Complementary Alternative Cardiovascular Medicine
Complementary Alternative Cardiovascular Medicine
Complementary Alternative Cardiovascular Medicine
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
Chapter 11 / Acupuncture and CVD 179<br />
Evidence Level B Observational Studies. In studies where acupuncture<br />
is used as part of a comprehensive management program<br />
(termed integrated rehabilitation), the studied effects should include<br />
prospective long-term cost-benefit analysis and quality-of-life measurements,<br />
along with clinical outcomes. Our ongoing observational study<br />
of a cohort of patients with stable, severe angina pectoris (31–33) includes<br />
103 consecutive patients who were candidates for invasive treatment.<br />
During an average of 3-yr observation, noted that 82% of the<br />
cohort no longer had required invasive therapy and that in-hospital days<br />
were reduced by 96% and the use of medication by 78%, and the 3-yr<br />
death rate was 2.0% (compared to 6.4% in the general Danish population<br />
matched for age and sex). The health care expenses were reduced by<br />
$12,000 per patient per year (33).<br />
In integrated rehabilitation, the patients receive 12 consultations for<br />
a 4-wk period and training in self-care. The acupuncture is performed<br />
with the patient in the supine position and in agreement with traditional<br />
Chinese practice (6). Principal points are used: Shanzhong (C.V. 17),<br />
Jueyinshu and Xinshu (U.B. 14 and 15), Neiguan (Per. 6), and Zuzanli<br />
(St. 36). A book containing a comprehensive presentation of the program,<br />
as well as the long-term results, has been submitted for publication<br />
in the United States (35).<br />
Level B Randomized Clinical Trials. More than 50 yr ago, substantial<br />
indications of an antianginal effect of cutaneous stimulation occurred<br />
when application of local anesthetics in trigger areas of the precordial<br />
muscles produced complete relief of anginal pain in all 31 patients with<br />
angina pectoris and in several cases led to monthlong relief (36).<br />
More recently, 21 patients with stable angina pectoris were randomized<br />
to acupuncture and a placebo pill in a crossover design for two 4-wk<br />
periods. A clinical effect was observed in the treatment period when compared<br />
to the placebo period (p < 0.01) (37). In contrast, in a study of 26<br />
patients with angina pectoris who were resistant to medical treatment,<br />
genuine acupuncture was compared to sham acupuncture, and a significant<br />
difference could not be demonstrated regarding the clinical effect<br />
variables although it was found concerning tolerance (p < 0.001) (38).<br />
The effect of TENS was studied in 34 patients with myocardial<br />
ischemia and no coronary artery stenosis, in 15 patients with coronary<br />
artery stenosis, and in 16 heart transplant patients. Measurement of coronary<br />
resting blood flow were obtained by Doppler. TENS was associated<br />
with a significant increase for the first two groups (p < 0.001) but not for<br />
the third group. There was no change in coronary arterial diameter as a<br />
result of the neurostimulation. There was a significant decrease in epinephrine<br />
levels for the first two groups (p = 0.01) but not for group 3