Coronary heart disease

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.

References

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.

How acupuncture can help

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:

  • minimising myocardial injury, probably partially by reducing serum cardiac troponin I and C-reactive protein levels (Ni 2012);
  • inhibiting cardiac sympathetic nervous system activity (and hence noradrenaline and adrenaline), in order to relieve  myocardial ischaemia (Li 2012a; Zhou 2012);
  • activation of myocardial opioid receptors, and subsequent signalling by protein kinases such as PKC, has a protective effect against ischaemia (Zhou 2012);
  • lowering levels of myocardial enzymes (serum aspartate aminotransferase, isoenzymes of creatine kinase, lactate dehydrogenase, creatine kinase, and alpha-hydroxybutyrate dehydrogenase) to prevent ischaemic myocardial injury (Huang 2012);
  • regulating nerve electrical activity in the spinal dorsal roots and concentrations of norepinephrine and dopamine in the paraventricular nucleus of the hypothalamus (Li 2012b);
  • regulating JNK signalling pathways (mitogen-activated protein kinases that transmit signals of stress stimuli)  to possibly  prevent and treat cardiac hypertrophy  (Wang 2012);
  • activating baroreceptor sensitive neurons in the nucleus tractus solitarius in a similar manner to the baroreceptor reflex in cardiovascular inhibition (Gao 2011);
  • upregulating myocardial nitric oxide and nitric oxide synthase content and downregulating myocardial intracellular calcium levels, which may contribute to its effect in relieving myocardial injury (Wang 2010);[h1]
  • acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010);
  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007).

Additional Info

Terms and conditions: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.

Last modified on Tuesday, 25 February 2014 00:36


 

 

 

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