Acupuncture decreases frequency and intensity of angina

Reference

Zhao L, Li D, Zhen H, et al. Acupuncture as adjunctive therapy for chronic stable angina. A randomized clinical trial. JAMA Intern Med 2019;179(10):1388-1397.

Synopsis

These investigators enrolled 398 patients with chronic stable angina with symptoms occurring at least twice a week. The patients' average age was 62.6 years and they'd had symptoms for an average 4 to 5 years before starting treatment. Almost all patients had at least a slight expectation that acupuncture would be effective, which is important to note since the placebo response to angina treatment is large. All patients continued their usual treatment. The patients were randomly assigned (allocation concealment unknown) into 1 of 4 groups: acupuncture on the acupoints on the disease-affected meridian (bilateral acupoints PC6 and HT5); acupuncture on the acupoints on the nonaffected meridian; sham acupuncture; or no acupuncture. The patients who received acupuncture were unaware of the type of acupuncture they received, and outcome assessors were also unaware of treatment assignment. Acupuncture (real and sham) was delivered 3 times a week for 4 weeks. Analysis was by intention to treat. In weeks 12 to 16 (4-8 weeks after the end of therapy), the frequency of angina attacks was significantly lower with disease-affected meridian acupuncture as compared with no treatment or the usual care group, an average of 1 to 1.5 fewer episodes of angina per week (P < .001 for comparisons with each group). Pain severity also was significantly lower with therapeutic acupuncture, as were self-ratings of anxiety and depression. Perhaps a marker of the placebo effect, angina rates decreased slightly in the nontherapeutic acupuncture group but were not significantly lower than the rates in the usual care group. The use of rescue medicine dropped in all groups and was not statistically different among the 4 groups.