Acupuncture potentiates coronary heart disease drug therapy. Patients receiving acupuncture combined with usual care had greater positive patient outcomes than patients receiving only drug therapy. In a clinical trial conducted at Nanyang First People’s Hospital, acupuncture combined with drug therapy produced an 85% total effective for the treatment of coronary heart disease (coronary artery disease). Patients receiving only drug therapy had a 62.5% total effective rate. The researchers note that the application of acupuncture “can significantly improve blood lipids, blood pressure, heart rate and electrocardiogram indicators in CHD patients while reducing coronary artery plaques.” [1]

The results indicate that acupuncture produces synergistic or additive effects when combined with drug therapy. The outcome measures included serum total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), mean arterial pressure (MAP), heart rate (HR), T-wave amplitude in leads V4–V6, vascular remodeling index (RI), plaque eccentricity index (EI) and necrotic core (NC). TC, TG, LDL-C, and HDL-C were used to measure blood lipids. MAP and HR examined heart function. T-wave amplitude in leads V4–V6 assessed electrocardiogram changes. RI, EI, and NC were used to study coronary artery plaques.

The total efficacy rate was 85.0% in the acupuncture plus drugs treatment group and 62.5% in the drug monotherapy control group. There was a statistically significant difference between the two groups (p<0.05). The indicators of blood lipids, MAP, HR, electrocardiogram results, and the indicators of coronary artery plaque all showed a significant change after treatment in the two groups (p<0.05). After the treatment, the indicators of blood lipids (TG, LDL-C), MAP, HR, electrocardiogram indicators, and the indicators of coronary artery plaque in the acupuncture plus drugs treatment group were significantly different from those in the drug monotherapy control group (p<0.05).

 

Design
Researchers (Wang et al.) used the following study design. A total of 80 patients were treated and evaluated in this study. The patients were hospitalized due to coronary heart disease (CHD) between June 2016 and January 2018. They were randomly divided into an acupuncture plus drugs treatment group and a drug monotherapy control group, with 40 patients in each group. For the control group patients, conventional drug therapy was provided. The treatment group received acupuncture in addition to the identical drug treatment protocol administered to the drug control group.

The statistical breakdown for each randomized group was as follows. The treatment group was comprised of 19 males and 21 females. The average age in the treatment group was 54 ±6 years. The average course of disease in the treatment group was 7.78 ±0.82 years. The control group was comprised of 17 males and 23 females. The average age in the control group was 54 ±6 years. The average course of disease in the control group was 7.65 ±0.88 years. There were no significant statistical differences in gender, age, and course of disease relevant to patient outcome measures for patients initially admitted to the study.

The study included patients satisfying the diagnostic criteria of CHD based on the Clinical and Pragmatic Cardiology’s Diagnostic Criteria Of Chronic Stable Angina (Peking University Medical Press) [2] and the Guiding Principles for Clinical Study of New Chinese Medicine’s Diagnostic Criteria Of CHD. The latter fit the differential diagnostic pattern of qi deficiency and blood stasis with primary symptoms including chest pain, oppression in the chest, and shortness of breath. Secondary symptoms included fatigue, palpitations, dark purple lips, and spontaneous sweating, and a pale or dark tongue with a string-like (wiry) and hesitant pulse. [3] The following selection criteria were also applied:

  • Stable angina occurred more than 2 times per week
  • Grade I–III according to the Canadian Cardiovascular Society Grading System
  • Informed consent was signed

Exclusion criteria included the following:

  • Acute myocardial infarction or other heart diseases
  • Pregnant or lactating
  • Mental disorders
  • American Society of Anesthesiologists (ASA) Score 3 (moderate to severe systemic disease with significant functional limitations)

 

Treatment
For both groups, patients received 20–40 mg of isosorbide mononitrate and 100 mg of aspirin tablets, once per day, for a total of four consecutive weeks. Intravenous infusion of nitroglycerin was allowed for severe cases. Additional medications (antiarrhythmics, anticoagulants, or calcium antagonists) were prescribed based on individual presentations.

Isosorbide mononitrate is a vascular dilator used to prevent angina due to CHD. Aspirin is a medication that interferes with blood clot formation. Nitroglycerin is an organic nitrate that helps relax the blood vessels and is used to treat angina in people with CHD. The following primary acupuncture points were applied for the acupuncture group:

  • CV17 (Danzhong)
  • PC6 (Neiguan)
  • PC4 (Ximen)
  • ST36 (Zusanli)
  • BL15 (Xinshu)

Treatment commenced with patients in a supine position. After disinfection of the acupoint sites, a 0.30 mm × 30 or 40 mm disposable filiform needle was inserted into each acupoint with a high needle entry speed​. Neiguan and Ximen were perpendicularly needled to a depth of 0.5–0.8 cun. Danzhong was obliquely needled to a depth of 0.3–0.5 cun. Zusanli was perpendicularly needled to a depth of 1.0–1.5 cun. Upon achieving a deqi sensation, the Ping Bu Ping Xie (mild attenuating and tonifying) manipulation technique was applied.

The acupuncture needles were retained for 30 minutes. Next, patients were asked to take a prone position. A 0.30 mm × 40 mm disposable filiform needle was obliquely inserted toward the spine into Xinshu, reaching a maximum insertion of 1–1.2 cun. The needle was manipulated every 5 minutes during a 15–20 minute needle retention time. The acupuncture treatment was conducted twice a day for a total of four consecutive weeks during hospitalization.

 

Evaluations
Evaluations were performed before and after acupuncture treatment. As a result of acupuncture therapy, patients achieved significantly improved indicators of blood lipids (TG, LDL-C), MAP, HR, electrocardiogram results, and indicators of coronary artery plaque (RI, EI, NC) (p<0.05). After completion of treatment, the efficacy rates for each patient were categorized into 1 of 3 tiers:

  • Significantly effective: Angina was reduced by 2 grades. Disappearance of angina for grade I and II patients. Angina didn’t occur even after vigorous physical activities. The ECG (EKG) ischemic changes returned to normal.
  • Effective: Angina was reduced by 1 grade. Angina didn’t occur after general physical activities. ST-segment was evaluated by ≥0.05 mv or returned to normal. Inverted T waves became shallower by ≥25%. Flattened T waves became erect.
  • Ineffective: No improvement of symptoms and ECG. Angina occurred after general physical activities.

 

Continuing Investigations
Research indicates that acupuncture is effective for the treatment of CHD. According to the research covered in this article, acupuncture benefits patients undergoing drug therapy for CHD by improving blood lipids, blood pressure, heart rate, and electrocardiogram indicators while reducing coronary artery plaques. This confirms similar research demonstrating that acupuncture reduces plaque buildup in the carotid arteries. [4]

Another investigation by researchers from the University of California, Los Angeles (UCLA) finds acupuncture effective for protecting the heart. In a lab experiment, electroacupuncture applied to acupuncture points PC6 and PC5 in rabbits with coronary arterial occlusion resulted in less ventricular arrhythmias. There were additional benefits. Electroacupuncture decreased heart infarct size (protected the heart from tissue death due to obstruction of blood and oxygen supply). Moreover, the researchers showed that electroacupuncture caused a decrease in left ventricle dysfunction. A decrease in harmful ST segment elevation was observed. [5] The results were published in the American Journal of Physiology Heart and Circulatory Physiology.

 

References:
[1] Wang YP. Observation on the efficacy of acupuncture in treating coronary heart disease and its effect on coronary artery plaque [J]. Shanghai Journal of Acupuncture and Moxibustion: 1-5[2019-02-01]. doi.org/10.13460/j.issn.1005-0957.2019.13.0016.
[2] Guo JH, Wang ZP, Zhang HC et al. Clinical and Pragmatic Cardiology [M]. Beijing: Peking University Medical Press, 2015:206-212.
[3] Zheng XY. Guiding Principles for Clinical Study of New Chinese Medicines (Pilot Version) [S]. Beijing: China Medical Science Press, 2002:1-5.
[4] Li YH, Huang HB, Wang WX & Yang LX. (2014). Observation of the head acupuncture through hole on the treatment of carotid artery atherosclerosis. Hebei Journal of Traditional Chinese Medicine. 36(8).
[5] Am J Physiol Heart Circ Physiol. 2012 May;302(9):H1818-25. Epub 2012 Feb 24.
Cardioprotection of electroacupuncture against myocardial ischemia-reperfusion injury by modulation of cardiac norepinephrine release. Zhou W, Ko Y, Benharash P, Yamakawa K, Patel S, Ajijola OA, Mahajan A. Department of Anesthesiology, UCLA – University of California, Los Angeles.

 

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