Complementary Alternative Cardiovascular Medicine

8 Alternative Cardiovascular Medicine
rational, evidenced-based, and patient need-responsive system. The
scoring system was incorporated into our instructions to the chapter
authors of this book.
The approach suggested in this text on CAM and CVD is to collect the
relevant published studies and reviews (from computer searches of
MEDLINE and appropriate alternative medicine databases, websites,
reference texts, and other sources) and to grade them according to
AHCPR criteria used for the Cardiac Rehabilitation Guidelines as
follows:
A. Well-designed and well-conducted clinical trials of sufficient
size and duration.
B. Observation studies and small clinical trials.
C. Expert opinions and panel consenses.
If class A studies exist (e.g., vitamin E and coronary heart disease
[CHD] event rate and mortality), then these should be noted and
briefly described with a clear outcome statement. If only type B studies
exist, then these should be noted and size, follow-up period, and possible
confounding factors also noted. In the absence of class A and B
studies, expert opinion and consensus data (e.g., German Commission
E Monographs) should be noted.
If there are class A and B studies of the treatment approach that are
important but do not address cardiovascular medicine (e.g., clinical
trials of homeopathic remedies for allergic rhinitis), these should,
especially in the absence of studies addressing CVD, be noted, because
they will be of interest and possible value to the clinician who will be
counseling patients. Also for consensus statements, the type of panel
or individuals, and the basis of the recommendations (personal experience
and collected experiences or review of literature and studies)
should be noted.
The goals of the clinical evidence section or aspect of your chapter are
to provide the reader with the clinical evidence (if it exists) and the
collected wisdom of practioners and societies. Negative studies and
recommendations should be noted, as well as positive ones. If the data
do not provide a basis for arriving at a conclusion regarding efficacy
(and safety), then this should be stated.
CONCLUSION
The use of alternative therapies for the prevention and treatment of
CVD is increasing. As a result, physicians will need to obtain the knowledge
and skills to counsel patients regarding these therapies. In our final