Coronary heart disease (sometimes called ischaemic heart disease) occurs when cholesterol builds up in the coronary arteries and atherosclerotic plaques form. Over time, this causes narrowing and hardening of the coronary arteries that supply blood to the heart. Oxygen supply to the heart muscle is reduced and this can lead to angina pectoris (chest pain) and eventually myocardial infarction (heart attack) or heart failure.
About 82,000 people die because of coronary heart disease every year in the UK. It is the country’s biggest killer, and accounts for around one in five deaths in men and one in eight deaths in women (NHS Choices 2014; Peterssen 2005). Risk factors include smoking, high blood cholesterol, hypertension, obesity, diabetes, physical inactivity and a family history of heart disease.
Conventional medical treatment includes lifestyle changes such as stopping smoking, modifying diet and increasing exercise; drugs such as statins, nitrates, ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, beta blockers and antiplatelet drugs; and surgery such as coronary artery bypass grafts.
Coronary heart disease. NHS Choices. Available: http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Introduction.aspx [Accessed 25 January 2014]
Peterssen S, Peto V, Scarborough PRM. Coronary Heart Statistics. London: British Heart Foundation, 2005.
This factsheet looks at the evidence for acupuncture in the treatment of coronary heart disease including angina pectoris and myocardial infarction. There are related factsheets on hypertension, stroke, and arrhythmias and heart failure.
A systematic review of 16 randomised controlled trials (RCTs) (Chen 2012) found that acupuncture added to plus conventional drugs reduced the occurrence of acute myocardial infarction. Compared with drugs alone, both acupuncture alone and acupuncture plus conventional drugs proved more effective at relieving angina symptoms and improving ECGs. However, compared with conventional treatment, acupuncture alone showed a longer delay before its onset of action, probably indicating that it is not suitable for emergency treatment of myocardial infarction.
A randomised controlled trial (RCT) found that acupoint pressing can significantly improve symptoms of angina pectoris, and has a similar therapeutic effect to glyceryl trinitrate, but provides more rapid relief and without adverse effects (Wang 2011). Another RCT found that acupuncture combined with medication is safe and effective for intractable angina pectoris and can improve short-term prognosis compared with medication alone (Xu 2005). A clinical study assessing the effect of acupuncture at point Neiguan (PC6) in patients with angina pectoris and acute myocardial infarction found it more effective than isosorbide dinitrate and nifedipine (Meng 2004).
Most or all of the RCTs in this area have been carried out in China and there is a need for them to be repeated elsewhere. The potential value of acupuncture for angina was strikingly demonstrated in a Danish matched control study (Ballegaard 1999) and reinforced subsequently by the same author (Ballegaard 2004). Integrated treatment combining acupuncture with self care with/without medication was found to be substantially cost-effective (due mainly to a reduced need for hospitalisation and surgery) and add years to patients’ lives.
For silent myocardial ischaemia, a RCT showed that acupuncture may have a good therapeutic effect on heart rate, blood pressure and ST segment depression (an indicator of ischaemia), superior to that of herbal medicine (Diao 2011).
Acupuncture is used in various settings for control of nausea and vomiting (see BAcC Fact Sheet on this subject) and it was found effective for this (as an adjunct to medication) for post-heart attack patients in one partially randomised trial (Dent 2003).
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.
There are many published studies from China investigating the mechanisms by which acupuncture may affect heart disease. Nearly all have used electro-stimulation in animal models of myocardial ischaemia. Research has shown that acupuncture treatment may benefit coronary heart disease by:
Acupuncture is a tried and tested system of traditional medicine, which has been used in China and other eastern cultures for thousands of years to restore, promote and maintain good health. Its benefits are now widely acknowledged all over the world, and in the past decade traditional acupuncture has begun to feature more prominently in mainstream healthcare in the UK. In conjunction with needling, the practitioner may use techniques such as moxibustion, cupping, massage or electro-acupuncture. They may also suggest dietary or lifestyle changes.
Traditional acupuncture takes a holistic approach to health and regards illness as a sign that the body is out of balance. The exact pattern and degree of imbalance is unique to each individual. The traditional acupuncturist’s skill lies in identifying the precise nature of the underlying disharmony and selecting the most effective treatment. The choice of acupuncture points will be specific to each patient’s needs. Traditional acupuncture can also be used as a preventive measure to strengthen the constitution and promote general wellbeing.
An increasing weight of evidence from Western scientific research (see overleaf) is demonstrating the effectiveness of acupuncture for treating a wide variety of conditions. From a biomedical viewpoint, acupuncture is believed to stimulate the nervous system, influencing the production of the body’s communication substances - hormones and neurotransmitters. The resulting biochemical changes activate the body's self-regulating homeostatic systems, stimulating its natural healing abilities and promoting physical and emotional wellbeing.
With over 3000 members, the British Acupuncture Council (BAcC) is the UK’s largest professional body for traditional acupuncturists. Membership of the BAcC guarantees excellence in training, safe practice and professional conduct. To find a qualified traditional acupuncturist, contact the BAcC on 020 8735 0400 or visit www.acupuncture.org.uk
Huang RL et al. Effect of electroacupuncture pre-treatment on myocardial enzyme levels in recurrent myocardial ischemia rabbits. [Article in Chinese] Zhen Ci Yan Jiu. 2012;37(3):224-8.
An animal study that looked at the effect of electroacupuncture (EA) preconditioning of "Neiguan" (PC 6) on myocardial enzyme levels in rabbits with acute recurrent myocardial ischaemia. EA preconditioning was found to have an effect in the prevention of ischaemic myocardial injury, an effect that was closely associated with its functions in lowering serum aspartate aminotransferase, isoenzymes of creatine kinase, lactate dehydrogenase, creatine kinase, and alpha-hydroxybutyrate dehydrogenase.
Li M et al. Effects of electroacupuncture at PC6 and BL15 on nerve electrical activity in spinal dorsal root and norepinephrine and dopamine contents in paraventricular nucleus of hypothalamus in rats with acute myocardial ischemia. [Article in Chinese] Zhong Xi Yi Jie He Xue Bao. 2012b;10(8):874-9.
An animal study that investigated the effects of electroacupuncture (EA) at Neiguan (PC6) and Xinshu (BL15) on the nerve electrical activity in the spinal dorsal root and norepinephrine (NE) and dopamine (DA) concentrations in the paraventricular nucleus of the hypothalamus in rats with acute myocardial ischaemia. The researchers concluded that EA at both PC6 and BL15 acupoints exhibited synergistic protective effects against acute myocardial ischaemia, and that the possible mechanism is related to regulating nerve electrical activity in spinal dorsal roots and the concentrations of NE and DA in paraventricular nucleus of the hypothalamus.
Zhou W et al. Cardioprotection of electroacupuncture against myocardial ischemia-reperfusion injury by modulation of cardiac norepinephrine release. Am J Physiol Heart Circ Physiol. 2012;302(9):H1818-25.
An animal study that looked at the effects of electroacupuncture (EA) on left ventricular (LV) function, O(2) demand, infarct size, arrhythmogenesis, and in vivo cardiac norepinephrine (NE) release in a myocardial ischaemia-reperfusion model. The researchers concluded that their results suggested that the cardioprotective effects of EA against myocardial ischaemia-reperfusion are mediated through inhibition of the cardiac sympathetic nervous system, as well as via opioid- and PKC-dependent pathways.
Gao XY et al. Acupuncture-like stimulation at auricular point Heart evokes cardiovascular inhibition via activating the cardiac-related neurons in the nucleus tractus solitarius. Brain Res. 2011;1397:19-27.
An animal study that investigated the role of baroreceptor sensitive neurons of the nucleus tractus solitarius in the regulation of cardiovascular inhibition during acupuncture at the auricular Heart point. The researchers concluded that their results showed that acupuncture at the auricular Heart point regulates cardiovascular function by activating baroreceptor sensitive neurons in the nucleus tractus solitarius in a similar manner to the baroreceptor reflex in cardiovascular inhibition.
Wang C et al. Influence of electroacupuncture on myocardial NO and NOS and intracellular Ca2+ contents in myocardial ischemia-reperfusion injury rats. [Article in Chinese] Zhen Ci Yan Jiu. 2010;35(2):113-7.
An animal study that investigated the effect of electroacupuncture (EA) on myocardial nitric oxide (NO) content, nitric oxide synthase (NOS), and intracellular Ca2+ levels in rats with experimental myocardial ischaemia-reperfusion injury (MI/RI), The research showed that EA of Neiguan (PC6) can upregulate myocardial NO and NOS content and downregulate myocardial intracellular Ca2+ levels in rats with MI/RI, which may contribute to its effect in relieving myocardial injury.
Hui KK et al. Acupuncture, the limbic system, and the anticorrelated networks of the brain. Auton Neurosci. 2010; 157(1-2): 81-90.
Studies have shown that acupuncture stimulation, when associated with sensations comprising deqi, evokes deactivation of a limbic-paralimbic-neocortical network, as well as activation of somatosensory brain regions. These networks closely match the default mode network and the anti-correlated task-positive network. The effect of acupuncture on the brain is integrated at multiple levels, down to the brainstem and cerebellum and appears to go beyond either simple placebo or somatosensory needling effects. Needling needs to be done carefully, as very strong or painful sensations can attenuate or even reverse the desired effects. Their results suggest that acupuncture mobilizes the functionally anti-correlated networks of the brain to mediate its actions, and that the effect is dependent on the psychophysical response. They discuss potential clinical application to disease states including chronic pain, major depression, schizophrenia, autism, and Alzheimer's disease.
Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther 2007; 6: 251-7.
Review article that suggests the anti-inflammatory actions of traditional and electro-acupuncture are mediated by efferent vagus nerve activation and inflammatory macrophage deactivation.
Terms and conditions The use of this fact sheet is for the use of British Acupuncture Council members and is subject to the strict conditions imposed by the British Acupuncture Council details of which can be found in the members area of its website www.acupuncture.org.uk.
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