Acupuncture for angina? Chinese study supports targeted approach

Acupuncture can reduce the frequency of chest pain episodes in patients with chronic stable angina pectoris, in combination with medical treatment, according to data from a randomized clinical trial conducted in China.

Unlike previous unsuccessful attempts to demonstrate the benefits of acupuncture in this setting, the present study clarifies exactly how treatment should be administered, focusing on acupuncture points located on the affected meridian. disease (DAM). Patients in the four-arm DAM-treated trial had fewer angina attacks than those treated in an unaffected meridian (AMN) or receiving simulated acupuncture or treatment without medical treatment.

This is hardly the first high-quality study ever done in China on the use of Traditional Chinese Medicine (TCM) to treat angina, lead author Ling Zhao, PhD, and lead author Fanrong Liang, MD (both of the Chengdu University of Traditional Chinese Medicine, China), told TCTMD in a jointly written email. But, they said, the current report has the largest sample size.

Indeed, acupuncture is already used for this indication, noted Zhao and Liang. "Due to the limited medical resources and controversial benefits of percutaneous coronary intervention, Chinese clinicians choose acupuncture in addition to anti-anginal treatment for chronic stable angina pectoris. Acupuncture has been used for several decades as a non-pharmacological treatment in traditional Chinese medicine hospitals, particularly to relieve symptoms of myocardial ischemia, improve heart function and prevent recurrence in the clinic.

Shaista Malik, MD, Ph.D. (University of California, Irvine), whose research focuses on the use of acupuncture in the treatment of cardiovascular disease, particularly hypertension, said: "This is a excellent study done well because she actually considered for a very specific indication. "

Malik has commented on acupuncture as a treatment for angina in the United States, Malik told TCTMD. "But more than half of our population uses complementary medicine approaches, including acupuncture. Unfortunately, in our traditional medical system, we do not ask questions about it, patients are reluctant to talk about it. In the end, I do not see this as an alternative therapy [but rather] used as an extra strategy. [This] Cardiologists, like me, are reluctant to tell patients, "You're going to trust something and we do not know how often you'll need it again."

In the context of a "safety net" for medical treatment, acupuncture could allow patients to take fewer medications or take them at a lower dose, thereby reducing side effects, suggested Malik. "I think it's a really powerful tool."

Nieca Goldberg, MD (NYU Langone Medical Center, New York, NY), described acupuncture in this context as an "interesting concept."

"Our country has millions of people with chronic heart disease," she said, noting that medications can have side effects or not completely resolve symptoms, noting that patients are often curious about alternative medicine. . However, it is not known how these results based on China could extend to other populations.

Nevertheless, "it's great that we start thinking differently in terms of treatment options for our patients," concluded Goldberg.

Targeted Acupoints

Zhao and his colleagues recruited 404 patients with chronic stable angina who had seizures at least twice a week in five centers between October 10, 2012 and September 19, 2015. The practitioners were licensed acupuncturists with more than three years of experience.

All study participants received anti-anginal therapy, including beta-blockers (or calcium channel blockers), aspirin (or clopidogrel), statins, and ACE inhibitors. Patients randomized to the DAM, NAM and sham groups were treated with acupuncture three times a week for 4 weeks. The follow-up was then maintained for an additional 12 weeks, during which patients recorded details of their angina attacks in their diaries.

In an intention-to-treat badysis of 398 people (mean age 63, women 64%), the initial characteristics were similar across the four groups. The average frequency of angina attacks during the first 4 weeks was 13.31. Between weeks 4 and 16, DAM acupuncture patients experienced a greater reduction in angina frequency than the other three groups.

Average change in frequency of angina attacks with acupuncture

Additional studies are needed to better understand the sustainability of the effects of acupuncture beyond 12 weeks, Zhao and Liang noted in TCTMD, suggesting that patients may need to return for additional sessions after an interval of about 3 to 6 months. There could also be potential for "portable and portable acupuncture point stimulation devices to simulate acupuncture," they said.

The Achilles heel of acupuncture therapy, said Malik, is: "You have to actually find an acupuncturist, you have to go to a physical place instead of being able to take a pill at home. However, until where should you go? What is the maintenance schedule? Answering these and other questions related to "perceived patient burden" will be the key to clinical adoption of the treatment, she added.

Regarding the mechanism, Malik said: "This concerns neuromodulation and neurostimulation. This is not all acupuncture points, but about 70% to 80% are badociated with a significant accumulation of nerve bundles at this location. Interestingly, our sensory nerves are unequally distributed over the body. . . . These acupuncture points have these nerve bundles and they have a lower electrical impedance than the surrounding tissue at that location. [location]. Stimulation of these nerve fibers or their small-diameter nerve path provokes a response from the central nervous system to the central nervous system.

Animal models have shown that the signal goes to the brainstem and the hypothalamus, which are involved in the regulation of blood pressure, with a mechanism involving the endogenous opioid system, she explained. "It makes a lot of sense with angina and pain."

Funding in this area is hard to come by as there are no devices or drugs to capture manufacturers' attention, Malik said, adding that it was crucial to advocate for continued funding from the National Institutes. of Health.