Stable Angina Pectoris

Prevalence

Cardiovascular disease is the leading cause of death in Australia every year. According to the statistics from the Australian Institute of Health and Welfare (AIHW 2020), approximately 580,300 Australians (2.8% of the adult population) reported coronary heart disease at some time in their lives in 2017, and 227,300 experienced angina.

What is Stable Angina?

Angina is caused by myocardial ischaemia, which manifests as temporary pain or discomfort in the chest when the heart doesn’t receive enough blood and oxygen supply. Chronic stable angina is a predictable pattern that is a consistent condition in duration and severity, and is provoked by overload of physical activity or emotional stress (Wee, Burns & Bett 2015). Medications such as beta blockers, calcium channel antagonists and nitrates are used for control symptoms.

The Combination of Acupuncture and Medication Reduced the Recurrence of Angina

Several researches proved that acupuncture combined with these medications reduced the frequency of angina attacks compared to medications alone. Richter et al. (1991) found that acupuncture showed a beneficial effect in patients with severe stable angina who received intensive treatment. Ballegaard et al. (1986) suggested that acupuncture may improve cardiac capacity in patients with angina pectoris that is unresponsive to medical treatment. In addition, Ballegaard et al. (1999) also found that acupuncture combined with pharmaceutical treatment and self-care education could reduce the cost of hospitalisation and surgery for patients with severe angina pectoris. Furthermore, a recent study that included 404 patients with chronic stable angina found that acupuncture on disease-affected meridians, such as the Heart and Pericardium meridians, significantly reduced the frequency of angina attacks compared with acupuncture on irrelevant meridians, sham acupuncture, and no acupuncture (Zhao et al. 2019).

How Does Acupuncture Work in Stable Angina?

In Chinese Medicine, angina pectoris is considered to be stagnation or deficiency in Heart channel. PC 6 (Neiguan) is a major point for angina. Needling on PC 6 can activate the channel, unbind the chest, regulate the Heart, and calm the mind (Deadman, Al-Khafaji & Baker 1998). Researches found that needling PC 6 can upregulate gamma aminobutyric acid (GABA), opioids, 5-HT, Nitric oxide (NO) and nitric oxide synthase (NOS), thus provide vasodilation, reduce blood pressure and reduce heart rate variability and the cardiovascular sympathoexcitatory reflex responses (Li et al. 2012). Furthermore, a rat study found that acupuncture on PC 6 specifically regulated myocardial contraction, vascular smooth muscle contraction, hypertrophic cardiomyopathy, oxidative phosphorylation, inflammation and immune response, and apoptosis pathways, thus PC 6 might be a useful therapy prior to the application of reperfusion to patients with myocardial ischemia (Huang et al. 2014).

To conclude, acupuncture has shown effectiveness as adjunctive therapy in alleviating angina attack. It is also a safe and cost effective treatment for patients with severe stable angina.

Reference

• Ballegaard, S., Jensen, G., Pedersen, F. & Nissen, V.H. 1986, 'Acupuncture in severe, stable angina pectoris: a randomized trial', Acta Med Scand, vol. 220, no. 4, pp. 307-13.

• Ballegaard, S., Johannessen, A., Karpatschof, B. & Nyboe, J. 1999, 'Addition of Acupuncture and Self-Care Education in the Treatment of Patients with Severe Angina Pectoris May be Cost Beneficial: An Open, Prospective Study', The Journal of Alternative and Complementary Medicine, vol. 5, no. 5, pp. 405-13.

• Cardiovascular disease 2020, Australian Institute of Health and Welfare (AIHW), viewed 10 Aug 2020, <https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/cardiovascular-health-compendium>.

• Deadman, P., Al-Khafaji, M. & Baker, K. 1998, A manual of acupuncture, Journal of Chinese Medicine Publications, Hove, East Sussex.

• Huang, Y., Lu, S.F., Hu, C.J., Fu, S.P., Shen, W.X., Liu, W.X., Li, Q., Wang, N., He, S.Y., Liang, F.R. & Zhu, B.M. 2014, 'Electro-acupuncture at Neiguan pretreatment alters genome-wide gene expressions and protects rat myocardium against ischemia-reperfusion', Molecules, vol. 19, no. 10, pp. 16158-78.

• Li, J., Li, J., Chen, Z., Liang, F., Wu, S. & Wang, H. 2012, 'The influence of PC6 on cardiovascular disorders: a review of central neural mechanisms', Acupuncture in Medicine, vol. 30, no. 1, pp. 47-50.

• RichterI, A., Herlitz, J. & Hjalmarson, Å. 1991, 'Effect of acupuncture in patients with angina pectoris', European Heart Journal, vol. 12, no. 2, pp. 175-8.

• Wee, Y., Burns, K. & Bett, N. 2015, 'Medical management of chronic stable angina', Australian prescriber, vol. 38, no. 4, pp. 131-6.

• Zhao, L., Li, D., Zheng, H., Chang, X., Cui, J., Wang, R., Shi, J., Fan, H., Li, Y., Sun, X., Zhang, F., Wu, X. & Liang, F. 2019, 'Acupuncture as Adjunctive Therapy for Chronic Stable Angina: A Randomized Clinical Trial', JAMA Internal Medicine, vol. 179, no. 10, pp. 1388-97.