Effects of Pomegranate on Vascular Endothelial Function: A Systematic Review and Meta-Analysis of Clinical Trials.

In this systematic review and meta-analysis of clinical trials, we investigated the effect of pomegranate on vascular endothelial function markers. We searched PubMed, Scopus, Web of Science, and the Cochrane Library until September 2024. Clinical trials that investigated the effect of pomegranate juice, extract, or its components on markers of vascular endothelial function, including flow-mediated dilation (FMD), intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), E-selectin, nitric oxide (NO), interleukin 6 (IL-6), IL-1, and IL-10, in healthy or diseased adults ages ≥ 18 years were eligible to be included. The quality of studies was assessed using the Cochrane tool. Random-effects meta-analysis was used to pool standardized mean differences (SMD) and 95% CI for the outcomes assessed by at least three studies. Nineteen studies were included. Analysis of studies indicated a nonsignificant effect on VCAM-1 (SMD: -041, 95%CI: -2.53 to 1.71, I2= 83.6%, n = 3), while a significant reduction in ICAM-1 was observed (SMD: -0.63, 95% CI: -0.85 to -0.40, I2 = 0.0%, n = 3). Pooled analysis of fourteen studies on IL-6 indicated a significant reduction (-0.58, 95% CI: -0.98 to -0.19, I2 = 82.63%). The results of the three studies on E-selectin were inconsistent. The FMD and NO were assessed in only one study. Pomegranate is effective in improving IL-6 and ICAM-1, but not VCAM-1.