| Objective:To investigate the effect of modified Huanglian Wendan Decoction (HLWDD) on trimethylamine N-oxide (TMAO) production and the lipid-inflammatory network in patients with coronary heart disease (CHD) complicated by atrial fibrillation (AF).Methods: A total of 120 CHD-AF patients admitted to Hubei Provincial Hospital of Traditional Chinese Medicine (March 2023–March 2025) were enrolled. The control group received conventional Western therapy, while the observation group received additional oral modified HLWDD. Therapeutic efficacy and relevant indicators were compared.Results:①Post-treatment TMAO levels were significantly lower in the observation group [(3.62±1.24) μmol/L vs. control: (4.78±1.72) μmol/L; P＜0.05].②The observation group exhibited markedly reduced TC [(4.83±0.61) mmol/L], TG [(1.72±0.42) mmol/L], and LDL-C [(1.81±0.27) mmol/L], alongside elevated HDL-C [(1.37±0.21) mmol/L] versus controls [TC: (5.67 ± 0.73) mmol/L; TG: (2.31 ± 0.55) mmol/L; LDL-C: (2.44±0.33) mmol/L; HDL-C: (1.09±0.19) mmol/L] (P＜0.05).③Inflammatory markers (hs-CRP, IL-6, TNF-α) were significantly lower in the observation group [hs-CRP: (3.57±0.48) mg/L; IL-6: (5.38±0.45) pg/L; TNF-α: (9.69±1.26) pg/L] than controls [hs-CRP: (5.42±0.63) mg/L; IL-6: (7.72±0.73) pg/L; TNF-α: (13.89±1.89) pg/L] (P＜0.05).④Oxidative stress improved in the observation group, with lower MDA [(4.64±1.18) nmol/mL] and higher SOD [(96.88±10.73) U/mL] versus controls [MDA: (5.91±1.43) nmol/mL; SOD: (88.15±11.96) U/mL] (P＜0.05).⑤Electrocardiographic parameters significantly favored the observation group: reduced mean ventricular rate [(69.77±5.35) bpm], fewer arrhythmias (12 cases of ECG abnormalities; 3 PVCs; 1 rapid ventricular rate; 2 ST-T changes; 2 long R-R intervals) (P＜0.05).⑥At 4 and 12 weeks, TCM symptom scores decreased more substantially in the observation group [4w: (15.25±2.26) vs. control (19.61±2.98); 12w: (11.61 ± 1.87) vs. control (14.85±2.16)] (P＜0.01).⑦Cardiovascular event incidence was lower in the observation group [1.96% (1/51; 1 non-fatal MI)] than controls [9.43% (5/53; 3 HF exacerbations; 2 strokes)] (χ2 = 3.15, P＜0.05). Adverse events showed no intergroup difference in hepatic/renal dysfunction (P＞0.05); 2 cases of transient gastrointestinal discomfort (HLWDD-related) resolved after dosing adjustment.Conclusion:Adjunct modified HLWDD effectively reduces serum TMAO, ameliorates dyslipidemia, attenuates inflammation and oxidative stress, improves ventricular rate/ECG parameters, lowers TCM symptom scores, and decreases cardiovascular events with favorable safety in CHD-AF patients, warranting clinical adoption. |