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BMC Complementary Medicine and Therapies
Published in: BMC Complementary Medicine and Therapies 1/2015

Open Access 01-12-2015 | Research article

Effectiveness of acupuncture for angina pectoris: a systematic review of randomized controlled trials

Authors: Changhe Yu, Kangshou Ji, Huijuan Cao, Ying Wang, Hwang Hye Jin, Zhe Zhang, Guanlin Yang

Published in: BMC Complementary Medicine and Therapies | Issue 1/2015

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Abstract

Background

The purpose of this systematic review is to assess the effectiveness of acupuncture for angina pectoris.

Methods

Eleven electronic databases were searched until January 2013. The study included randomized controlled trials that the effectiveness of acupuncture alone was compared to anti-angina medicines (in addition to conventional treatment) and the effectiveness of a combination of acupuncture plus anti-angina medicines was compared to anti-angina medicines alone. The trial selection, data extraction, quality assessment and data analytic procedures outlined in the 2011 Cochrane Handbook were involved.

Results

The study included 25 randomized controlled trials (involving 2,058 patients) that met our inclusion criteria. The pooled results showed that the number of patients with ineffectiveness of angina relief was less in the combined acupuncture-anti-angina treatment group than in the anti-angina medicines alone group (RR 0.33, 95% CI 0.23-0.47, p < 0.00001, I2 = 0%). Similarly, compared to the anti-angina medicines alone group, fewer patients in the combined treatment group showed no ECG improvement (RR 0.50, 95% CI 0.40-0.62, p < 0.00001, I2 = 0%). However, no differences were observed between acupuncture treatment alone and anti-angina medicines alone for both outcome measures. Only four trials mentioned adverse effects. One trial found no significant difference between acupuncture and Chinese medicine, and three reported no adverse events. The quality of the trials was found to be low.

Conclusions

The findings showed very low evidence to support the use of acupuncture for improving angina symptoms and ECG of angina patients. However, the quality of the trials included in this study was low. Large and rigorously designed trials are needed to confirm the potential benefit and adverse events of acupuncture.
Appendix
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Literature
1.
Kones R. Recent advances in the management of chronic stable angina I: Approach to the patient, diagnosis, pathophysiology, risk stratification, and gender disparities. Vasc Health Risk Manag. 2010;6:635–56.CrossRefPubMedPubMedCentral
2.
O’Toole L. Angina (chronic stable). Clinical evidence handbook. London: BMJ publishing group; 2010. p. 15–7.
3.
Wright RS, Anderson JL, Adams CD, Bridges CR, Casey DE, Ettinger SM, et al. ACCF/AHA Focused Update of the Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction (Updating the 2007 Guideline). Circulation. 2011;2011(123):2022–60.
4.
5.
Unit JHS. Health survey for England 2006. London: The Stationery Office; 2008.
6.
Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, et al. Heart disease and stroke statistics-2010 update: a report from the American Heart Association. Circulation. 2010;121:e46–215.CrossRefPubMed
7.
The collaborative study group on trends of cardiovascular diseases in China and prevention. Current status of major cardiovascular risk factors in Chinese populations and their trends in the past two decades. Chin J Cardiol. 2001;29:74–9.
8.
Fraker TD, Fihn SD. 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to Develop the Focused Update of the 2002 Guidelines for the Management of Patients With Chronic Stable Angina. Circulation. 2007;116:2762–72.CrossRefPubMed
9.
Kim TH, Lee MS, Kim KH, Kang JW, Choi TY, Ernst E. Acupuncture for angina pectoris (Protocol). Cochrane Database Syst Rev 2011, doi:10.1002/14651858.CD009056.
10.
Torpet LA, Kragelund C, Reibel J, Nauntofte B. Oral Adverse Drug Reactions to Cardiovascular Drugs. Crit Rev Oral Biol Med. 2004;15:28–46.CrossRefPubMed
11.
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011;124:e574–651.CrossRefPubMed
12.
Duan X, Zhou L, Wu T, Liu GJ, Qiao J, Wei J et al. Chinese herbal medicine suxiao jiuxin wan for angina pectoris. Cochrane Database Syst Rev. 2008; doi: 10.1002/14651858.CD004473.pub2.
13.
Ng CS, Wang SP, Cheong JL, Wu YD, Jia YL, Leung SW. Systematic review and meta-analysis of randomized controlled trials comparing Chinese patent medicines Compound Danshen Pills and Di’ao Xinxuekang in treating angina pectoris. Zhong Xi Yi Jie He Xue Bao. 2012;10:25–34.CrossRefPubMed
14.
Jia Y, Huang F, Zhang S, Leung SW. Is danshen (Salvia miltiorrhiza) dripping pill more effective than isosorbide dinitrate in treating angina pectoris? A systematic review of randomized controlled trials. Int J Cardiol. 2012;157:330–40.CrossRefPubMed
15.
Zhang J, Zhang MZ, Wang L. The systematic review of Compound Danshen pills in treatment of coronary heart disease. Chin J New Drugs. 2009;18:465–8.
16.
Wang L, Xiong ZY, Wang G, Li YQ. Systematic Assessment on Randomized Controlled Trials for Treatment of Stable Angina Pectoris by Compound Salvia Pellet. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2004;24:500–4.PubMed
17.
Jia Y, Zhang S, Huang F, Leung SW. Could ginseng-based medicines be better than nitrates in treating ischemic heart disease? A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med. 2012;20:155–66.CrossRefPubMed
18.
Han T, Den LJ, Feng L. Clinical therapeutic effect and mechanism research of Suxiao JiuXin Wan for CHD angina pectoris. J Tradit Chin Med. 2002;41:733–42.
19.
Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM, et al. ACC/AHA/ACP -ASIM Guidelines for the Management of Patients With Chronic Stable Angina: Executive Summary and Recommendations A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). Circulation. 1999;99:2829–48.CrossRefPubMed
20.
Kim LW, Zhu J. Acupuncture for essential hypertension. Altern Ther Health Med. 2010;16:18–29.PubMed
21.
White AR, Rampes H, Liu JP, Stead LF, Campbell J. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst Rev. 2011; doi:10.1002/14651858.CD000009.pub4.
22.
Abdi H, Abbasi-Parizad P, Zhao B, Ghayour-Mobarhan M, Tavallaie S, Rahsepar AA, et al. Effects of auricular acupuncture on anthropometric, lipid profile, inflammatory and immunologic markers: a randomized controlled trial study. J Altern Complement Med. 2012;18:668–77.CrossRefPubMed
23.
Liu Z, Sun F, Li J, Shi X, Hu L, Wang Y, et al. Prophylactic and therapeutic effects of acupuncture on simple obesity complicated by cardiovascular diseases. J Tradit Chin Med. 1992;12:21–9.PubMed
24.
Cho SH, Lee JS, Thabane L, Lee J. Acupuncture for obesity: a systematic review and meta-analysis. Int J Obes (Lond). 2009;33:183–96.CrossRef
25.
Angina Treatment Pattern Survey Collaborative Group. Current status of medical therapy of chronic stable angina pectoris in mainland of China: the second survey. Chin J Cardiol. 2010;38:1060–4.
26.
Ernst E. Angina pectoris: saving a lot of money with acupuncture. MMW Fortschr Med. 1999;141:23–4.PubMed
27.
28.
Arthur HM, Patterson C, Stone JA. The role of complementary and alternative therapies in cardiac rehabilitation: a systematic evaluation. Eur J Cardiovasc Prev Rehabil. 2006;13:3–9.PubMed
29.
Chen SL, Li YL. Neural basic relationship between two acupoints Neiguan, Xinshu and heart. Chin Acupunct Moxibustion. 1996;12:33–5.
30.
Bueno E, Mamtani R, Frishman W. Alternative approaches to the medical management of angina pectoris: Acupuncture, electrical nerve stimulation and spinal cord stimulation. Heart Dis. 2001;3:236–41.CrossRefPubMed
31.
Wan W. Treatment of angina pectoris with stimulating the Zhiyang point. Mod Diagn Treat. 1991;2:568–72.
32.
Kurono Y, Egawa M, Yano T, Shimoo K. The effect of acupuncture on the coronary arteries as evaluated by coronary angiography: a preliminary report. Am J Chin Med. 2002;30:387–96.CrossRefPubMed
33.
Li J, Li J, Chen Z, Liang FX, Wu S, Wang H. The influence of PC6 on cardiovascular disorders: a review of central neural mechanisms. Acupunct Med. 2012;30:47–50.CrossRefPubMedPubMedCentral
34.
Ballegaard S, Jensen G, Pedersen F, Nissen V. Acupuncture in severe, stable angina pectoris: A randomized trial. J Intern Med. 1986;220:307–13.
35.
Ballegaard S, Pedersen F, Pietersen A, Nissen V, Olsen N. Effects of acupuncture in moderate, stable angina pectoris: A controlled study. J Intern Med. 1990;227:25–30.CrossRefPubMed
36.
Richter A, Herlitz J, Hjalmarson A. Effects of acupuncture in patients with angina pectoris. Eur Heart J. 1991;12:175–8.CrossRefPubMed
37.
38.
Checklist of STRICTA Items to Reporting Interventions in Controlled Trials of Acupuncture [www.stricta.info=checklist.htm]
39.
Zhu J. Research on the factors affecting the acupuncture treatment courses. Yunnan Tradit Chin Med J. 2009;30:63–4.
40.
41.
Cao JP, Wei LX, Li X, Gao F, Luo K. Observation of DCG and Clinical Effectiveness in the treatments of Acupuncture combined with Medicines for unstable angina. Chin Acupunct Moxibustion. 2002;22:363–5.
42.
Chang PF. Acupuncture Treatment for 30 Cases of Stable Angina Pectoris. Acupunct Res. 2005;30:50–2.
43.
Diao LH, Yan J, Yi SX, Chang XR, Lin YP. Different TCM Therapies for Stable Angina Pectoris. J Tradit Chin Med. 2006;47:442–4.
44.
Hu NK, Yu GE. Acupuncture at Neiguan on hemorheology in patients with angina pectoris. Chin J Integr Tradit West Med Intensive Crit Care. 1997;4:16–7.
45.
Huang J, Yan J, Chang XR, Wang C, Yi SX, And Lin YP. Electro-acupuncture at Neiguan for 40 stable angina patients. J Tradit Chin Med Univ Hunan. 2004;24:53–4.
46.
Huang J. Clinical Therapeutic for Stable angina Pectoris through Electro-acupuncture Point Neiguan, Composite Salviae dropping Pill, Combination of Electro-acupuncture and medicine. Hunan College of Traditional Chinese Medicine: Hunan; 2004. MD thesis.
47.
Li CP, Zhang YL, Liu PZ, Zhang HS. Acupuncture for 70 cases of angina pectoris according to tonifying kidney and spleen. Chin J Inform Tradit Chin Med. 2005;12:76–9.
48.
Li HJ, Zhang LL, Tao P, Ma XD. Acupuncture combined with Danshen injection for 36 cases of angina pectoris. J Tradit Chin Med Chin Jilin. 2003;23:37.
49.
Liu JL. Clinical therapeutic effect of acupuncture combined with medicines unstable angina pectoris and affection on CRP. Fujian College of Traditional Chinese Medicine: MD thesis; 2007.
50.
Liu JR, Tan Y, Pan WJ. The clinical observation of the acupuncture treatment for angina pectoris. New J Tradit Chin Med. 2010;42:68–70.
51.
Liu WP, Xing ZH, Tan HY, Lin ZZ, Cai CL, Zhang C. Case observation of acupuncture treatment on patients with variant angina pectoris and its effect on the function of vascular endothelial system. J Tradit Chin Med Univ Hunan. 2004;24:52–3.
52.
Liu WP, Xing ZH, Lin ZZ. Acupuncture Treatment on Quality of Life in Patients with Stable Angina Pectoris. Chin J Rehabil. 2003;18:350–1.
53.
Liu YF, Zhang YJ. Clinical observation of Tonifying kidney and activating blood for stable angina pectoris. Heilongjiang J Tradit Chin Med. 2012;41:35–6.
54.
Tong YH, Zhang ZH, Huang FQ, Zhang MX, Shi Y. Electro-acupuncture combined with western medicines for angina pectoris. Hubei Coll TraditChin Med J. 2005;7:53–4.
55.
Wang PJ. Observation of different Chinese medicine methods for Stable angina pectoris. Clin J Chin Med. 2011;3:29–31.
56.
Wang X, Zhang YT, Jiang B. Clinical observation of acupuncture treatment for unstable angina. J Clin Acupunct Moxibustion. 2000;16:17–8.
57.
Wu CY, Jia LH, Lv ZJ. Clinical study on moxibustion with warming needle for treatment of coronary heart disease angina pectoris. Clin J Chin Med. 2009;1:51–3.
58.
Wu HH, Wang XL, Zhang J. Clinical observation on acupuncture combined medicines for angina pectoris. J Clin Acupunct Moxibustion. 2005;21:21.
59.
Xie ZQ. The Influence of needling Gongsun and Neiguan Points on High Risk Patients with Unstable Angina. Hebei Medical University: MD thesis; 2003.
60.
Xu GD, Tong YH, Huang FQ, Tong LM, Xu YF. Observation of Acupuncture combined with medicines for angina pectoris on the quality of life. J Clin Acupunct Moxibustion. 2006;22:16–7.
61.
Tong YH, Tong LM, Xu GD, Wang SC, Li Q. Electro-acupuncture combined with Western Medicines for Angina Pectoris. Chin J Rehabil. 2005;20:276–7.
62.
Yu W. Acupuncture at Neiguan on patients with angina pectoris in plasma NO and cGMP. MD thesis. Beijing University of Traditional Chinese Medicine; 2006.
63.
Zhang L, Zuo L. Observation of acupuncture combined with Western medicines for angina pectoris. J Clin Acupunct Moxibustion. 2011;27:27–9.
64.
Zhang LJ, Xie C. The combinations of acupuncture and medicines for angina pectoris of coronary heart disease and their effects on the plasma TXB2, 6-k-PGF1 α, ET, CGRP. Chin J Gerontol. 2005;25:836–7.
65.
Zhang JH, Shang HC, Gao XM, Ernst E. Acupuncture-related adverse events: a systematic review of the Chinese literature. Bull World Health Organ. 2010;88:915–921C.CrossRefPubMedPubMedCentral
66.
Chen J, Ren Y, Tang Y, Li Z, Liang F. Acupuncture therapy for angina pectoris: a systematic review. J Tradit Chin Med. 2012;32(4):494–501.CrossRefPubMed
67.
Vickers A, Goyal N, Harland R, Rees R. Do certain countries produce only positive results? A systematic review of controlled trials. Controlled Clin Trials. 1998;19:159–66.CrossRefPubMed
68.
Ballegaard S. Acupuncture and the Cardiovascular System: a scientific challenge. Acupunct Med. 1998;16:2–9.CrossRef
69.
Witt CM, Ml A, Baca T, Cherkin D, Haan MN, Hammerschlag R, et al. Effectiveness guidance document (EGD) for acupuncture research - a consensus document for conducting trials. BMC Complementary and Alternative Medicine. 2012;12:148.CrossRefPubMedPubMedCentral
70.
Metadata
Title
Effectiveness of acupuncture for angina pectoris: a systematic review of randomized controlled trials
Authors
Changhe Yu
Kangshou Ji
Huijuan Cao
Ying Wang
Hwang Hye Jin
Zhe Zhang
Guanlin Yang
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Complementary Medicine and Therapies / Issue 1/2015
Electronic ISSN: 2662-7671
DOI
https://doi.org/10.1186/s12906-015-0586-7

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