Evaluation of the Therapeutic Potential and Safety of Terminalia arjuna in Heart Failure Management: A Systematic Review and Meta-analysis of Randomized Controlled Trials

INTRODUCTION: Herbal remedies such as Terminalia arjuna have been explored as adjuncts to conventional therapies for heart failure because of their potential cardioprotective properties attributed to bioactive compounds including flavonoids, glycosides, and triterpenoids. This systematic review and meta-analysis synthesized evidence from randomized controlled trials (RCTs) to evaluate the efficacy and safety of T. arjuna in adults with heart failure. METHODS: This systematic review and meta-analysis was conducted following PROSPERO registration. PubMed, Cochrane Library, Scopus, and Web of Science databases were searched for comparative studies published up to December 2025 evaluating Terminalia arjuna for improving cardiac function in adults with heart failure. Data were analyzed using RevMan software. RESULTS: Nine studies involving 537 patients were included in the meta-analysis. Terminalia arjuna significantly reduced left ventricular mass (mean difference [MD]: -44.32; P = 0.0001) with no heterogeneity, suggesting potential favorable effects on cardiac remodeling. Left ventricular ejection fraction showed a modest but non-significant improvement (MD: 1.85; P = 0.1). High-density lipoprotein levels increased significantly (MD: 3.53; P = 0.0006), whereas blood pressure, triglycerides, and low-density lipoprotein levels showed no significant changes. CONCLUSION: Terminalia arjuna may serve as a potential adjunctive therapy in heart failure, demonstrating reductions in left ventricular mass and improvement in high-density lipoprotein levels. However, inconsistent effects on ejection fraction and other cardiovascular parameters underscore the need for larger, high-quality trials to confirm its efficacy and safety.