Question

What alternative therapies can be used to facilitate the management of acute or chronic cardiovascular conditions?

Answer 1

Complementary and alternative medicine (CAM) may offer benefits as well as risks to people with cardiovascular disease. Understanding the prevalence and the nature of CAM use will encourage beneficial CAM therapies, prevent potential herb-drug interactions and foster communication between patients and physicians.

The National Center for Complementary and Alternative Medicine (NCCAM) defines complementary and alternative medicine (CAM) as “a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine”. Complementary medicine is used along with conventional medicine, whereas alternative medicine is used in place of conventional medicine.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortalityatients and physicians. In cardiac patients, the use of CAM offers both risks and benefits. For instance, physical therapies such as qigong appear helpful for hypertension while coenzyme Q10 supplements have favourable effects in those with heart failure. Biological therapies such as dietary supplements and herbal medicine may interfere with the action of prescription medications, a potentially harmful consequence. Herb-drug interactions are of concern in cardiac patients because of the narrow therapeutic window and range of cardiac medications.

People with chronic diseases frequently use CAM therapies to manage their condition, and thus increase exposure to herb-drug interactions. It is therefore important to understand the prevalence and the nature of CAM use in this patient cohort to encourage beneficial CAM therapies and to prevent potential herb-drug interactions.

CAM may be broadly divided into 5 separate categories:

1. Biologically-based therapies,
2. Mind-body therapies,
3. Manipulative and body-based therapies,
4. Whole medical systems,
5. Energy medicine.

Biologically-Based Therapies

• The biologically-based therapies include aromatherapy, chelation therapy, diet-based therapies, folk medicine, iridology, megavitamin therapy, neural therapy, and phytotherapy/herbal medicine.
• Marine-derived omega-3 polyunsaturated fatty acids (fish oil) are often touted as being preventative of major cardiovascular adverse outcomes by the postulated mechanisms of lowering triglyceride levels (for which they are approved by the United States Food and Drug Administration (FDA)), preventing arrhythmias, decreasing platelet aggregation, or lowering blood pressure. And while experts agree that fish rich in omega-3 fatty acids should be included in a heart-healthy diet, there is no evidence that omega-3 fatty acids in supplement form protect against heart disease.
• Garlic is used most frequently as a dietary supplement for treatment of hyperlipidemia, heart disease, and hypertension.
• Ginkgo biloba is purported to have cardioprotective effects by several studies through its antioxidant, antiplatelet, antithrombotic, vasodilatory, and antihypertensive properties.
• L-carnitine is FDA approved for replacement therapy in primary (i.e., inborn errors of metabolism) and secondary (i.e., secondary to hemodialysis) L-carnitine deficiencies.Acetyl-L-carnitine (ALC) and propionyl-L-carnitine (PLC), two naturally occurring carnitine derivates, have potential strategies in the management of peripheral arterial disease (PAD), heart and cerebral ischemia, and congestive heart failure.
• Chelation therapy is used to rid the body of excess or toxic metals (i.e., in lead poisoning).EDTA chelation is recommended as a treatment for coronary heart disease (CHD).

Mind-Body Therapies

• The mind-body therapies(MBT) are relatively safe and have measurable benefits for cardiovascular health. Cardiac patients used MBT most commonly for stress, emotional health, and general wellness.
• The mind-body therapies (MBT) include anthroposophical medicine, autogenic training, biofeedback, bioresonance, cognitive-behavioral therapies, deep-breathing exercises, group support, hypnosis, imagery, meditation, prayer, relaxation, Qigong, tai chi, yoga, and shiatsu.
• Relaxation techniques include practices such as progressive relaxation, guided imagery, biofeedback, self-hypnosis, and deep-breathing exercises. The goal of these techniques is to consciously produce the body’s natural relaxation response, characterized by slower breathing, lower blood pressure and oxygen consumption, and a feeling of calm and well-being.
• Meditation refers to a group of techniques such as mantra meditation, mindfulness meditation, transcendental meditation, and Zen Buddhist meditation. The transcendental meditation may reduce blood pressure as well as other risk factors for CVD such as cholesterol, oxidized lipids, and smoking.
• Yoga has many different styles, some more physically demanding than others. In general, practicing yoga, as well as other forms of regular exercise, leads to several cardiovascular benefits. Yoga typically causes increased heart rate during the act, but following prolonged training, a decrease occurs in exercise-induced heart rate.

Manipulative and Body-Based Therapies

• The manipulative and body-based therapies include acupressure, Alexander technique, Bowen technique, chiropractic manipulation, Feldenkrais method, massage, osteopathic manipulation, reflexology, Rolfing, Trager bodywork, and Tui na.
• Massage therapy encompasses many different techniques, such as Swedish massage, sports massage, deep tissue massage, and trigger point massage.
• Spinal manipulation, as found in chiropractic and osteopathic manipulation, has been reported to successfully treat hypertension.

Whole Medical Systems

• The whole medical systems include acupuncture (as part of traditional Chinese medicine), Ayurveda, homeopathy, and naturopathy.
• Acupuncture is a therapeutic modality anchored in traditional Chinese medicine (which also includes Chinese herbal medicine, moxibustion, cupping, Chinese massage, mind-body therapies such as Qigong and tai chi, and dietary therapy).

Energy Medicine

• Energy medicine includes healing touch, light therapy, magnetic therapy, millimeter wave therapy, Qigong, Reiki, and sound energy therapy.

Complementary and Alternative Medicine use among patients with CVD is prevalent, with biologically-based and mind-body therapies being the most commonly used treatment modalities.