Abstract
Background
Heart rate variability (HRV) is reduced in stable ischemic heart disease (SIHD) patients
and is associated with sudden cardiac death (SCD). We evaluated the impact of traditional
acupuncture (TA) on cardiac autonomic function measured by HRV in SIHD patients.
Methods
We conducted a randomized controlled study of TA, sham acupuncture (SA), and waiting
control (WC) in 151 SIHD subjects. The TA group received needle insertion at acupuncture
sites, the SA group received a sham at non-acupuncture sites, while the WC group received
nothing. The TA and SA groups received 3 treatments/week for 12 weeks. 24-Hour, mental arithmetic stress, and cold pressor (COP) HRV was collected
at entry and exit, along with BP, lipids, insulin resistance, hs-CRP, salivary cortisol,
peripheral endothelial function by tonometry (PAT), and psychosocial variables.
Results
Mean age was 63 ± 10; 50% had prior myocardial infarction. Comparison of WC and SA groups demonstrated
differences consistent with the unblinded WC status; therefore by design, the control
groups were not merged. Exit mental stress HRV was higher in TA vs. SA for markers
of parasympathetic tone (p ≤ 0.025), including a 17% higher vagal activity (p = 0.008). There were no differences in exit 24-hour or COP HRV, BP, lipids, insulin
resistance, hs-CRP, salivary cortisol, PAT, or psychosocial variables.
Conclusions
TA results in intermediate effects on autonomic function in SIHD patients. TA effect
on HRV may be clinically relevant and should be explored further. These data document
feasibility and provide sample size estimation for a clinical trial of TA in SIHD
patients for the prevention of SCD.
Condensed abstract
We conducted a randomized, single-blind trial of traditional acupuncture (TA) vs.
sham acupuncture (SA) vs waiting control (WC) in stable ischemic heart disease (SIHD)
patients to evaluate cardiac autonomic function measured by heart rate variability
(HRV). Exit mental stress HRV was higher in the TA compared to SA group for time and
frequency domain markers of parasympathetic tone (all p ≤ 0.025), including a 17% higher vagal activity (p = 0.008). These data document feasibility and provide sample size estimation for an
outcome-based clinical trial of TA in SIHD patients for the prevention of sudden cardiac
death.
Abbreviations:
CES-D (Center for Epidemiologic Study Depression Scale), COP (cold pressor testing), DASI (Duke Activity Status Index), HOMA (homeostasis model assessment), HRV (heart rate variability), PAT (peripheral arterial tonometry), SA (sham acupuncture), SAQ (Seattle Angina Questionnaire), SIHD (stable ischemic heart disease), TA (traditional acupuncture), WC (waiting control)HRV abbreviations:
TP (total power), HF (high frequency), LF (low frequency), SDNN (standard deviation of normal RR (NN) intervals), SDANN (standard deviation of 5-minute mean RR intervals), aSDNN (average of standard deviations of normal RR intervals in 24h), rMSSD (root-mean square of difference of successive RR intervals), pNN50 (proportion of adjacent RR intervals more than 50ms different)Keywords
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Article info
Publication history
Published online: July 11, 2014
Accepted:
July 5,
2014
Received in revised form:
May 19,
2014
Received:
February 15,
2014
Footnotes
☆This work was supported by National Institutes of Health grants 5R01AT1482 (National Center for Complementary and Alternative Medicine) and K23HL105787 (National Heart, Lung, and Blood Institute), GCRC grant MO1-RR00425 from the National Center for Research Resources which is now the National Center for Advancing Translational Sciences (UL1TR000124, UL1RR033176), and grants from the Gustavus and Louis Pfeiffer Research Foundation, Denville, New Jersey, the Women’s Guild of Cedars-Sinai Medical Center, the Society for Women’s Health Research (SWHR), Washington, D.C., the Edythe L. Broad Women’s Heart Research Fellowship, the Barbra Streisand Women’s Cardiovascular Research and Education Program, and the Linda Joy Pollin Women’s Heart Health Program, Cedars-Sinai Medical Center, Los Angeles, CA. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCCAM, or the National Institutes of Health.
☆☆ClinicalTrials.gov Identifier: NCT00570024.
Identification
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© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
