Integrative Medicine for Coronary Artery Disease

Along with dietary changes and exercise, integrative therapies that reduce stress and help a person achieve emotional health can slow or even reverse the progression of coronary artery disease. Integrative therapies (also referred to as complementary therapies or complementary and alternative medicine) also support healthy lifestyle changes to help reduce a person’s risk of developing coronary artery disease.

Integrative medicine, as defined by the National Center for Complementary and Alternative Medicine (NCCAM), “Combines mainstream medical therapies and complementary or alternative therapies for which there is some high-quality scientific evidence of safety and effectiveness.” By definition, integrative therapies are beneficial when used as adjuncts to traditional coronary artery disease treatments, but alternative medicine should not be used as the primary treatment for coronary artery disease.

If you are experiencing a high level of stress, try a few of the mind-body and relaxation techniques listed below to relieve tension and reduce stress and anxiety so this risk factor is under your control. Choose the techniques that you believe will work for you, based on your personal preferences and prior experiences, but don’t be afraid to try some new techniques, too. If you need to lower your cholesterol or follow a heart-healthy diet, talk to your doctor or a registered dietitian about food and dietary supplements that will help you get back on track.

Most importantly, be open with your doctor and discuss all of your treatment options for coronary artery disease, including integrative therapies. Many large hospitals have integrative practitioners (physicians who include use both allopathic and alternative/complementary therapies in treatment plans) on their staff, or they can provide referrals to external integrative medicine practitioners.

Mind-Body and Relaxation Techniques

Stress is a key risk factor that contributes to the morbidity and mortality of coronary artery disease. Mind-body and relaxation techniques, including Reiki, massage therapy, yoga, tai chi, guided imagery, meditation, relaxation exercises, prayer and music therapy are all beneficial complementary therapies for coronary artery disease. Using these techniques to manage stress will help you reduce this key risk factor for coronary artery disease and improve your emotional health. In turn, you may be more motivated to stick with your prescribed exercise and diet regimen.

Reiki is a form of touch therapy in which a practitioner's hands are placed on the client to promote a sense of deep relaxation. As an energy-based healing therapy for coronary artery disease, Reiki provides an alternative relaxation technique for managing stress. People with coronary artery disease can use Reiki for relaxation in preparation for a medical test or procedure, or recovery from a procedure or surgery. Healing and therapeutic touch are other methods that direct healing energy from the practitioner to the patient.

Massage therapy can be used to reduce tension and pain and improve blood flow as an integrative treatment for coronary artery disease. Massage therapy also can be used after heart surgery to improve circulation.

Yoga is an excellent method for inducing relaxation as well as improving cardiovascular fitness and overall well being. In yoga, participants use a combination of deep breathing exercises, meditation and gentle stretching postures to improve flexibility, balance, and fitness levels.

Tai chi has been shown to reduce blood pressure in patients with coronary artery disease. Tai chi is an ancient Chinese martial art that uses movement, meditation, and breathing to improve health and well being.

Guided imagery is a type of guided relaxation that has been proven to decrease stress, anxiety, and pain, improve sleep, and also reduce hospital stays for some patients recovering from heart surgery. Guided imagery can help people with coronary artery disease manage stress.

Meditation and relaxation exercises involve a specific mental focus and can be used as integrative therapies for coronary artery disease by aiding stress management and promoting relaxation. In one randomized, controlled trial, transcendental meditation was used for stress reduction in black Americans with high blood pressure. Results showed that blood pressure was effectively reduced and participants were compliant with the practice, and found it culturally acceptable. Meditation and relaxation exercises also have been used to manage certain coronary artery disease risk factors such as smoking, alcohol abuse, and stress.

Prayer is one of the oldest relaxation exercises involving a specific mental focus. Prayer and other spiritual practices can help a person with coronary artery disease achieve a mind-body balance to manage stress. Spiritual practices and involvement with a religious community have been proven to improve cholesterol and blood pressure levels, as well as reduce the incidence of heart attack, improve survival after coronary artery bypass graft (CABG) surgery and improve overall survival.

Music has the ability to induce a peaceful, relaxed state of mind, and one study showed that patients who listened to tranquil music during the intraoperative period experienced lower blood pressure than the control group who received usual care.

Acupuncture

Acupuncture is effective for patients recovering from cardiovascular events such as heart attack and stroke. Acupuncture also has been used as a hypertension management technique in Europe and China, although it is not widely accepted for hypertension management in the United States because its benefits may not be sustained after the acupuncture session.

Hypnosis

Hypnosis can help a patient recover from addictive behaviors that contribute to coronary artery disease risk, including smoking and excessive alcohol use, as well as aid weight loss.

Biofeedback

Biofeedback is the use of sensors or other equipment to help a person become aware of certain bodily processes that normally occur involuntarily in response to stress, such as increased heart rate and respiration rate. Biofeedback training can help people with coronary artery disease learn how to manage heart rate and blood pressure in response to stress and thereby improve their health. It can also be used to help manage irregular heart rhythms or arrhythmias. Respiratory biofeedback therapy is a form of biofeedback that focuses on breathing and respiration and can be used to improve heart rate variability, the natural change in heart rate.

Chelation Therapy

Chelation therapy is the administration of a series of intravenous (IV) infusions that contain disodium ethylene diamine tetraacetic acid (EDTA), a man-made amino acid, and other substances such as vitamins and minerals. Chelation therapy is thought to potentially remove calcium ions, thereby leading to the regression of atherosclerotic plaque in coronary artery disease. However, the safety of this therapy for treating coronary artery disease has not been proven scientifically, and the adverse effects may outweigh the benefits. A large, five-year research study is being conducted currently at more than 120 U.S. medical centers by the National Heart, Lung and Blood Institute and the National Center for Complementary and Alternative Medicine to evaluate the safety and efficacy of chelation therapy, with study enrollment to be completed in 2009.

Foods and Dietary Supplements

Foods and dietary supplements used as integrative therapies for coronary artery disease include:

• Soy protein as a substitute for animal protein
• Nuts
• Tea
• Alcohol – moderate consumption of red wine
• Antioxidant vitamins including vitamin E, vitamin C, beta-carotene, folic acid, vitamin B6, vitamin B12 and magnesium
• Coenzyme Q10 (CoQ10, also known as ubuquinone)
• L-carnitine
• L-arginine
• Plant sterols and stanols
• Omega-3 fatty acids (fish oils, flaxseed)
• Soluble fiber
• Garlic (Allium Sativum)
• Herbal supplements including hawthorn (Crataegus), gingko biloba (gingko leaf extract), horse chestnut (Aesculus hippocastanum), guggulipid (goggul gum), red yeast rice (Monascus purpureas), policosanol, epheda (Ma huang), oleander (Nerium oleander/Thevetia peruviana), Tong-Xin-Luo (TXL)

How these products work to reduce heart and blood vessel diseases varies, but many are touted to reduce cholesterol levels or promote healthy cholesterol levels (HDL). There are varying levels of scientific support for these products as integrative therapies for coronary artery disease. Under the Dietary Supplement Health and Education Act of 1994, products available as food supplements, as well as herbal products, are not required by the Food and Drug Administration to be proven safe before they are marketed.

Some dietary supplements may interact with certain prescription medications for coronary artery disease. For example, garlic and gingko increase the risk of bleeding in patients taking antiplatelet medications such as aspirin and warfarin (Coumadin), and ginseng interferes with the absorption of warfarin. Therefore, make sure you read labels carefully and discuss the products with your cardiologist before you start taking them to evaluate potential interactions.

Talk to Your Doctor

It is important to let your doctor know what integrative therapies you are considering for the management of coronary artery disease, particularly foods and dietary supplements, so you can avoid potential interactions with prescription medications or other treatments. Alternative and complementary therapies for coronary artery disease should be components of an integrative medicine program including allopathic treatments. They should not be used as primary treatment or as a substitution for lifestyle changes or conventional therapies recommended by your doctor. An integrative medicine practitioner can provide guidance about the appropriate treatments that will help you manage coronary artery disease.

Additional Resources

The American Heart Association website offers a wealth of information on different ways to manage coronary artery disease.

Bolling SF, et al. Integrating complementary medicine into cardiovascular medicine: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (Writing Committee to Develop an Expert Consensus Document on Complementary and Integrative Medicine). Journal of the American College of Cardiology, July 5, 2005. 46(1):184-221.

Miller KL, RS Liebowitz, LK Newby. Complementary and alternative medicine in cardiovascular disease: a review of biologically based approaches. American Heart Journal, March 2004. 147(3):401-11.