Complementary medicine and the heart

Issue: November 2006

ByWilliam H. Frishman, MD, MACP

An increasing number of individuals are looking beyond the borders of conventional medicine for at least part of their health care needs. In the United States, more visits are being made to nonconventional healers than to physicians, at an annual cost of more than $30 billion; most of this cost to patients is out-of-pocket.

As a health care discipline, alternative medicine has been defined in recent years as medical approaches that were not traditionally addressed in allopathic medical schools. Complementary medicine is a term first used in Great Britain to describe the use of alternative medicine as an adjunct to, and not primarily a replacement for, conventional medical care. In the 21st century, there is an ongoing effort to integrate complementary and alternative medicine (CAM) into conventional medical practice.

William Frishman, MD, MACP [photo]
William Frishman

This has been called integrative medicine. In 1998, the National Institutes of Health, recognizing the need to vigorously evaluate the efficacy and safety of CAM therapies, created the National Center for Complementary and Alternative Medicine (NCCAM), which supports ongoing research. Multiple medical centers have formed centers of integrative medicine, and most medical schools are now offering course work in complementary/alternative medicine.

CAM gaining popularity

Many of the CAM modalities, as defined today, have been used for thousands of years as the mainstay of the healing arts in various cultures and societies. Chinese medicine has used bioenergy (“qi” manipulation [qi gong], insertion of needles [acupuncture] and ingestion [herbs and foods]) as part of a systemic approach to health care. Practitioners of Indian medicine (Ayurveda and Yoga) have used the combination of herbs, meditation and exercise as part of their healing approach. Native American medicine emphasizes “shamanism” and spiritualism. Western medicine has included the development of the CAM fields of homeopathy, vitamin and nutraceuticals therapy, osteopathic manual manipulation, chelation therapy and various talk therapies.

The scientific community can no longer ignore the worldwide exponential surge in public enthusiasm for CAM therapies. This increase in interest relates to the chronicity of many illnesses, the information explosion on the Internet and a more active participation of individuals in their own health care. At the same time, however, a large percentage of individuals who use CAM therapies do not inform their personal physicians of this activity, making them vulnerable to the possible adverse effects from herb-drug interactions and other potential side effects of CAM treatments.

CAM and the heart

CAM therapies have also been used to treat cardiovascular disorders. We must remember that some of our current medical treatments – digitalis (digitalis purpurea), the statins (lovastatin was isolated from red yeast) and rauwolfia, the natural source of the alkaloid reserpine, are all derivatives of the herbal medicine tradition. However, the use of CAM for treating CVD continues to be a highly charged subject.

Critics do not understand or accept anecdotal statements of benefits from CAM and are right in demanding rigorous placebo controlled studies. These are essentially lacking in most situations. Although in recent years, randomized, double blind studies have been carried out that have shown the lack of efficacy of vitamin E, beta carotene and folic acid (for treating hyperhomocysteinemia) in the prevention of CVD despite the early claims of benefit with each modality.

A large double blind, placebo controlled, NIH sponsored study is now examining the efficacy and safety of chelation therapy with ethylenediaminetetraacetic acid in the treatment of patients with a history of MI. Another large randomized study (SPICE) is examining the herb crataegeus (hawthorn extract) in the treatment of patients with CHF. CAM therapies are a challenge to the scientific training of many cardiovascular physicians, with most positive observations considered a placebo effect.

However, physicians can no longer ignore some of the possibilities of CAM, and a growing number are already integrating CAM into their practices or are referring their patients to CAM practitioners. The American College of Cardiology is sponsoring an annual course on CAM as part of its continuing medical education efforts. In a recent workshop, the NCCAM emphasized the need for an exchange of ideas between CAM practitioners and scientists, and for future collaborative research efforts.

We must keep a skeptical yet open mind about CAM since the human body is a complex structure, and we are a long way from having cures and panaceas for the CVDs that continue to plague our patients.

William Frishman, MD, MACP, is Rosenthal Professor and Chairman of the Department of Medicine, New York Medical College and Director of Medicine at the Westchester Medical Center, Valhalla, N.Y. He is a member of the Cardiology Today Editorial Board.