Acupuncture in Severe, Stable Angina Pectoris: a Randomized Trial

Abstract

Twenty‐six patients with stable angina pectoris, resistant to medical treatment, were randomized to either active or sham acupuncture in a single‐blind design. Sham acupuncture was defined as the insertion of needles in a point within the same spinal segments as the active acupuncture, but outside the Chinese meridian system. The effect was evaluated from anginal attack rate, nitroglycerin consumption and exercise tests. Compared to patients receiving sham acupuncture the patients receiving active acupuncture increased cardiac work capacity significantly, expressed as dPRP (difference in pressure‐rate‐product between rest and maximum exercise) and maximal PRP during exercise (p<0.001). None of the other variables showed any significant difference between the two groups. Concerning exercise tolerance the median difference was 138 Wmin (95% confidence limits ‐12.5 to 325 Wmin), concerning anginal attack rate the median difference was 29.5% (95% confidence limits 55% to ‐11%) and with regard to nitroglycerin consumption the median difference was 5% (95% confidence limits +67% to ‐44%). No significant effect of sham treatment was observed, no adverse effect was observed. We suggest that acupuncture may improve cardiac work capacity in patients with angina pectoris, refractory to medical treatment.

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

“…Twenty-six patients with severe angina resistant to standard medical therapy were studied in one of the first randomized trials comparing acupuncture and sham acupuncture. 917 There was no difference between groups in the frequency of angina or use of nitroglycerin, although patients treated with acupuncture achieved a higher pressure-rate product on exercise testing. A subsequent study by the same investigators in patients with less severe ischemia failed to show a difference in either exercise variables or subjective measures between acupuncture and placebo patients.…”

Electroacupuncture modulates vlPAG release of GABA through presynaptic cannabinoid CB1 receptors

“…somatic afferents; sympathoexcitatory reflex; cannabinoid type 1 receptor; microdialysis ELECTROACUPUNCTURE (EA), a potent alternative to manual acupuncture, has been suggested to be effective in treating certain cardiovascular diseases including hypertension, arrhythmias, and angina pectoris (5,6,41). Clinically, EA at the NeiguanJianshi (P5-6) acupoints has been used to treat cardiovascular diseases in Eastern and, more recently, Western countries (5,21,41).…”

“…Clinically, EA at the NeiguanJianshi (P5-6) acupoints has been used to treat cardiovascular diseases in Eastern and, more recently, Western countries (5,21,41). We and others have demonstrated that EA at P5-6 acupoints overlying the median nerve on the wrist modulate blood pressure elevation evoked by gastric distension (GD) in rats (27) or by gallbladder stimulation in cats (50) through a long-loop neural pathway, extending from the arcuate nucleus (ARC) in the hypothalamus to the ventrolateral periaqueductal gray (vlPAG) in the midbrain and, ultimately, to the rostral ventrolateral medulla (rVLM) (13,26,50,58).…”

Alternative Non-Medical, Non-Surgical Therapies for the Treatment of Angina Pectoris

“…The report concluded that acupuncture should be considered a beneficial treatment even for patients with severe, intensively treated angina pectoris. Other studies have come to the same conclusion (117,118) in the treatment of angina. In one research project at the Nanjing Medical College involving 267 patients, all suffering from angina pectoris, acupuncture treatment was shown to have a 93.3% success rate with no harmful side effects (119).…”