MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Still in the spirit of ACUPUNCTURE AWARENESS WEEK, I have another critical look at a recent paper. If you trust some of the conclusions of this new article, you might think that acupuncture is an evidence-based treatment for coronary heart disease. I think this would be a recipe for disaster.

This condition affects millions and eventually kills a frighteningly large percentage of the population. Essentially, it is caused by the fact that, as we get older, the blood vessels supplying the heart also change, become narrower and get partially or even totally blocked. This causes lack of oxygen in the heart which causes pain known as angina pectoris. Angina is a most important warning sign indicating that a full blown heart attack might be not far.

The treatment of coronary heart disease consists in trying to let more blood flow through the narrowed coronaries, either by drugs or by surgery. At the same time, one attempts to reduce the oxygen demand of the heart, if possible. Normalisation of risk factors like hypertension and hypercholesterolaemia are key preventative strategies. It is not immediate clear to me how acupuncture might help in all this – but I have been wrong before!

The new meta-analysis included 16 individual randomised clinical trials. All had a high or moderate risk of bias. Acupuncture combined with conventional drugs (AC+CD) turned out to be superior to conventional drugs alone in reducing the incidence of acute myocardial infarction (AMI). AC+CD was superior to conventional drugs in reducing angina symptoms as well as in improving electrocardiography (ECG). Acupuncture by itself was also superior to conventional drugs for angina symptoms and ECG improvement. AC+CD was superior to conventional drugs in shortening the time to onset of angina relief. However, the time to onset was significantly longer for acupuncture treatment than for conventional treatment alone.

From these results, the authors [who are from the Chengdu University of Traditional Chinese Medicine in Sichuan, China] conclude that “AC+CD reduced the occurrence of AMI, and both acupuncture and AC+CD relieved angina symptoms and improved ECG. However, compared with conventional treatment, acupuncture showed a longer delay before its onset of action. This indicates that acupuncture is not suitable for emergency treatment of heart attack. Owing to the poor quality of the current evidence, the findings of this systematic review need to be verified by more RCTs to enhance statistical power.”

As in the meta-analysis discussed in my previous post, the studies are mostly Chinese, flawed, and not obtainable for an independent assessment. As in the previous article, I fail to see a plausible mechanism by which acupuncture might bring about the effects. This is not just a trivial or coincidental observation – I could cite dozens of systematic reviews for which the same criticism applies.

What is different, however, from the last post on gout is simple and important: if you treat gout with a therapy that is ineffective, you have more pain and eventually might opt for an effective one. If you treat coronary heart disease with a therapy that does not work, you might not have time to change, you might be dead.

Therefore I strongly disagree with the authors of this meta-analysis; “the findings of this systematic review need NOT to be verified by more RCTs to enhance statistical power” — foremost, I think, the findings need to be interpreted with much more caution and re-written. In fact, the findings show quite clearly that there is no good evidence to use acupuncture for coronary heart disease. To pretend otherwise is, in my view, not responsible.

There might be an important lesson here: A SEEMINGLY SLIGHT CORRECTION OF CONCLUSIONS OF SUCH SYSTEMATIC REVIEWS MIGHT SAVE LIVES.

21 Responses to Acupuncture for coronary heart disease? Be aware and beware!

  • Hi Edzard, Have you read The God Complex by Chris Titus? It’s basically the DaVinci Code of Chinese medicine. I think you’d enjoy it b/c it explains a lot of the finer points about acupuncture that you might not see in these studies … and it’s a damn good story if you like medical mysteries.

  • Forgive my ignorance Prof, but is acupuncture for these purposes defined as acupuncture with prescribed “chi” points in “meridians” and entirely separate from dry-needling such as that used by chiropractors, physios and sports medicine people for treatment of muscular “trigger points”?

  • Hi Edward,

    What would be interesting is to read of a collection of measurable results from people treated with acupuncture for CHD in clinic, would you agree? Rather than relying on controlled testing that sets parameters which often aren’t pertinent to the clinic.

    That is never particularly visible in journals to my knowledge, and seeing as different practitioners can vary dramatically in advice and treatment style, I think it might well offer another perspective on things.

    What are your thoughts?

    • if you want to know whether it was the acupuncture that had the observed effect [rather than placebo, regression towards the mean, natural history etc.] you need a controlled clinical trial.

  • It seems like a lot of this could be cleared up with transparency. Tracking Chinese journals and separating reliable ones from unreliable is so difficult. Do you have any journals that you trust as much as those in the West?

  • i had a serious bout of heart failure followed by a later relapse which left me very weak . unfortunately the heart problems were caused by doctor neglect.out of desperation to try and improve my energy i am receiving acupuncture treatment .this treatment is ongoning but at this stage i definitely detect an improvement in my energy .i would be grateful for the views from any other persons in similar health circumstances or the results if any after a full course of acupuncture .

    • Dear Mr. Furlong,
      I live in Israel where acupuncture is widely used. I am interested in knowing how well you fared after acupuncture treatment. My husband suffers from CHF and also lacks energy and appetite. He’s had 2 valve replacements in October 2015 and recently hernia surgery. When we see his cardiologist I’d like to have some medical verification to to “state the case” to try the treatment. How much walking are you able to do as a result of the treatment?
      All the best,
      Ida

      • It is heart-breaking to see people spending time and money on useless make-believe medicine like acupuncture. There is no reason to believe acupuncture helps for heart-failure and there are no studies that support such a contention.
        Mr. Furlong has been deceived into thinking his natural improvement is helped over time by the theatrical sticking of mystical needles with erroneous claims that it is ancient oriental art when in reality it was invented (not discovered) during early twentieth century.
        Better to spend your money and time on doing something nice with your husband like going to the theater. Acupuncture does not work for anything, it only “entertains” the patient while nature takes its course.

  • Though I don’t have major coronary disease, I do have severe aortic calcification due to kidney problems and dialysis.
    I have spent a year doing acupuncture and along with diet have reduced the time and dosage of my daily peritoneal
    dialysis sessions. If your heart disease is due to calcification, vitamin K2 along with magnesium, vitamin C and D3
    help to break down calcium deposits and direct it back to your bones and teeth. Do a Google search on the importance
    of K2. You may also want to do a coronary calcium scan to see the level of stenosis in you arteries and valves.
    I believe diet, mineral supplements and acupuncture can help. Best of health to you.

    • I believe diet, mineral supplements and acupuncture can help.

      Thank you for informing us of what you believe. Now can you point us to some robust evidence to convince us that your belief might belong in the world of reality? (The link you have posted is to a propaganda organization, not science.)

  • Here is a link that may interest everyone.

    http://anhinternational.org/2012/07/04/efsa-denies-vitamin-k2s-unique-role-in-preventing-vascular-calcification/

    Make sure to read the entire article which supports the use of vitamin K2

  • The information and use of vitamin K2 is a regimen that requires time and patience.
    Naturally life and death situations need conventional medicine intervention.

  • Proof is everywhere and you just have to Google. Concrete results have been obtained by physicians in the U.K., U.S.A., Canada and everywhere else, not just in China. Acupuncture has been around for at least 2,000 years, first found in eastern Asia (China), and some archaeological finds even suggest that it was used as far back as 6,000 BCE!

    Yes, just like any medicine and therapy, be it orthodox, ancient or acupuncture, some treatments work and some don’t. It varies from person to person and at what time we apply the therapy. Those who hate orthodox medicine, citing side effects and what not, are simply naive and ignorant. Those who claim that Chinese medicine or acupuncture is just quackery are probably even worse, if you ask me.

    Simply put, if we can heal ourselves (come on, not every time, of course) only by our will, spirits, and our self-defense mechanism without any medicinal aid, can anyone be so sure that electrical stimulation, instilled by either putting electrodes on our body or by targeting pain at certain points of our body using needles, has no effect on our anti-inflammatory and or immunity system? If the answer to the above question is a definite yes, you should go join the ostrich and bury your head in the sand.

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