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

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.