Complementary Alternative Cardiovascular Medicine

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