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Is there a place for complementary alternative therapies in the treatment of chronic stable angina?

Comment by Maria Simonenko, Secondary Prevention and Rehabilitation Section

Preventive Cardiology
Risk Factors and Prevention

Chronic stable angina (CSA) is the main symptom of myocardial ischemia and is associated with an increased risk of major cardiovascular events and sudden cardiac death [3]. In the clinical environment, patients also seek complementary and alternative therapy for symptom relief. One of the most frequently chosen treatments is acupuncture. Acupuncture has long been used to treat CSA, but the acupuncture prescription for CSA varies. It can be safely administered in patients with mild to moderate CSA. Compared with the nonaffected meridian, sham acupuncture, and wait-list groups, adjunctive acupuncture on the disease-affected meridian showed superior benefits in CSA treatment within 16 weeks. Acupuncture should be considered as one option for adjunctive treatment in alleviating angina [3]. According to a recent trial by Zhaoxuan He et al. the effectiveness of puncturing at acupoints on the Heart Meridian will not be the same as those on the Lung Meridian. The results provide further evidence of Meridian-Viscera Association theory and references for acupoints selection in the clinical practice [4].

Recent result by Mingxiao Yang et al. suggested that acupuncture may safely and effectively improve physical restrictions, emotional distress, and attack frequency in patients with stable angina pectoris. However, angina intensity and medication use were not reduced [1].

However, the effectiveness of acupuncture in the treatment of patients with CSA remains unclear due to a lack of solid clinical evidence, according to the 2012 guideline for the diagnosis and management of patients with stable ischemic heart disease [2]. On the other hand, acupuncture combined with conventional drugs reduced the occurrence of acute myocardial infarction, and both acupuncture with or without conventional drugs 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 [5].

While the acupuncture treatment for CSA is not common in European countries, we might want to open the discussion whether this can be suitable for those patients who refuse to follow the drug administration. In addition, as healthcare specialists we prescribe patients not only medication and/or recommend surgical treatment but part of our role is also to explain the importance of a healthy lifestyle, including diet, physical activity and stress management. Patients management has never been only one item but the complex of actions. The article by Mingxiao Yang et al. highlighted the efficacy of acupuncture and I believe we need more randomized controlled trials to compare different CSA management. This can be also helpful to raise and to promote the idea of combined treatment (from physiotherapy to drug management) for patients’ improvement.


Maria Simonkeno commented on this article:

1. Mingxiao Yang, Mingsheng Sun, Ting Du, Hulin Long, Ji Chen, Fanrong Liang, and Lixing Lao - The efficacy of acupuncture for stable angina pectoris: A systematic review and meta-analysis, European Journal of Preventive Cardiology, Volume 28, Issue 13, November 2021, Pages 1415–1425,

other references:

2. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/ STS guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2012;60:e44–e164
3. Ling Zhao, PhD; Dehua Li, PhD; Hui Zheng, PhD; Xiaorong Chang, MD; Jin Cui, PhD; Ruihui Wang, PhD;
Jing Shi, MD; Hailong Fan, PhD; Ying Li, PhD; Xin Sun, PhD; Fuwen Zhang, PhD; Xi Wu, PhD; Fanrong Liang, MD - Acupuncture as Adjunctive Therapy for Chronic Stable Angina: A Randomized Clinical Trial, JAMA Internal Medicine, 2019; 179(10): 1388-1397 DOI: 10.1001/jamainternmed.2019.2407
4. Zhaoxuan He, Yi Yang, Qiao Wen, Tao Yin, Zhengjie Li, Peihong Ma, Hui Zheng, Yunhong Yang, Yongliang Jiang, Jianqiao Fang, Lei Lan, Fang Zeng - Acupuncture for chronic stable angina pectoris based on the theory of Meridian-Viscera Association: study protocol for a multicenter randomized controlled trial, Trials, 2020; 21(915):1-9 DOI: 10.1186/s13063-020-04836-8
5. Ji Chen, Yulan Ren, Yong Tang, Zhengije Li, Fanrong Liang – Acupuncture therapy for angina pectoris: a systematic review, Journal of Traditional Chinese Medicine, 2012; 32(4): 494-501


Notes to editor

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.