INTEGRATIVE AND COMPLEMENTARY MEDICINE IN CARDIOLOGY: NEW HOPE OR JUST HIP AND HYPE?
Freny V. Mody, M.D.,
VA Greater Los Angeles HCS, CA, USA
Objectives: To review rigorous scientific evidence of benefit and effective treatments in integrative medicine (IM) for cardiovascular disease (CVD). IM integrates traditional medicine with non-conventional therapeutic modalities referred to as complementary alternative medicine (CAM).
Background: CAM use is widespread in the world’s population (38%). The demography of CAM users includes younger age, more educated, and wealthier population. Only 20% discuss CAM use with their physicians. Increasing prevalence of IM warrants elucidating the mechanism of action for benefit, and magnitude of efficacy in CVD for rationale and appropriate use.
Methods: Systematic review of meta-analysis and bibliographic computerized databases was conducted for CAM studies in CVD for efficacy and mechanism of action.
Results: Robust data is lacking for herbal supplementation, the most utilized CAM modality in CVD. Physician referral for acupuncture (AP) worldwide is >40%, but < 5% for CVD. AP benefit in hypertension reduces systolic BP by a small significant 5-10 mmHg with attenuation of sympathetic outflow in animal models. AP efficacy in angina is mixed with small studies, and moderate-high risk of bias based on Cochrane Collaboration analysis. Mind-body CAM using transcendental meditation (TM) has the strongest evidence for reduction in CVD morbidity (hypertension, ischemia on treadmill p<0.001) and all-cause mortality (23% reduction, p< 0.04) in small trials of elderly with control group design. Stress, a major CVD risk factor, influences TM’s mechanism of benefit via BP reduction and heart rate variability.
Conclusions: No established benefit exists in CVD with herbal supplements, the most common CAM. AP and mind-body therapies such as TM are infrequently used and may be overlooked for CVD and need larger studies for conclusive evidence. Current evidence warrants further investigation to augment the therapeutic armamentarium of cardiologists. Elucidation of scientific mechanisms, will encourage physician referral for effective CAM, and foster improved communication between patients and physicians.