Inspired by Wu et al. BMC Complement Altern Med 2018.
The title of this paper is rather eye-catching for the Western medic:
Acupuncture decreased the risk of coronary heart disease in patients with rheumatoid arthritis in Taiwan…
Really? Are you suggesting that acupuncture is the next statin? Surely not!
Well, let me start by saying that the title is not really justified. It should actually read:
This is a large retrospective observational study so it can comment on associations but not causality. Indeed, very little research can do the latter.
This is not the first paper of its type from this group. They started with a similar one on fibromyalgia (FM), but that one did not strike me so dramatically. On reflection I am not sure why, since they showed an even better hazard ratio for CHD in FM patients using acupuncture. Perhaps it is because RA is a more tangible disease?
Anyway, this research was possible thanks a large national database in Taiwan with the rather alarming name: the Registry of Catastrophic Illness Patients Database. This comes from within the Taiwanese National Health Insurance Research Database.
From this database the team drew all patients who were newly diagnosed with RA over a 13-year period (1997 to 2010), found 9932 who had been treated with acupuncture (traditional manual or electroacupuncture or both), and matched these to 9932 out of a total of 19.5k who had not had acupuncture treatment. The matching was very thorough, including: age, sex, CHD-relevant co-morbidities and drug use.
RA patients who had acupuncture suffered fewer CHD events (hazard ratio 0.60). This ratio was the same across all variables including all the different disease modifying RA drugs and statins. Interestingly, the ratio was even better when electroacupuncture was included in the treatment (hazard ratio 0.36). This ratio was lower than that for statins (hazard ratio 0.69), or even for TNF-alpha inhibitors (hazard ratio 0.48).
If acupuncture treatment is responsible for this reduction in CHD, what could be the mechanism? It seems likely that the vagal anti-inflammatory reflex is a strong contender, and I am more convinced than ever that teaching patients with RA (or any other chronic inflammatory disease) to perform their own EA at home twice a week is the way forward.
A final comment… the National Health Insurance in Taiwan allows a maximum of 15 acupuncture sessions per month, and 2-3 per week!
- Wu M-Y, Huang M-C, Liao H-H, et al. Acupuncture decreased the risk of coronary heart disease in patients with rheumatoid arthritis in Taiwan: a Nationwide propensity score-matched study. BMC Complement Altern Med 2018;18:341. doi:10.1186/s12906-018-2384-5
- Wu M-Y, Huang M-C, Chiang J-H, et al. Acupuncture decreased the risk of coronary heart disease in patients with fibromyalgia in Taiwan: a nationwide matched cohort study. Arthritis Res Ther 2017;19:37. doi:10.1186/s13075-017-1239-7
- Tracey KJ. The inflammatory reflex. Nature 2002;420:853–9. doi:10.1038/nature01321