V.; Rajput, P.; Ramadan, M.M.; Ramasamy, S.K.; Ramasubramani, P.; Ramazanu, S.; Ramteke, P.W.; Rana, J.; Rana, K.; Ranabhat, C.L.; Rane, A.; Rani, U.; Ranta, A.; Rao, C.R.; Rao, M.; Rao, P.C.; Rao, S.J.; Rasella, D.; Rashedi, S.; Rashedi, V.; Rashidi, M.; Rashidi, M-M.; Rasouli-Saravani, A.; Ratan, Z.A.; Rathnaiah Babu, G.; Rauniyar, S.K.; Rautalin, I.; Rawaf, D.L.; Rawaf, S.; Rawassizadeh, R.; Razo, C.; Reda, Z.F.F.; Reddy, M.M.R.K.; Redwan, E.M.M.; Reifels, L.; Reitsma, M.B.; Remuzzi, G.; Reshmi, B.; Resnikoff, S.; Restaino, S.; Reyes, L.F.; Rezaei, M.; Rezaei, N.; Rezaei, N.; Rezaeian, M.; Rhee, T.G.; Riaz, M.A.; Ribeiro, A.L.P.; Rickard, J.; Robinson-Oden, H.E.; Rodrigues, C.F.; Rodrigues, M.; Rodriguez, J.A.B.; Roever, L.; Romadlon, D.S.; Ronfani, L.; Rosauer, J.J.; Roshandel, G.; Rostamian, M.; Rotimi, K.; Rout, H.S.; Roy, B.; Roy, N.; Rubagotti, E.; Ruela, G.A.; Rumisha, S.F.; Runghien, T.; Russo, M.; Ruzzante, S.W.; S N, C.; Saad, A.M.A.; Saber, K.; Saber-Ayad, M.M.; Sabour, S.; Sacco, S.; Sachdev, P.S.; Sachdeva, R.; Saddik, B.; Saddler, A.; Sadee, B.A.; Sadeghi, E.; Sadeghi, M.; Sadeghi Majd, E.; Saeb, M.R.; Saeed, U.; Safari, M.; Safi, S.; Safi, S.Z.; Sagar, R.; Sagoe, D.; Saheb Sharif-Askari, F.; Saheb Sharif-Askari, N.; Sahebkar, A.; Sahoo, S.S.; Sahu, M.; Saif, Z.; Sajid, M.R.; Sakshaug, J.W.; Salam, N.; Salamati, P.; Salami, A.A.; Salaroli, L.B.; Salehi, L.; Salehi, S.; Salem, M.R.; Salem, M.Z.Y.; Salihu, D.; Salimi, S.; Salum, G.A.; Samadi Kafil, H.; Samadzadeh, S.; Samodra, Y.L.; Samuel, V.P.; Samy, A.M.; Sanabria, J.; Sanjeev, R.K.; Sanna, F.; Santomauro, D.F.; Santric-Milicevic, M.M.; Sarasmita, M.A.; Saraswathy, S.Y.I.; Saravanan, A.; Saravi, B.; Sarikhani, Y.; Sarmiento-Suárez, R.; Sarode, G.S.; Sarode, S.C.; Sartorius, B.; Sarveazad, A.; Sathian, B.; Sattin, D.; Sawhney, M.; Saya, G.K.; Sayeed, A.; Sayeed, M.A.; Sayyah, M.; Schinckus, C.; Schmidt, M.I.; Schuermans, A.; Schumacher, A.E.; Schutte, A.E.; Schwarzinger, M.; Schwebel, D.C.; Schwendicke, F.; Selvaraj, S.; Semreen, M.H.; Senthilkumaran, S.; Serban, D.; Serre, M.L.; Sethi, Y.; Shafie, M.; Shah, H.; Shah, N.S.; Shah, P.A.; Shah, S.M.; Shahbandi, A.; Shaheen, A.A.; Shahid, S.; Shahid, W.; Shahsavari, H.R.; Shahwan, M.J.; Shaikh, M.A.; Shaikh, S.Z.; Shalash, A.S.; Sham, S.; Shamim, M.A.; Shams-Beyranvand, M.; Shamshirgaran, M.A.; Shamsi, M.A.; Shanawaz, M.; Shankar, A.; Sharfaei, S.; Sharifan, A.; Sharifi-Rad, J.; Sharma, M.; Sharma, U.; Sharma, V.; Shastry, R.P.; Shavandi, A.; Shehabeldine, A.M.E.; Shehzadi, S.; Sheikh, A.; Shen, J.; Shetty, A.; Shetty, B.S.K.; Shetty, P.H.; Shiani, A.; Shiferaw, D.; Shigematsu, M.; Shin, M-J.; Shiri, R.; Shittu, A.; Shiue, I.; Shivakumar, K.M.; Shivarov, V.; Shool, S.; Shorofi, S.A.; Shrestha, R.; Shrestha, S.; Shuja, K.H.; Shuval, K.; Si, Y.; Siddig, E.E.; Silva, D.A.S.; Silva, L.M.L.R.; Silva, S.; Silva, T.P.R.; Simpson, C.R.; Singh, A.; Singh, B.B.; Singh, B.; Singh, G.; Singh, H.; Singh, J.A.; Singh, M.; Singh, N.P.; Singh, P.; Singh, S.; Sinto, R.; Sivakumar, S.; Siwal, S.S.; Skhvitaridze, N.; Skou, S.T.; Sleet, D.A.; Sobia, F.; Soboka, M.; Socea, B.; Solaimanian, S.; Solanki, R.; Solanki, S.; Soliman, S.S.M.; Somayaji, R.; Song, Y.; Sorensen, R.J.D.; Soriano, J.B.; Soyiri, I.N.; Spartalis, M.; Spearman, S.; Spencer, C.N.; Sreeramareddy, C.T.; Stachteas, P.; Stafford, L.K.; Stanaway, J.D.; Stanikzai, M.H.; Stein, C.; Stein, D.J.; Steinbeis, F.; Steiner, C.; Steinke, S.; Steiropoulos, P.; Stockfelt, L.; Stokes, M.A.; Straif, K.; Stranges, S.; Subedi, N.; Subramaniyan, V.; Suleman, M.; Suliankatchi Abdulkader, R.; Sundström, J.; Sunkersing, D.; Sunnerhagen, K.S.; Suresh, V.; Swain, C.K.; Szarpak, L.; Szeto, M.D.; Tabaee Damavandi, P.; Tabarés-Seisdedos, R.; Tabatabaei, S.M.; Tabatabaei Malazy, O.; Tabatabaeizadeh, S-A.; Tabatabai, S.; Tabche, C.; Tabish, M.; Tadakamadla, S.K.; Taheri Abkenar, Y.; Taheri Soodejani, M.; Taherkhani, A.; Taiba, J.; Takahashi, K.; Talaat, I.M.; Tamuzi, J.L.; Tan, K-K.; Tang, H.; Tat, N.Y.; Taveira, N.; Tefera, Y.M.; Tehrani-Banihashemi, A.; Temesgen, W.A.; Temsah, M-H.; Teramoto, M.; Terefa, D.R.; Teye-Kwadjo, E.; Thakur, R.; Thangaraju, P.; Thankappan, K.R.; Thapar, R.; Thayakaran, R.; Thirunavukkarasu, S.; Thomas, N.; Thomas, N.K.; Tian, J.; Tichopad, A.; Ticoalu, J.H.V.; Tiruye, T.Y.; Tobe-Gai, R.; Tolani, M.A.; Tolossa, T.; Tonelli, M.; Topor-Madry, R.; Topouzis, F.; Touvier, M.; Tovani-Palone, M.R.; Trabelsi, K.; Tran, J.T.; Tran, M.T.N.; Tran, N.M.; Trico, D.; Trihandini, I.; Troeger, C.E.; Tromans, S.J.; Truyen, T.T.T.T.; Tsatsakis, A.; Tsermpini, E.E.; Tumurkhuu, M.; Udoakang, A.J.; Udoh, A.; Ullah, A.; Ullah, S.; Ullah, S.; Umair, M.; Umakanthan, S.; Unim, B.; Unnikrishnan, B.; Upadhyay, E.; Urso, D.; Usman, J.S.; Vaithinathan, A.G.; Vakili, O.; Valenti, M.; Valizadeh, R.; Van den Eynde, J.; van Donkelaar, A.; Varga, O.; Vart, P.; Varthya, S.B.; Vasankari, T.J.; Vasic, M.; Vaziri, S.; Venketasubramanian, N.; Verghese, N.A.; Verma, M.; Veroux, M.; Verras, G-I.; Vervoort, D.; Villafañe, J.H.; Villalobos-Daniel, V.E.; Villani, L.; Villanueva, G.I.; Vinayak, M.; Violante, F.S.; Vlassov, V.; Vo, B.; Vollset, S.E.; Volovat, S.R.; Vos, T.; Vujcic, I.S.; Waheed, Y.; Wang, C.; Wang, F.; Wang, S.; Wang, Y.; Wang, Y-P.; Wanjau, M.N.; Waqas, M.; Ward, P.; Waris, A.; Wassie, E.G.; Weerakoon, K.G.; Weintraub, R.G.; Weiss, D.J.; Weiss, E.J.; Weldetinsaa, H.L.L.; Wells, K.M.; Wen, Y.F.; Wiangkham, T.; Wickramasinghe, N.D.; Wilkerson, C.; Willeit, P.; Wilson, S.; Wong, Y.J.; Wongsin, U.; Wozniak, S.; Wu, C.; Wu, D.; Wu, F.; Wu, Z.; Xia, J.; Xiao, H.; Xu, S.; Xu, X.; Xu, Y.Y.; Yadav, M.K.; Yaghoubi, S.; Yamagishi, K.; Yang, L.; Yano, Y.; Yaribeygi, H.; Yasufuku, Y.; Ye, P.; Yesodharan, R.; Yesuf, S.A.; Yezli, S.; Yi, S.; Yiğit, A.; Yigzaw, Z.A.; Yin, D.; Yip, P.; Yismaw, M.B.; Yon, D.K.; Yonemoto, N.; You, Y.; Younis, M.Z.; Yousefi, Z.; Yu, C.; Yu, Y.; Zadey, S.; Zadnik, V.; Zakham, F.; Zaki, N.; Zakzuk, J.; Zamagni, G.; Zaman, S.B.; Zandieh, G.G.Z.; Zanghì, A.; Zar, H.J.; Zare, I.; Zarimeidani, F.; Zastrozhin, M.S.; Zeng, Y.; Zhai, C.; Zhang, A.L.; Zhang, H.; Zhang, L.; Zhang, M.; Zhang, Y.; Zhang, Z.; Zhang, Z-J.; Zhao, H.; Zhao, J.T.; Zhao, X-J.G.; Zhao, Y.; Zhao, Y.; Zhong, C.; Zhou, J.; Zhou, J.; Zhou, S.; Zhu, B.; Zhu, L.; Zhu, Z.; Ziaeian, B.; Ziafati, M.; Zielińska, M.; Zimsen, S.R.M.; Zoghi, G.; Zoller, T.; Zumla, A.; Zyoud, S.H.; Zyoud, S.H.; Murray, C.J.L.; Gakidou, E. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: A systematic analysis for the global burden of disease study 2021.Lancet2024403104402162220310.1016/S0140‑6736(24)00933‑438762324
    [Google Scholar]
  16. KarakasisP. PatouliasD. StachteasP. LefkouE. DimitroulasT. FragakisN. Accelerated atherosclerosis and management of cardiovascular risk in autoimmune rheumatic diseases: An updated review.Curr. Probl. Cardiol.2023481210199910.1016/j.cpcardiol.2023.10199937506959
    [Google Scholar]
  17. SoleimaniH. MousaviA. ShojaeiS. TavakoliK. SalabatD. Farahani RadF. AskariM.K. NelsonJ. RuziehM. HosseiniK. Safety and effectiveness of high‐intensity statins versus low/moderate‐intensity statins plus ezetimibe in patients with atherosclerotic cardiovascular disease for reaching LDL‐C goals: A systematic review and meta‐analysis.Clin. Cardiol.20244782433410.1002/clc.2433439135464
    [Google Scholar]
  18. GholamalizadehH. EnsanB. KaravS. JamialahmadiT. SahebkarA. Regulatory effects of statins on CCL2/CCR2 axis in cardiovascular diseases: New insight into pleiotropic effects of statins.J. Inflamm.20242115110.1186/s12950‑024‑00420‑y39696507
    [Google Scholar]
  19. LinY.W. WangC.C. WuC.C. HsuY.T. LinF.J. Effectiveness of statins for the primary prevention of cardiovascular disease in the Asian elderly population.Int. J. Cardiol.2023373253210.1016/j.ijcard.2022.11.03136435332
    [Google Scholar]
  20. NewmanC.B. PreissD. TobertJ.A. JacobsonT.A. PageR.L. GoldsteinL.B. ChinC. TannockL.R. MillerM. RaghuveerG. DuellP.B. BrintonE.A. PollakA. BraunL.T. WeltyF.K. Statin safety and associated adverse events: A scientific statement from the American heart association.Arterioscler. Thromb. Vasc. Biol.2019392e38e8110.1161/ATV.000000000000007330580575
    [Google Scholar]
  21. ŠimićI. ReinerZ. Adverse effects of statins - Myths and reality.Curr. Pharm. Des.20152191220122610.2174/138161282066614101313444725312733
    [Google Scholar]
  22. AdhyaruB.B. JacobsonT.A. Safety and efficacy of statin therapy.Nat. Rev. Cardiol.2018151275776910.1038/s41569‑018‑0098‑530375494
    [Google Scholar]
  23. ChiX. ZhangH. ZhangS. MaK. Chinese herbal medicine for gout: A review of the clinical evidence and pharmacological mechanisms.Chin. Med.20201511710.1186/s13020‑020‑0297‑y32082411
    [Google Scholar]
  24. ChengL. PanG. ZhangX. WangJ. WangW. ZhangJ. WangH. LiangR. SunX. Author Correction: Yindanxinnaotong, a Chinese compound medicine, synergistically attenuates atherosclerosis progress.Sci. Rep.2025151184010.1038/s41598‑024‑81400‑339805843
    [Google Scholar]
  25. ChengL. LiuY. SunX. The clinical efficacy of yindanxinnaotong soft capsule in the treatment of stroke and angina pectoris: A meta‐analysis.Evid. Based Complement. Alternat. Med.201720171206054910.1155/2017/206054928539962
    [Google Scholar]
  26. GongL. XuH. YuanH. WangL. YinX. FanM. ChengL. MaX. LiangR. YangH. Identification of absorbed constituents and evaluation of the pharmacokinetics of main compounds after oral administration of yindanxinnaotong by UPLC-Q-TOF-MS and UPLC-QqQ-MS.RSC Advances2018828157251573910.1039/C7RA12659J35539456
    [Google Scholar]
  27. JiH. DongZ. YangY. CuiW. HanJ. HuY. ChenH. QiaoC. LiQ. LiH. WuS. Neixiao-ruanmai decoction No 2 improves carotid atherosclerosis by modulating gut microbiota and inhibiting TLR4/NF-κB pathway activation.Phytomedicine202514215677510.1016/j.phymed.2025.15677540286751
    [Google Scholar]
  28. ShiY. ZhangY. CaiY. YanZ. JingY. ZhuY. LiH. ZhengG. ChenJ. YangX. HuangY. GanY. HanY. YongH. XiongQ. Key proteins identification of Buyang Huanwu Decoction in regulating macrophage polarization to alleviate atherosclerosis via an integrated strategy combining network pharmacology, batch molecular docking and experimental verification.Int. J. Biol. Macromol.2025310Pt 314338010.1016/j.ijbiomac.2025.14338040258538
    [Google Scholar]
  29. ChengS. LuoW. ZhangZ. LiJ. LiX. WangY. WengX. DongZ. Shexiang Baoxin Pill alleviates atherosclerosis by inhibiting macrophage-mediated inflammation via suppressing KMT5A mediated Irf7 transcription.J. Ethnopharmacol.202534811983310.1016/j.jep.2025.11983340252984
    [Google Scholar]
  30. HeX. LiZ. LiS. ZhangX. LiuD. HanX. HeH. ChenJ. DongX. LongW. LuH. YeT. MengF. LiaoH. YangZ. LuL. NiS. Huoxue Tongluo tablet enhances atherosclerosis efferocytosis by promoting the differentiation of Trem2+ macrophages via PPARγ signaling pathway.Phytomedicine202514015657910.1016/j.phymed.2025.15657940068297
    [Google Scholar]
  31. GuoY. LiuX.C. WangY.J. LiQ. YangQ. WengX.G. ChenY. CaiW.Y. KanX.X. ChenX. HuangH.F. ZhuX.X. LiY.J. Effects of Shenlian extract on experimental atherosclerosis in ApoE-deficient mice based on ultrasound biomicroscopy.BMC Complement. Altern. Med.201616146910.1186/s12906‑016‑1449‑627846838
    [Google Scholar]
  32. LiuL. LiQ. YinJ. ZhaoZ. SunL. RanQ. DuX. WangY. LiY. YangQ. ChenY. WengX. CaiW. ZhuX. ShenLian extract enhances TGF-β functions in the macrophage-SMC unit and stabilizes atherosclerotic plaques.Front. Pharmacol.20211266973010.3389/fphar.2021.66973034122091
    [Google Scholar]
  33. HanS. NieC. WangC. SongM. LiJ. CuiX. YangQ. LiY. ChenY. LiQ. CaiW. WengX. WangY. ZhuX. Shenlian extract improves atherosclerosis by relieving adventitial inflammation.J. Ethnopharmacol.202432011733910.1016/j.jep.2023.11733937866468
    [Google Scholar]
  34. LiJ.J. WangY.J. WangC.M. LiY.J. YangQ. CaiW.Y. ChenY. ZhuX.X. Shenlian extract decreases mitochondrial autophagy to regulate mitochondrial function in microvascular to alleviate coronary artery no‐reflow.Phytother. Res.20233751864188210.1002/ptr.770336740450
    [Google Scholar]
  35. ChenW. ChenG. Danshen (Salvia miltiorrhiza Bunge): A prospective healing sage for cardiovascular diseases.Curr. Pharm. Des.201723345125513510.2174/138161282366617082210111228828985
    [Google Scholar]
  36. ChenY. LiuJ. ZhangJ. YangL. JinL. Research progress in the quality evaluation of Salvia miltiorrhiza based on the association of ‘morphological features — Functional substances — pharmacological action — Clinical efficacy’.Heliyon20239102032510.1016/j.heliyon.2023.e2032537780757
    [Google Scholar]
  37. LiZ. XuS. LiuP. Salvia miltiorrhizaBurge (Danshen): A golden herbal medicine in cardiovascular therapeutics.Acta Pharmacol. Sin.201839580282410.1038/aps.2017.19329698387
    [Google Scholar]
  38. YangR. HuangS. YanF. LuX. XingY. LiuY. LiuY. ZhaoY. Danshensu protects vascular endothelia in a rat model of hyperhomocysteinemia.Acta Pharmacol. Sin.201031101395140010.1038/aps.2010.16720871618
    [Google Scholar]
  39. WuY. XuS. TianX.Y. The effect of salvianolic acid on vascular protection and possible mechanisms.Oxid. Med. Cell. Longev.202020201910.1155/2020/547209633062143
    [Google Scholar]
  40. GaoY. YeF. DongY. WangT. XiongL. ChenT. WangY. LiuX. ZhangY. QiuZ. JiangJ. LiuX. HuQ. ZhangC. Salvianic acid A ameliorates atherosclerosis through metabolic-dependent anti-EndMT pathway and repression of TGF-β/ALK5 signaling.Phytomedicine202513615630710.1016/j.phymed.2024.15630739740380
    [Google Scholar]
  41. YangS. ChenH. SuW. Protective effects of Salvianic acid A against multiple-organ ischemia-reperfusion injury: a review.Front. Pharmacol.202314129712410.3389/fphar.2023.129712438089048
    [Google Scholar]
  42. SongQ. ZhangY. han, X.; Zhang, Y.; Zhang, X.; Gao, Y.; Zhang, J.; Chu, L.; Zhao, S. Potential mechanisms underlying the protective effects of salvianic acid A against atherosclerosis in vivo and vitro.Biomed. Pharmacother.201910994595610.1016/j.biopha.2018.10.14730551549
    [Google Scholar]
  43. ZhouX. ChanS.W. TsengH.L. DengY. HoiP.M. ChoiP.S. OrP.M.Y. YangJ. LamF.F.Y. LeeS.M.Y. LeungG.P.H. KongS.K. HoH.P. KwanY.W. YeungJ.H.K. Danshensu is the major marker for the antioxidant and vasorelaxation effects of Danshen (Salvia miltiorrhiza) water-extracts produced by different heat water-extractions.Phytomedicine201219141263126910.1016/j.phymed.2012.08.01123026310
    [Google Scholar]
  44. KumarS. SinghB. BajpaiV. Andrographis paniculata (Burm.f.) Nees: Traditional uses, phytochemistry, pharmacological properties and quality control/quality assurance.J. Ethnopharmacol.202127511405410.1016/j.jep.2021.11405433831465
    [Google Scholar]
  45. TyagiV. KumarA. ShankerK. PalA. Andrographis paniculata restores gut health by suppressing inflammation and strengthening mucosal immunity.Front. Pharmacol.202516153668310.3389/fphar.2025.153668340242449
    [Google Scholar]
  46. SongvutP. RangkadilokN. PholphanaN. Comparative pharmacokinetics and safety evaluation of high dosage regimens of Andrographis paniculata aqueous extract after single and multiple oral administration in healthy participants.Front. Pharmacol.202314123040110.3389/fphar.2023.123040137663270
    [Google Scholar]
  47. HsiehY.L. ShibuM.A. LiiC.K. ViswanadhaV.P. LinY.L. LaiC.H. ChenY.F. LinK.H. KuoW.W. HuangC.Y. Andrographis paniculata extract attenuates pathological cardiac hypertrophy and apoptosis in high-fat diet fed mice.J. Ethnopharmacol.201619217017710.1016/j.jep.2016.07.01827401291
    [Google Scholar]
  48. ChenC.C. LiiC.K. LiuK.L. LinY.L. LoC.W. LiC.C. YangY.C. ChenH.W. Andrographolide attenuates oxidized LDL-induced activation of the NLRP3 inflammasome in bone marrow-derived macrophages and mitigates HFCCD-induced atherosclerosis in mice.Am. J. Chin. Med.20235182175219310.1142/S0192415X2350093337930331
    [Google Scholar]
  49. GouT. HuM. XuM. ChenY. ChenR. ZhouT. LiuJ. GuoL. AoH. YeQ. Novel wine in an old bottle: Preventive and therapeutic potentials of andrographolide in atherosclerotic cardiovascular diseases.J. Pharm. Anal.202313656358910.1016/j.jpha.2023.05.01037440909
    [Google Scholar]
  50. LiuY. LiuY. ZhangH.L. YuF.F. YinX.R. ZhaoY.F. YeF. WuX.Q. Amelioratory effect of neoandrographolide on myocardial ischemic‐reperfusion injury by its anti‐inflammatory and anti‐apoptotic activities.Environ. Toxicol.202136122367237910.1002/tox.2335034397165
    [Google Scholar]
  51. WuT. PengY. YanS. LiN. ChenY. LanT. Andrographolide ameliorates atherosclerosis by suppressing pro-inflammation and ros generation-mediated foam cell formation.Inflammation20184151681168910.1007/s10753‑018‑0812‑929948505
    [Google Scholar]
  52. ZhouY. WangP. ZhouZ. ZhouM. ChiM. ZhengL. HuangY. Quantitative analysis of three bioactive components of Biancaea decapetala extracts in rat plasma and RAW264.7 cells using UPLC-MS/MS and its application to comparative pharmacokinetics in normal and diseased states.J. Chromatogr. B Analyt. Technol. Biomed. Life Sci.2024124812435610.1016/j.jchromb.2024.12435639509965
    [Google Scholar]
  53. LiuC. YouJ. ZhouK. GongZ. PanJ. SunJ. LiuT. WangA. WangY. LuY. LiY. Comparative pharmacokinetics of 11 components from the active part of Gerberae Piloselloidis Herba after oral administration in control and asthmatic mice.J. Sep. Sci.202245224023403810.1002/jssc.20210101036070105
    [Google Scholar]
  54. MeiY. TongX. HuY. LiuW. WangJ. LvK. LiX. CaoL. WangZ. XiaoW. GaoX. Comparative pharmacokinetics of six bioactive components of Shen-Wu-Yi-Shen tablets in normal and chronic renal failure rats based on UPLC-TSQ-MS/MS.J. Ethnopharmacol.202331711681810.1016/j.jep.2023.11681837348793
    [Google Scholar]
  55. SunH. FrassettoL. BenetL.Z. Effects of renal failure on drug transport and metabolism.Pharmacol. Ther.20061091-211110.1016/j.pharmthera.2005.05.01016085315
    [Google Scholar]
  56. ShiY. ZhongG. HuangH. LiN. ZengJ. ZhuJ. YuanJ. LiangJ. Comparative pharmacokinetics of five primary constituents in Huai-hua powder: A study on normal rats and rats with ulcerative colitis.J. Pharm. Pharmacol.20247691160116810.1093/jpp/rgae06238913100
    [Google Scholar]
  57. XiongS. LiX. ChuH. Comparative pharmacokinetics of four major compounds after oral administration of Mori Cortex total flavonoid extract in normal and diabetic rats.Front. Pharmacol.202314114833210.3389/fphar.2023.114833236937873
    [Google Scholar]
  58. Xing-xingC. Ri-jinH. Xin-geW. Cai-yingY. QingY. YingC. QiL. Xiao-xinZ. LihongY. LongC. YuD. Mechanistic exploration of the shenlian formula in the suppression of atherosclerosis progression via network pharmacology and in vivo experimental validation.J. Ethnopharmacol.202433311834710.1016/j.jep.2024.11834738801914
    [Google Scholar]
  59. QuS.Q. LiangY. DengS.Q. LiY. DaiY. LiuC.C. LiuT. WangL.Q. ChenL.N. LiY.J. Shenlian extract protects against ultrafine particulate matter-aggravated myocardial ischemic injury by inhibiting inflammation and cell apoptosis.Biomed. Environ. Sci.202538220621810.3967/bes2024.13740159173
    [Google Scholar]
  60. QuS. LiK. YangT. YangY. ZhengZ. LiuH. WangX. ZhangY. DengS. ZhuX. ChenL. LiY. Shenlian extract protects against ultrafine particulate matter‐aggravated myocardial ischemic injury by inhibiting inflammation response via the activation of NLRP3 inflammasomes.Environ. Toxicol.20213671349136110.1002/tox.2313133729688
    [Google Scholar]
  61. SongM. CuiX. ZhangJ. Shenlian extract attenuates myocardial ischaemia-reperfusion injury via inhibiting M1 macrophage polarization by silencing miR-155.Pharm. Biol.20226012011202410.1080/13880209.2022.211782836239618
    [Google Scholar]
  62. National Pharmacopoeia CommitteeThe State Pharmacopoeia Chinese Pharmacopoeia: four. China Medical Science and Technology Press, Beijing.
    [Google Scholar]
  63. QiuJ.M. QinC.F. WuS.G. JiT.Y. TangG.T. LeiX.Y. CaoX. XieZ.Z. A novel salvianolic acid A analog with resveratrol structure and its antioxidant activities in vitro and in vivo.Drug Dev. Res.202182110811410.1002/ddr.2173432780460
    [Google Scholar]
  64. LiuJ. XuP. LiuD. WangR. CuiS. ZhangQ. LiY. YangW. ZhangD. TCM regulates PI3K/Akt signal pathway to intervene atherosclerotic cardiovascular disease.Evid. Based Complement. Alternat. Med.2021202111110.1155/2021/485475534956379
    [Google Scholar]
  65. LiP. ChenJ. WangJ. ZhouW. WangX. LiB. TaoW. WangW. WangY. YangL. Systems pharmacology strategies for drug discovery and combination with applications to cardiovascular diseases.J. Ethnopharmacol.201415119310710.1016/j.jep.2013.07.00123850710
    [Google Scholar]
  66. ChenB. SunS. FuJ. GeL. NieW. ZhouP. CaoP. ZhouQ. Ethanol extract of Portulaca oleracea L. mitigates atherosclerosis through modulation of cholesterol efflux and uptake pathways.Front. Pharmacol.202516155081210.3389/fphar.2025.155081240176886
    [Google Scholar]
  67. QiJ. ZhouS. WangG. HuaR. WangX. HeJ. WangZ. ZhuY. LuoJ. ShiW. LuoY. ChenX. The antioxidant Dendrobium officinale polysaccharide modulates host metabolism and gut microbiota to alleviate high-fat diet-induced atherosclerosis in ApoE−/− mice.Antioxidants202413559910.3390/antiox1305059938790704
    [Google Scholar]
  68. YeW. WangJ. LittleP.J. ZouJ. ZhengZ. LuJ. YinY. LiuH. ZhangD. LiuP. XuS. YeW. LiuZ. Anti-atherosclerotic effects and molecular targets of ginkgolide B from Ginkgo biloba.Acta Pharm. Sin. B202414111910.1016/j.apsb.2023.09.01438239238
    [Google Scholar]
  69. LiD. LiY. YangS. YuZ. XingY. WuM. Mechanism and potential target of blood-activating chinese botanical drugs combined with anti-platelet drugs: Prevention and treatment of atherosclerotic cardiovascular diseases.Front. Pharmacol.20221381142210.3389/fphar.2022.81142235721128
    [Google Scholar]
  70. Atilano-RoqueA. RodaG. FogueriU. KiserJ.J. JoyM.S. Effect of disease pathologies on transporter expression and function.J. Clin. Pharmacol.201656Suppl. 7S205S22110.1002/jcph.76827385176
    [Google Scholar]
  71. HuangY. ZhouZ. YangW. GongZ. LiY. ChenS. WangY. WangA. LanY. LiuT. ZhengL. Comparative pharmacokinetics of gallic acid, protocatechuic acid, and quercitrin in normal and pyelonephritis rats after oral administration of a Polygonum capitatum extract.Molecules20192421387310.3390/molecules2421387331717895
    [Google Scholar]
  72. ZhaoM. QianD. ShangE. JiangS. GuoJ. LiuP. SuS. DuanJ. DuL. TaoJ. Comparative pharmacokinetics of the main compounds of Shanzhuyu extract after oral administration in normal and chronic kidney disease rats.J. Ethnopharmacol.201517328028610.1016/j.jep.2015.07.03726231452
    [Google Scholar]
  73. PanY. ZhangW. ZhangW. BaiX. RenS. ZhengJ. WangD. LiuX. Pharmacokinetic comparison of two phenolic acids after oral administration of Typhae pollen to normal rats and rats with acute cold blood stasis.Biomed. Chromatogr.20173112402810.1002/bmc.402828622708
    [Google Scholar]
  74. XiR. AbdullaR. SherzodJ. IvanovnaV.V. HabasiM. LiuY. Metabolic and Pharmacokinetic Profiling Studies of N, N-Dimethylaniline-Heliamine in Rats by UHPLC-Q-Orbitrap MS/MS.Molecules20242918432410.3390/molecules2918432439339319
    [Google Scholar]
  75. ZhangW. WangR. LiL. ChenJ. ZhaiJ. WangW. LiuS. LiuH. WeiH. HanS. Effect of Wuzhi capsule (WZC) on the pharmacokinetics of tacrolimus in renal transplantation recipients.Curr. Drug Metab.2025261810.2174/011389200232068625031005415240108919
    [Google Scholar]
  76. LiX. WangM. ZhongY. YinQ. HuZ. TianW. LiuZ. LiuZ. Comparative pharmacokinetics of six components in normal and rheumatoid arthritis rats after intragastrical administration of Qianghuo Shengshi Decoction granules by LC-MS/MS.Chin. Herb. Med.202416345746510.1016/j.chmed.2023.07.00539072204
    [Google Scholar]
  77. CiceklerM.A. OguzH. CorumO. Effect of salbutamol on the disposition kinetics of levofloxacin in the plasma and lung of rats.Curr. Drug Metab.202425642543010.2174/011389200231413624081609460939171585
    [Google Scholar]
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