Complementary Alternative Cardiovascular Medicine

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.