Complementary Alternative Cardiovascular Medicine

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182 Alternative Cardiovascular Medicine LEVEL B RANDOMIZED CLINICAL TRIALS EVALUATING THE CLINICAL EFFECT OF ACUPUNCTURE IN OTHER CVDS Heart Failure. The effect of genuine vs dummy acupuncture on left ventricular ejection fraction (LVEF) was examined in 22 subjects with angiographically proven coronary artery disease (CAD) and 22 normal subjects in a nonrandomized crossover design. Genuine acupuncture increased LVEF significantly (p < 0.05) in the heart patients, whereas dummy acupuncture did not. No changes were observed in the normal subjects (59). Peripheral Arterial Insufficiency. In a nonrandomized study of 34 candidates for limb amputation, only 38% of the patients who received SCS underwent amputation during a 16-mo follow-up period, compared to 90% in a comparable group of unstimulated patients (60). Placental Ischemia. The effect of TENS in 33 patients with placental ischemia was compared to bed rest in 22 control subjects in a nonrandomized study. A significant increase in blood flow was observed in the umbilical artery and fetal aorta of the TENS group (p < 0.05), whereas no change was observed in the control group (61). EVIDENCE LEVEL B SCIENTIFIC STUDIES ON THE EFFECT OF ACUPUNCTURE IN CVD More than 50 yr ago, indications of circulatory effects on the inner organs from cutaneous stimulation were observed. In decerebrated cats, application of moderate localized warming or vacuum cups produced vasodilatation in the cutaneous stimulation area and in the corresponding segmental area of the gastrointestinal (GI) tract. However, in animals that had been subjected to bilateral section of the splanchnic nerves and extirpation of the lumbar trunk of the sympathetic trunk, no such changes were observed (62). In 22 cats, the cardiac effects of painting the skin of the chest with a skin irritant solution were studied, using painting at the skin of the gluteal region in seven cats as a control. ECG recordings revealed that when compared to the control group, stimulation of the chest influenced heart activity. Histological examinations showed that stimulation caused vasodilatation, hyperemia, inflammation, and, in some cases, myocytes necrosis (63). EVIDENCE LEVEL C CONSENSUS REPORTS The National Institutes of Health (NIH) in the United States has held a consensus conference on acupuncture. Acupuncture was considered to be effective in treating postoperative and chemotherapy-induced nausea and vomiting and dental pain. There are other situations, such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow,
Chapter 11 / Acupuncture and CVD 183 fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program (64). The British Medical Association (BMA) has approved acupuncture as an effective treatment in the management of back and dental pain, nausea and vomiting, and migraine (65). An evaluation of acupuncture in CVD (not characterized as effective) is included in the NIH and BMA reports. However, the latter of the studies presented in this analysis were not available at the time of their evaluation. EVIDENCE-BASED SUMMARY Introduction An editorial in JAMA suggests that when the effect is large and the risk associated with the treatment is small, prospective observational studies suffice to support clinical recommendations (66).This is an important consideration when discussing the level of evidence needed to support the clinical use of acupuncture alone or in combination with comprehensive management programs, such as integrated rehabilitation, for angina pectoris. Furthermore, although invasive treatments and medication are based on level A evidence when compared to placebo (67,68), the evidence level is C when compared to several natural remedies (31–33,69–80). Conclusions 1. Level A evidence exists concerning a clinical effect of acupuncture in angina pectoris and ischemic skin flaps. 2. Level A evidence exists concerning some of the possible physiological mechanisms underlying the observed clinical effect of acupuncture in angina pectoris. 3. Level B evidence exists concerning a clinical long-term effect of acupuncture, when performed in its classical Chinese context as part of a comprehensive treatment complex for angina pectoris. 4. Level B evidence exists concerning the use of acupuncture in essential hypertension. 5. Level B indications of an effect on heart failure, peripheral arterial insufficiency, and placental ischemia exist. Request Clinicians who wish to explore the potential of integrated rehabilitation on their heart patients are urged to contact the author of this chapter to include your data into a mutual clinical database.
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Complementary and Alternative Cardi
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CONTEMPORARY CARDIOLOGY CHRISTOPHER
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© 2004 Humana Press Inc. 999 River
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vi Preface physician or other healt
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viii Contents 10 Massage Therapy an
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x Contributors ERIN L. OLIVO, PhD
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Chapter 1 / CAM and CVD 1 1 Complem
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Chapter 1 / CAM and CVD 3 patients
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Chapter 1 / CAM and CVD 5 The crite
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Chapter 1 / CAM and CVD 7 disease c
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Chapter 1 / CAM and CVD 9 analyses,
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12 Alternative Cardiovascular Medic
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Chapter 3 / Botanical Medicine and
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Chapter 4 / Herb and Dietary Supple
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Chapter 5 / Vitamin Therapy and CVD
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Table 2 Type and Quantity of Dietar
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Table 2 (Continued) Type and Quanti
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Chapter 16 / A Guide for Physicians
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Index 279 INDEX A N-Acetylcysteine
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Index 281 taurine studies, 106 Conj
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Index 283 Homeopathic medicine, see
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Index 285 funding of studies, 148 g
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Contemporary Cardiology COMPLEMENTA
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