Volume 55, Issue 3, March 2009, Pages 121-192 doi:10.1016/j.disamonth.2008.12.002 Alternative and Complementary Medicine for Preventing and Treating Cardiovascular Disease
A review of Alternative and Complementary Medicine for Preventing and Treating Cardiovascular Disease was recently published in Disease-a-month journal.
The authors concluded that: Alternative medicine represents those healing traditions that in the recent past were not part of standard allopathic medical training. However, more and more individuals are seeking CAM practitioners and remedies for part of their health care needs. Although most CAM therapies are relatively innocuous and often improve patient well-being most likely through a placebo effect, some involve the use of pharmacologically active substances (eg, herbal medicine, megavitamin therapy, and some folk remedies) that could complicate existing medical therapy or even cause harm.
Physicians must be aware of CAM practices so that they can best counsel their patients in an atmosphere of open communication. Rather than dismissing a patient’s highly motivated intentions toward health-conscious behaviors, it behooves the physician to understand the range of CAM treatments and when they might be safely integrated with conventional medicine.
Despite the lack of scientific rigor in previous studies of CAM therapies, the NCCAM, a part of the NIH, is now actively coordinating clinical trials, advancing scientific research, and training researchers to study CAM. Ultimately it will be the fusion of the best medical practices from those which are rigorously studied in clinical trials that will provide the most favorable clinical outcomes in medicine.
In addition, physicians must remember that many of our current drugs came out of herbal medicine practice (eg, digitalis, aspirin, lovastatin, reserpine), and homeopathy (nitroglycerin). Much of our bedside approach to sick patients was adopted and modified from ancient and deeply rooted cultures (eg, Ayurveda). We have the responsibility as medical professionals to preserve and protect the physical, psychological, and spiritual “heart” of our patients. Achieving a “placebo effect,” while doing “no harm,” is a benefit clinicians should not ignore.
Massage therapy has been available for centuries; however, the idea of therapeutic or healing touch was strongly promoted in the 1970s. Although the theory of “energy transfer” to patients with cardiovascular disease has been postulated, there is no scientific substantiation of this concept. There is more evidence of a potential anti-anxiety effect, which bears further scrutiny. A study by Song et al. analyzed electroencephalograms and electrocardiograms in 22 subjects who focused attention on their heartbeats with and without kinesthetic (touch) biofeedback. Heart-focused attention and awareness of creative pulsations revealed increased electroenceph-alographic activities synchronized with the electrocardiogram, possibly reflecting increased baroreceptor and somatosensory feedback. This suggests a homeostatic self-regulation between the brain and the target organ, which may underlie the self-healing mechanisms apparent in mind-body medicine.
Tiller et al. demonstrated that patients trained in heart-focused stress reduction techniques shifted attention away from stress and directly influenced the parasympathetic feedback loop.299 These and other studies on the physiology of self-attention provide a crossover reference to the effects demonstrated with therapeutic touch. Heidt studied 90 patients who were hospitalized in a cardiovascular unit, comparing the effects of therapeutic touch, casual touch, or no touch with all patients receiving a 5-minute intervention. Pre- and postinterventional anxiety scores showed a significantly greater reduction in post touch anxiety among the patients receiving therapeutic touch. An extensive review of the literature concludes that there is evidence to support the practice of therapeutic touch for the reduction of both pain and anxiety. Nine of 11 studies analyzed showed statistically significant benefits from this treatment.
Massage therapy has a long history of use for musculoskeletal and orthopedic complaints with a variety of positive responses reported. There have been relatively few studies in regard to the treatment of cardiovascular patients and any long-term benefit. One study by Olney found regular therapeutic massage to be helpful in lowering blood pressure in hypertensive patients. McNamara et al. studied back massage before diagnostic cardiac catheterization and found some benefit from a 20-minute massage intervention.303 In the treatment group, systolic blood pressure was reduced a mean 8.6 mmHg and perceived psychological distress was reduced as well. The mechanism of benefit in massage therapy appears to be both a reduction of anxiety levels and an increase in cardiac parasympathetic activity. The MANTRA studies suggest clinical benefit on cardiac outcomes in patients undergoing angioplasty with therapeutic touch,but no significant difference was seen between treatment groups. Additional trials seem warranted, as is evidenced by the validity of massage therapy to reduce stress, which is a major provocative factor in CAD.