HEART DISEASE (© JCM Ltd)

HERBAL MEDICINES SAY NO TO CIRCULATORY DISEASE
Research from the USA suggests that traditional Chinese herbal medicines (TCMs) used to treat cardiovascular disease may act by producing large amounts of nitric oxide (NO). NO is a chemical messenger molecule that is crucial to the cardiovascular system because of its vasodilatory action. It promotes blood flow through the heart and circulatory system, eliminates blood clots, lowers high blood pressure and reduces formation of atherosclerotic plaques. Many cardiovascular diseases are characterised by NO insufficiency. The scientists tested a number of TCMs - including single herbs such as Dan Shen (Salviae miltiorrhizae Radix) and Gua Lou (Trichosanthis Fructus) as well as herbal formulae - for their ability to produce NO. All of the TCMs tested showed NO bioactivity through their nitrite and nitrate content and their ability to reduce nitrite to NO via the activity of the enzyme nitrite reductase. Many of the TCMs were found to have nitrite reductase activity 1000 times greater than that of biological tissues, providing a natural system for generation of nitric oxide in the inner walls of blood vessels and thus accounting for some of their therapeutic effects. Each of the TCMs tested was also found to exert vasodilatory activity in an animal model. (Nitric oxide bioactivity of traditional Chinese medicines used for cardiovascular indications. Free Radic Biol Med. 2009 Sep 15;47(6):835-40).

ACUPUNCTURE FOR CARDIAC ARRHYTHMIAS
A review article from authors in the USA supports the use of acupuncture in treating cardiac arrhythmias. According to the eight studies reviewed, 87% to 100% of participants converted to normal sinus rhythm after acupuncture. However, the limited methodological quality of current studies necessitates better-controlled clinical trials. (The effects of acupuncture on cardiac arrhythmias: a literature review. Heart Lung. 2008 Nov-Dec;37(6):425-31).

TAI CHI FOR HEART FAILURE
Tai chi can enhance sleep stability in patients with chronic heart failure. Researchers analysed 24-hour continuous ECG data obtained in a clinical trial of tai chi in 18 patients with heart failure. At 12 weeks, those who participated in tai chi showed a significant increase in EEG parameters that indicated improved sleep stability. These improvements were correlated with better disease-specific quality of life and could lead to a decrease in blood pressure and likelihood of arrhythmia. (Enhancement of sleep stability with Tai Chi exercise in chronic heart failure: Preliminary findings using an ECG-based spectrogram method. Sleep Med. 2007 Aug 2 [Epub ahead of print]). Another study carried out in 52 patients with chronic heart failure found that although objective measures of exercise tolerance did not improve significantly with tai chi, patients who did tai chi showed improvement in symptom scores of heart failure and depression, compared with patients in the control group. (An evaluation of the effects of Tai Chi Chuan and Chi Kung training in patients with symptomatic heart failure: a randomised controlled pilot study Postgrad Med J. 2007 Nov;83(985):717-21).

ANGINA PECTORIS: INTEGRATED REHABILITATION
This study was designed to compare the outcomes and treatment costs of patients with advanced angina pectoris who were treated with integrated rehabilitation compared to known statistics for similar patients treated by surgery or other care. 168 patients took part in the study, 103 of whom were candidates for invasive treatment and 63 of whom had been rejected for such treatment due to the risk of complications. Integrative rehabilitation consisted of acupuncture treatment and a self-care programme including acupressure, Chinese health philosophy, stress management techniques, and lifestyle adjustments. Over a 3-year period, the risk of death among the 103 patients was 2.0%, compared to 6.4% for the general Danish population, and 5.4% and 8.4% for patients who underwent percutaneous transluminal balloon angioplasty and coronary artery bypass grafting, respectively (in New York). For the 65 inoperable patients the risk of death due to heart disease was 7.7%, compared to 16% and 25% for American patients who were treated with laser revascularisation or medication respectively. Of the 103 candidates for invasive treatment, only 19 (18%) still required surgery. Cost savings over 3 years were US $36,000 and US $22,000 for surgical and nonsurgical patients, respectively, mainly achieved by the reduction in the use of invasive treatment and a 95% reduction in in-hospital days. (Journal of Alternative and Complementary Medicine. Oct 2004, Vol. 10, No. 5: 777-783).

ACUPUNCTURE & CARDIOVASCULAR DISEASE
The Susan Samueli Center for Integrative Medicine at the University of California has received a $2 million, five-year federal grant to continue studying how acupuncture can help treat cardiovascular illnesses such as heart disease, hypertension and arrhythmias. This grant extends a previous five-year grant from the National Heart, Lung and Blood Institute. The study, lead by Dr. John Longhurst, a practising cardiologist, will look at how acupuncture excites brain cells to release neurotransmitters that either inhibit or heighten cardiovascular activity. Longhurst says that needling specific acupuncture points triggers the release of opioid chemicals that reduce excitatory responses in the cardiovascular system. This decreases the heart’s activity and its need for oxygen, which in turn lowers blood pressure and promotes healing for a number of cardiac ailments, such as myocardial ischemia (insufficient blood flow to the heart) and arrhythmias. “What we’re trying to show is that acupuncture can be an excellent complement to other medical treatments, especially for those treating the cardiac system,” Longhurst said. Longhurst has received an additional $2 million grant from the National Heart, Lung and Blood Institute to study central nervous system mechanisms triggered by acupuncture. (www.today.uci.edu/news/release_detail.asp?key=1091).

ACUPUNCTURE HELPS HEART PATIENTS
Research carried out at the University of California Los Angeles School of Medicine has shown that acupuncture can dramatically reduce the pressure on the heart in patients with severe heart failure. Over-activation of the sympathetic nervous communication between the brain and the heart is common in heart failure patients, with advanced heart failure patients often having two or three times more sympathetic nerve activity than normal. This may damage their long-term prospects because it forces the weakened heart to work harder, as the blood has to be forced through blood vessels that are constricted by the nervous activity. It also makes it more likely that the heart will develop potentially lethal rhythm patterns. It has been shown that the greater this activity is, the worse the outlook for the patient. Although beta-blockers are normally prescribed, some patients with heart failure do not respond to them, while others cannot take them at all. The researchers divided 14 critically ill chronic heart failure patients referred for heart transplantation evaluation into three groups. One group received acupuncture at traditional acupuncture sites, the second received "non-acupoint" acupuncture in which needles were placed at sites not traditionally believed to be useful in acupuncture, and the third group had a "no-needle" simulation of the treatment, in which a needle holder was tapped onto the back of their neck, but no needle was inserted. Blood pressure, heart rate and sympathetic nerve activity were measured in all the patients following a four-minute mental stress test. There was a 25% increase in sympathetic nerve activity after the mental stress tests without active acupuncture, while with a single session of real acupuncture, sympathetic nerve activation was significantly reduced and was similar to what it had been before the patients underwent the stress test (Middlekauf HR et.al., Proceedings of the American Heart Association 2001 Scientific Sessions conference, Anaheim, 14/11/2001).

ACUPUNCTURE IN ANGINA PECTORIS
A study carried out at the Department of Internal Medicine P. Rigshospitalet in Denmark found that acupuncture treatment decreased the time of onset of attacks of angina pectoris pain by 10%, reduced nitroglycerin consumption by 58%, and reduced the attack rate by 38%. There was additionally a noticeable improvement in exercise tolerance among the treated patients. The study also showed that there was no apparent effect on results from acupuncture treatment from patient expectations (Ballegaard, S. et. al. Acupuncture in angina pectoris: do psycho-social and neurophysiological factors relate to the effect? Acupunct Electrother Res 1995 Apr-Jul; 20(2):101-16).