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.

31 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.

        • Acupuncture has been around for over 2000 years. There is scientific research that PROVES it works.

          • BTW- acupuncture can’t hurt, can only help. Everyone is different- some respond to treatment- some don’t. All I know is that is NOT quackery.

          • very convincing!
            thank you

          • care to cite some proofs>

          • “There is scientific research that PROVES it works.” Please, for goodness’ sake, POINT US to this research. Just stating there’s research without citing the source is worthless arm waving. All the research I’ve seen says acupuncture works no better than placebo.

        • So your trying to say a 3000+ year old practice thats effective is quakery? Interesting. It would make sense to say something like this if you A. Work in the field of western medicine , hence its taking away from what you practice. Or B. Your an average joe that never used acupuncture by a good acupuncturist. Anyways, each to there own. You believe on either or dont act like one is better then the other.

          • “So your trying to say a 3000+ year old practice thats effective is quakery?”
            apart from the 2 spelling mistakes, there is a logical mistake in this sentence.
            can you spot it?
            no?
            let me help you:
            acupuncture is not effective [for coronary heart disease]; therefore it is quackery!
            if it were effective, it wouldn’t be quackery.

        • @Isa Farkash

          “How much walking are you able to do as a result of the treatment?” Well done! You’re asking a rational question — most people who make comments here never do. Systematically quantifying an effect is the very first step towards obtaining robust data that show acupuncture is not nonsense.

          Unfortunately, on the few occasions when this sort of question has been investigated properly, acupuncture turns out to be caca de vaca: just a theatrical placebo. Its ‘successes’ are down to natural history of the disease, regression to the mean, etc. That’s why acupuncture is considered a pseudoscience (and therefore a pseudo medicine).

          • Age is not a viable way to judge a form of medicine. Humoral medicine has been around 2000 years and is worthless. Bloodletting, magnets and mercury also have long track records. Believe what you want – certainly it’s your right. Sadly, belief is all you will have.

      • @Isa Farkash

        “How much walking are you able to do as a result of the treatment?” Well done! You’re asking a rational question — most people who make comments here never do. Systematically quantifying an effect is the very first step towards obtaining robust data that show acupuncture is not nonsense.

        Unfortunately, on the few occasions when this sort of question has been investigated properly, acupuncture turns out to be caca de vaca: just a theatrical placebo. Its ‘successes’ are down to natural history of the disease, regression to the mean, etc. That’s why acupuncture is considered a pseudoscience (and therefore a pseudo medicine).

  • 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.

  • I love how you ask for proof and resort to name calling when proof is provided. Seriously, just google it, its not that hard. You will find numerous findings by creditable sources that acupuncture works. Instead of making a fool of yourself and ranting on a board where people are having serious discussions, take that time and go educate yourself.

    • Jack said:

      I love how you ask for proof and resort to name calling when proof is provided. Seriously, just google it, its not that hard. You will find numerous findings by creditable sources that acupuncture works. Instead of making a fool of yourself and ranting on a board where people are having serious discussions, take that time and go educate yourself.

      I did as you suggested and searched for “evidence that acupuncture works” and this is the first result in my browser: Acupuncture.

      Is that what you meant?

  • No Jack. You are wrong, on all counts.
    If you had checked credible sources, contemporary historical records and properly performed research like so many experts have done, you would know that acupuncture, i.e. the modern kind with thin needles and trying not to damage anything (and sometimes failing that) is not 2000 years old. It is not even 400 years old because back then the thin stiff needles could not be produced.
    The modern version of acupuncture was invented (not discovered mind you) in the nineteenth century and not really put into practice until Mao promoted it to give the masses something to keep them busy because there was not enough real “western” medicine to distibute. Mao neither liked nor used this fake medicine himself.
    Before this, there was “acu-puncture” which consisted of barbarian pricking and lancing with crude instruments according to prescientific philosophical fantasies.
    You can find attempts to prove the earth is flat and that water can memorize by Googleing for these fantasies. Even if acupuncture is somewhat more plausible than these examples, the totality of evidence clearly shows that acupuncture has no discernible efficacy.What you have been led to consider proof has been thoroughly and repeatedly examined by experts who have also looked at the totality of evidence. The results are clear, the better the research, the less likely there is to be variability that can be cherry picked and massaged to claim positive results.
    Most of what proponents of acupuncture call evidence isn`t even research on acupuncture.
    Now let us hear what you have to say that might refute what I just wrote. We have been through this many times here on this blog but there is always room for more debate. But please spare us the references to old scriptures or philosophical oriental fantasies anout non-falsifiable phenomena like qi or yin and yang. They only exists as words. Also spare us references to research on TENS with needles and other non-acupuncture trials. Just plain old needling of meridian points in properly controlled trials.
    We will not be waking up waiting for your referenced evidence but we can promise it will be taken into consideration if it is worth scrutiny.
    If you want to see a properly performed evaluation of the evidence, why don`t you start by reading this recent review?
    http://www.scienceinmedicine.org.au/wp-content/uploads/2017/06/acupuncturereview.pdf

    If you want to see some contemporary stories of what acu-puncture was like in China a little more than a century ago, and perhaps also 2000 years ago?, then why don`t you Google Dugald Christie`s book named Thirty years in Moukden, which was published in New York in 1914. You can dowmload a facsimile copy electronically from the library of congress… or was it the National library? – You`ll find it.
    Mr. Christie was a god fearing Scottish missionary surgeon (surgeons are addressed as Mr. over there) who tells how the Chinese “doctors” in Manchuria killed young children with bellyache by trying to acu-puncture out the imaginary excess of fire in their abdomen with sharp lances. And he tells how children with epilepsy were treated by drawing blood from under their fingernails. I guess they did not dare go to the “doctor” again so he probably wrote the case up as successful and treated the next one the same way.
    Now that`s not what acupuncture is today, is it? And this is not the only historical evidence that tells us acupuncture today is not based on ancient evidence. It is based on fantasy and imagination and the “evidence” purportedly showing its effectiveness/efficacy is mistakenly accumulated and erroneously evaluated by its proponents. Acupuncture was historically equivalent to ritualistic lood-letting in other parts of the world. Its modern version is in effect what has been called a “Theatrical placebo”
    Feel free to prove me æwrong on this.

    • In my long winded late night ramblings above, I inadvertently wrote “…waking up waiting…”, it should of corse read “…sitting up awake, waiting…”

      Happy New Years weekend everyone.

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