Acupuncture has gained recognition as an alternative treatment for various medical conditions. Recent evidence supports its utility in managing chronic coronary syndromes (CCS), including symptom relief, reduced angina frequency, and decreased nitroglycerin use. This study aimed to evaluate the effect of acupuncture on serum asymmetric dimethylarginine (ADMA) levels in patients with CCS.
Methods:
In this prospective cross-sectional study conducted between January and October 2019, patients with CCS were recruited from cardiology and traditional/complementary medicine clinics. Patients who received 10 sessions of acupuncture comprised the Case group, with their ADMA levels measured before and after treatment. Patients who declined acupuncture formed the Control group, with their ADMA levels assessed at the same intervals. Acupoints used were primarily on the pericardial and heart meridians, notably Neiguan (PC6) and Shenmen (HT7).
Results:
Baseline ADMA levels were similar between the groups. However, posttreatment ADMA levels were significantly lower in the Case group [1.81 (0.80–139.04) vs. 9.46 (0.51–167.80); p = 0.019]. A significant reduction in ADMA levels was observed in the Case group following acupuncture [3.13 (0.88–189.00) vs. 1.81 (0.80–139.04); p < 0.0001], whereas no significant change occurred in the Control group compared with the Case group [7.20 (0.72–198.7) vs. 9.46 (0.51–167.80); p = 0.019].
Conclusions:
Acupuncture, when combined with guideline-directed medical therapy, significantly reduced serum ADMA levels in CCS patients. This suggests its potential role in modulating endothelial function via the ADMA-nitric oxide pathway. Larger studies with long-term follow-up are warranted to confirm these findings and assess clinical applicability.
CoronadoF, MelvinSC, BellRA, et al.Global responses to prevent, manage, and control cardiovascular diseases. Prev Chronic Dis, 2022; 19:E84.
2.
TsaoCW, AdayAW, AlmarzooqZI, et al.; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2023 update: A report from the American heart association. Circulation, 2023; 147(8):e93–e621.
3.
SchlaegerJ, CaiHY, SteffenAD, et al.Acupuncture to ımprove symptoms for stable angina: Protocol for a randomized controlled trial. JMIR Res Protoc, 2019; 8(7):e14705.
4.
PiepoliMF, HoesAW, AgewallS, et al.2016 European guidelines on cardiovascular disease prevention in clinical practice. Rev Esp Cardiol (Engl Ed), 2016; 69(10):939.
5.
AhmadiA, ArgulianE, LeipsicJ, et al.From subclinical atherosclerosis to plaque progression and acute coronary events: JACC state-of-the-art review. J Am Coll Cardiol, 2019; 74(12):1608–1617.
6.
FoxKAA, MetraM, MoraisJ, et al.The myth of ‘stable’ coronary artery disease. Nat Rev Cardiol, 2020; 17(1):9–21.
7.
Complementary and alternative medicine use among adults and children: United States, 2007, 2008.
BallegaardS, MeyerCN, TrojaborgW. Acupuncture in angina pectoris: Does acupuncture have a specific effect? J Intern Med, 1991; 229(4):357–362.
10.
LiuY, WangT, ZhangJ. Treatment of angina pectoris with medicinal plaster fixed at acupoints–a report of 54 cases. J Tradit Chin Med, 1998; 18(1):12–14.
11.
GaoJ, FuW, JinZ, et al.Acupuncture pretreatment protects heart from injury in rats with myocardial ischemia and reperfusion via inhibition of the beta(1)-adrenoceptor signaling pathway. Life Sci, 2007; 80(16):1484–1489.
12.
ZhouW, KoY, BenharashP, et al.Cardioprotection of electroacupuncture against myocardial ischemia-reperfusion injury by modulation of cardiac norepinephrine release. Am J Physiol Heart Circ Physiol, 2012; 302(9):H1818–H25.
13.
LinX-S, WangH-Y, ZhangZ, et al.Effects of acupoint application therapy with tiangui powder on osteoporosis in ovariectomized rats through TGF-beta1 and Smad2/3 signaling pathway. Orthop Surg, 2019; 11(1):143–150.
14.
AnderssonS, LundebergT. Acupuncture—from empiricism to science: Functional background to acupuncture effects in pain and disease Pain and disease. Med Hypotheses, 1995; 45(3):271–281.
15.
QingP, ZhaoJF, ZhaoCH, et al.Effect of acupuncture on patients with cancer-related fatigue and serum levels of CRP, IL-6, TNF-alpha and sTNF-R1. Zhongguo Zhen Jiu, 2020; 40(5):505–509.
16.
PalmerRM, FerrigeAG, MoncadaS. Nitric oxide release accounts for the biological activity of endothelium-derived relaxing factor. Nature, 1987; 327(6122):524–526.
17.
WallisJP. Nitric oxide and blood: A review. Transfus Med, 2005; 15(1):1–11.
18.
BogerRH. Asymmetric Dimethylarginine (ADMA): a novel risk marker in cardiovascular medicine and beyond. Ann Med, 2006; 38(2):126–136.
19.
SibalL, AgarwalSC, HomePD, et al.The role of Asymmetric Dimethylarginine (ADMA) in endothelial dysfunction and cardiovascular disease. Curr Cardiol Rev, 2010; 6(2):82–90.
20.
BogerRH. The emerging role of asymmetric dimethylarginine as a novel cardiovascular risk factor. Cardiovasc Res, 2003; 59(4):824–833.
21.
MeinitzerA, SeelhorstU, WellnitzB, et al.Asymmetrical dimethylarginine independently predicts total and cardiovascular mortality in individuals with angiographic coronary artery disease (the Ludwigshafen Risk and Cardiovascular Health study). Clin Chem, 2007; 53(2):273–283.
22.
ValkonenVP, PäiväH, SalonenJT, et al.Risk of acute coronary events and serum concentration of asymmetrical dimethylarginine. Lancet, 2001; 358(9299):2127–2128.
23.
MaSX, LeePC, AndersonTL, et al.Response of local nitric oxide release to manual acupuncture and electrical heat in humans: Effects of reinforcement methods. Evid Based Complement Alternat Med, 2017; 2017:4694238.
24.
KnuutiJ, WijnsW, SarasteA, et al.; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J, 2020; 41(3):407–477.
25.
BrookRD, RajagopalanS. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high. blood pressure in adults. A report of the American college of cardiology/American heart association task force on clinical practice guidelines. J Am Soc Hypertens. 2018; 12(3):238.
26.
PetersmannA, Müller-WielandD, MüllerUA, et al.Definition, classification and diagnosis of diabetes mellitus. Exp Clin Endocrinol Diabetes, 2019; 127(S 01):S1–S7.
27.
AboyansV, RiccoJ-B, BartelinkM-LEL, et al.2017 ESC Guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Rev Esp Cardiol (Engl Ed), 2018; 71(2):111.
28.
MachF, BaigentC, CatapanoAL, et al.; ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Eur Heart J, 2020; 41(1):111–188.
29.
SafarovaMS, BaileyKR, KulloIJ. Association of a family history of coronary heart disease with initiation of statin therapy in individuals at ıntermediate risk: Post hoc analysis of a randomized clinical trial. JAMA Cardiol, 2016; 1(3):364–366.
30.
LimS. WHO standard acupuncture point locations. Evid Based Complement Alternat Med, 2010; 7(2):167–168.
31.
HoriT, MatsubaraT, IshibashiT, et al.Significance of Asymmetric Dimethylarginine (ADMA) concentrations during coronary circulation in patients with vasospastic angina. Circ J, 2003; 67(4):305–311.
32.
LølandKH, BleieO, BorgeraasH, et al.The association between progression of atherosclerosis and the methylated amino acids asymmetric dimethylarginine and trimethyllysine. PLoS One, 2013; 8(5):e64774.
33.
KremplTK, MaasR, SydowK, et al.Elevation of asymmetric dimethylarginine in patients with unstable angina and recurrent cardiovascular events. Eur Heart J, 2005; 26(18):1846–1851.
34.
WangSK, LuC, WangYJ. Effects of Electroacupuncture Stimulation of “Neiguan” (PC 6) at different frequencies on plasma vasoactive substance levels in myocardial ıschemic reperfusion rats. Zhen Ci Yan Jiu, 2015; 40(5):378–382.
35.
LiP, TjenALSC, LonghurstJC. Excitatory projections from arcuate nucleus to ventrolateral periaqueductal gray in electroacupuncture inhibition of cardiovascular reflexes. Am J Physiol Heart Circ Physiol, 2006; 290(6):H2535–H42.
36.
Lin Ya PYS-X, YanJ. Protective effect of electroacupuncture on”neigun”point on myocardial postischemic reperfusion injury. Chinese J Basic Med Traditional Chinese Med, 2004; 10(4):66–68.
37.
Pei-HuaX, Juan-XiuL, Da-NianZ. Effects of acupuncture at acupoint Neiguan (PC 6) and intravenous injection of Larginine on the improvement of acute myocardial ischemia. J Acupunct Tuina Sci, 2006; 4(3):136–139.
38.
WuZJ, CaiRL, HeL, et al.Effects of electroacupuncture stimulation of “Neiguan” (PC 6) and “Shenmen” (HT7) on contents of 5-hydroxytryptamine in hypothalamic paraventricular nucleus region and serum in hyperlipidemia rats with acute myocardial infarction]. Zhen Ci Yan Jiu, 2013; 38(6):482–487.
39.
ZhangZ, ChenM, ZhangL, et al.Meta-analysis of acupuncture therapy for the treatment of stable angina pectoris. Int J Clin Exp Med, 2015; 8(4):5112–5120.
