meta-analysisEvidence: limited
Heart failure (pooled)
Systematic review and meta-analysis of comparative studies to Dec 2025; 9 studies, 537 adults with heart failure; PROSPERO-registered.
Arjuna was associated with a reduction in left ventricular mass (MD -44.32) and a rise in HDL-cholesterol (MD 3.53); the improvement in ejection fraction was modest and not statistically significant (MD 1.85, p = 0.1); blood pressure, triglycerides and LDL did not change significantly.[3]
Limitations: Small, mostly Indian trials of varying preparations; authors call for larger high-quality trials; published online ahead of print in a general medical journal.
meta-analysisEvidence: limited
Heart failure (network comparison)
Network meta-analysis of 28 RCTs (3,650 patients) of 15 plant extracts in heart failure, searched to June 2024.
Water extract of arjuna stem bark ranked first (SUCRA 80.4%) for the number of patients with improved NYHA class; it did not lead on ejection fraction, quality of life or 6-minute walk.[4]
Limitations: SUCRA rankings rest on few arjuna trials and indirect comparisons; authors urge cautious interpretation.
RCTEvidence: moderate
Chronic heart failure (largest trial)
Double-blind, placebo-controlled add-on trial, AIIMS New Delhi; n = 100, NYHA class II, LVEF ≤40%, on standard therapy; standardised water extract 750 mg twice daily vs placebo for 12 weeks.
Null on the primary outcome: no change in LVEF (24.3% vs 25.5%, p = 0.4) and no difference in most secondary outcomes; well tolerated. Post-hoc subgroup analyses suggested gains in 6-minute walk distance, antioxidant markers and some quality-of-life domains in some patients.[6]
Limitations: 12 weeks only; post-hoc findings are hypothesis-generating; one co-author affiliated with an Ayurvedic manufacturer.
RCTEvidence: preliminary
Severe refractory heart failure
Double-blind crossover; n = 12, NYHA class IV (mostly dilated cardiomyopathy); bark extract 500 mg every 8 hours vs placebo, 2 weeks each, added to maximal conventional therapy; followed by open-label phase (mean 24 months).
Compared with placebo, arjuna was associated with improved symptoms and NYHA class, smaller LV volumes and higher LVEF (35.3% vs 30.2%).[7]
Limitations: Very small sample, 2-week periods, single centre; long-term phase uncontrolled.
systematic reviewEvidence: limited
Chronic stable angina (pooled)
Systematic review and meta-analysis (PGIMER Chandigarh) of randomised, pseudo-randomised and before-after studies comparing arjuna or commercial arjuna products with standard treatment.
Included studies were of poor methodological design; no significant difference between arjuna and control for the outcomes that could be pooled. Evidence judged insufficient to draw conclusions for or against arjuna in stable angina.[5]
Limitations: Few, small, heterogeneous studies, some using multi-herb products.
RCTEvidence: limited
Chronic stable angina
Double-blind, placebo-controlled crossover; n = 58 men with provocable ischaemia; bark extract 500 mg every 8 hours vs isosorbide mononitrate 40 mg/day vs placebo, 1 week each.
Compared with placebo, arjuna was associated with fewer angina episodes, less rescue nitrate use and better treadmill parameters (exercise duration 6.14 vs 4.76 min); results were similar to isosorbide mononitrate; no significant untoward effects reported.[8]
Limitations: One-week treatment periods; men only; single centre.
RCTEvidence: limited
Blood lipids in coronary heart disease
n = 105 CHD patients not on lipid-lowering drugs, Latin-square allocation to placebo, vitamin E 400 IU/day, or bark powder 500 mg/day for 30 days.
Arjuna group showed within-group falls in total cholesterol (-9.7%) and LDL (-15.8%), with no significant lipid change in placebo or vitamin E groups; lipid peroxides fell with both arjuna and vitamin E.[9]
Limitations: 30 days; within-group comparisons; Latin-square rather than conventional randomisation; single centre.
RCTEvidence: limited
Lipids and inflammation in stable CAD
Randomised, double-blind, placebo-controlled; n = 116 stable CAD patients on usual medication; arjuna 500 mg twice daily; markers at 3 and 6 months.
Arjuna was associated with lower triglycerides, VLDL-C and immuno-inflammatory markers versus placebo.[10]
Limitations: Surrogate markers only; microarray work on a few samples.
RCTEvidence: preliminary
Cardiovascular risk factors vs conventional drugs
Unani setting; n = 48 (40 completed); Arjun Chāl powder 5 g twice daily vs amlodipine 5 mg + atorvastatin 10 mg for 8 weeks.
Both groups improved lipids, blood pressure and BMI; between-group difference was not statistically significant.[12]
Limitations: Small, open comparison; not designed as non-inferiority; short.
RCTEvidence: preliminary
Stage 1 essential hypertension (add-on)
Triple-blind, placebo-controlled; n = 44; arjuna 1.5 g twice daily vs placebo for 28 days, all on telmisartan 40 mg.
Greater fall in systolic and diastolic BP and in cholesterol, triglycerides and VLDL in the arjuna group than placebo; no drug-related adverse events reported.[13]
Limitations: Small, 4 weeks, single centre.
RCTEvidence: preliminary
Endothelial function in smokers
Double-blind crossover; n = 18 healthy male smokers; 500 mg every 8 hours vs placebo, 2 weeks each.
Flow-mediated dilation improved after arjuna but not placebo (9.31% vs 5.17%).[11]
Limitations: Very small, short, surrogate outcome.
RCTEvidence: limited
Cardiac performance in healthy exercising adults
Double-blind, placebo-controlled; n = 32 men; proprietary aqueous extract (E-OJ-01) 400 mg/day for 56 days.
LVEF and right ventricular performance index improved versus placebo; CK-MB and troponin-T unchanged.[14]
Limitations: Small, single proprietary extract, one author from the product developer; not generalisable to other preparations.
observationalEvidence: limited
Long-term safety in chronic CAD
n = 35 on bark extract powder 500 mg three times daily plus conventional drugs vs 35 on conventional drugs alone; followed 9 months to 4 years 9 months.
Apart from gastritis and constipation, no noteworthy adverse effects; no significant change in blood counts, liver or kidney tests.[15]
Limitations: Small, non-randomised.
These studies explain possible mechanisms. They do not show the same effect in people.