A report of JAMA supports acupuncture as adjunctive therapy for chronic stable angina

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


Unlike earlier, failed attempts to show a benefit with acupuncture in this setting, the current study specified exactly how the therapy should be administered, focusing on acupoints on the disease-affected meridian (DAM). Patients in the four-arm trial who were treated in the DAM had fewer angina attacks than those who were treated in nonaffected meridian (NAM) or received sham acupuncture or no treatment beyond medical therapy.

This is hardly the first high-quality study to be done in China on the use of traditional Chinese medicine (TCM) for angina, lead author Ling Zhao, PhD, and senior author Fanrong Liang, MD (both from 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 in use for this indication, Zhao and Liang noted. “Because of limited medical resources and controversial benefits from percutaneous coronary intervention, Chinese clinicians choose acupuncture in addition to antianginal treatment for chronic stable angina. Acupuncture has been used as a nonpharmacologic treatment in TCM hospitals for several decades, especially to relieve symptoms of myocardial ischemia, improve cardiac function, and prevent recurrence in clinic.”


Here is the abstract of the manuscript


Title:

Acupuncture as Adjunctive Therapy for Chronic Stable Angina--A Randomized Clinical Trial


Importance The effects of acupuncture as adjunctive treatment to antianginal therapies for patients with chronic stable angina are uncertain.


Objective To investigate the efficacy and safety of acupuncture as adjunctive therapy to antianginal therapies in reducing frequency of angina attacks in patients with chronic stable angina.


Design, Setting, and Participants In this 20-week randomized clinical trial conducted in outpatient and inpatient settings at 5 clinical centers in China from October 10, 2012, to September 19, 2015, 404 participants were randomly assigned to receive acupuncture on the acupoints on the disease-affected meridian (DAM), receive acupuncture on the acupoints on the nonaffected meridian (NAM), receive sham acupuncture (SA), and receive no acupuncture (wait list [WL] group). Participants were 35 to 80 years of age with chronic stable angina based on the criteria of the American College of Cardiology and the American Heart Association, with angina occurring at least twice weekly. Statistical analysis was conducted from December 1, 2015, to July 30, 2016.


Interventions All participants in the 4 groups received antianginal therapies as recommended by the guidelines. Participants in the DAM, NAM, and SA groups received acupuncture treatment 3 times weekly for 4 weeks for a total of 12 sessions. Participants in the WL group did not receive acupuncture during the 16-week study period.

Main Outcomes and Measures Participants used diaries to record angina attacks. The primary outcome was the change in frequency of angina attacks every 4 weeks from baseline to week 16.


Results A total of 398 participants (253 women and 145 men; mean [SD] age, 62.6 [9.7] years) were included in the intention-to-treat analyses. Baseline characteristics were comparable across the 4 groups. Mean changes in frequency of angina attacks differed significantly among the 4 groups at 16 weeks: a greater reduction of angina attacks was observed in the DAM group vs the NAM group (difference, 4.07; 95% CI, 2.43-5.71; P < .001), in the DAM group vs the SA group (difference, 5.18; 95% CI, 3.54-6.81; P < .001), and in the DAM group vs the WL group (difference, 5.63 attacks; 95% CI, 3.99-7.27; P < .001).


Conclusions and Relevance Compared with acupuncture on the NAM, SA, or no acupuncture (WL), acupuncture on the DAM as adjunctive treatment to antianginal therapy showed superior benefits in alleviating angina.


Key Points


Question What is the efficacy and safety of acupuncture adjunctive therapy to antianginal therapies in reducing the frequency of angina attacks?


Findings This randomized clinical trial that included 404 patients with chronic stable angina found that acupuncture on the acupoints in the disease-affected meridian significantly reduced the frequency of angina attacks compared with acupuncture on the acupoints on the nonaffected meridian, sham acupuncture, and no acupuncture.


Meaning Adjunctive therapy with acupuncture had a significant effect in alleviating angina within 16 weeks.



Figure. Frequency of Angina Attacks Over Time During the Study

DAM indicates disease-affected meridian; NAM, nonaffected meridian; SA, sham acupuncture; and WL, wait list.


Links:

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2739058

https://www.tctmd.com/news/acupuncture-angina-chinese-study-backs-targeted-approach

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