Acupuncture for CVD in disability

Stimulated by Jun et al 2025.[1]

CVD – cardiovascular disease
PSM – propensity score matching
aHR – adjusted hazard ratio
CI – confidence interval

– key to acronyms

This is another one of those large retrospective cohort studies. This time it is from Iksan, Korea and investigates the association of acupuncture with mortality in patients with disabilities who develop heart failure. Please note that my blog title is not strictly accurate, although the effect of acupuncture on CVD in patients with disabilities may have influenced the results. The latter is entirely speculation of course.

I don’t think I was aware of the increased CVD risks associated with having disabilities, but it seems understandable. There is increased risk of CVD and CVD mortality, although the former is not fully explained by considering the standard risk factors. People with disability show higher CVD incidence and mortality than those without disability, regardless of the type of disability or risk factors for CV disease.[2]

This paper looked at all-cause mortality, but presumably the heart failure inclusion criterion tipped this in favour of CVD mortality.

The timeframe for this study was relatively short (3-year enrolment, 3-year follow-up, 7 years total) compared with others I have highlighted here. For example, the first of these I ever featured had an enrolment period of 13 years – see: CHD incidence in RA and acupuncture from 29^th December 2018.

Patients with disabilities and a new diagnosis of heart failure between the start of 2014 and the end of 2016 were enrolled (n=95 685). This cohort was divided into those exposed to acupuncture at least twice within a year following diagnosis (n=29 779) and those that were not exposed to any acupuncture (n=54 493). After PSM, these cohorts were reduced to 21 001 each.

All-cause mortality was reduced in the acupuncture cohort by 20% (aHR 0.80); however, this increased to 36% (aHR 0.64) in the subgroup receiving the most acupuncture (19 or more sessions).

The authors conclude that there was a dose response relationship in the association of acupuncture with all-cause mortality, which if it were true, would add weight to the possibility of a causative link. Unfortunately, the cohort (acupuncture 3) that received 9-18 sessions had a less favourable aHR (0.88) than the cohort (acupuncture 2) that received 5-8 sessions (0.81). The CIs were rather similar, that is there was a considerable overlap in the first 3 acupuncture treatment intensity cohorts (1-3). I am pleased to say that there was no overlap of CIs in the highest intensity group (acupuncture 4).

The supplementary data provided with the paper shows aHRs for acupuncture intensity cohorts across 30 different covariates (patient characteristics and comorbidities) all presented in a forest plots. From this it is easy to see where acupuncture may have had its biggest impact. For example, there appears to be a bigger impact in women, patients aged 75 and over, and those with severe disabilities.

Rather alarmingly, there is no significant reduction in all-cause mortality associated with acupuncture in men, and whilst this is the most obviously anomalous forest plot in the supplement, it gets no mention in the text of the paper.

References

1          Jun H, Park D, Sul J-U, et al. Impact of acupuncture on mortality in patients with disabilities and newly diagnosed heart failure: a nationwide cohort study. Front Med. 2025;12:1519588. doi: 10.3389/fmed.2025.1519588

2          Son KY, Kim SH, Sunwoo S, et al. Association between disability and cardiovascular event and mortality: A nationwide representative longitudinal study in Korea. PloS One. 2020;15:e0236665. doi: 10.1371/journal.pone.0236665

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Declaration of interests MC