Stimulated by Jun et al 2025.[1]
IHD – ischaemic heart disease
CVD – cardiovascular disease
KIOM – Korean Institute of Oriental Medicine
doi – digital object identifier
rTPA – recombinant tissue plasminogen activator (aka Alteplase)
DALY – disability-adjusted life year
CHA₂DS₂-VASc score – a scoring system that predicts the risk of CV events
VIM – variability independent of mean
SD – standard deviation– key to acronyms
This is the third of these retrospective cohorts that I have highlighted this year from the same team in Iksan, South Korea. The first was in February (Acupuncture for CVD in disability) and the second in August (Acupuncture and heart failure).[2,3] All three have a focus on cardiovascular disease and mortality outcomes, and share the same first and last authors.
Some eagle-eyed readers may have noticed that this is the second blog post in a row to feature a journal article with a date in the future (2026). Both papers are from the same journal, Integrative Medicine Research (IF 3.0), which is an open access journal and the official journal of KIOM. The doi includes 2025 of course, which reflects the date of online publication, but the paper will have been assigned to a print issue that is in the future, in 2026. Since the start of online first publishing (publishing the accepted manuscript, either before or after formal page setting in the journal style), we have often seen the date of the reference change by a year when the paper is assigned to an issue of the journal. This is the first time (this and last week) that I have seen the reference include the date of an issue far in the future. It is a little odd, but I’m sure we’ll get used to it.
Despite a lot of fancy medical interventions, such as thrombolysis (see Spinal epidural haematomas 2020 for my first experience of rTPA as a junior doctor), and some reduction in global prevalence, IHD is still the leading cause of DALYs and mortality associated with non-communicable diseases.[4]
The team from Iksan, along with our friend Jennifer (Ye-Seul Lee) from Jaseng in Seoul (see Acupuncture and polypharmacy and MSAT for MSK pain), used the Korean National Insurance Database to identify patients of 65 years and over with newly diagnosed IHD. They found just under 10k eligible patients within the entry period of about 7 years (2007 to mid-2014) from an initial cohort of over 70k.
667 received at least 6 acupuncture sessions within 6 months of diagnosis. Just over 9k were left in what was referred to as the conventional cohort. Propensity score matching was not used in this study, but all the usual demographics and comorbidities were taken into consideration, including the CHA₂DS₂-VASc score, which we first came across with the previous paper from this group (see Acupuncture and heart failure).
The acupuncture group was subdivided into those that received regular acupuncture and those that received less regular acupuncture using something called VIM, which has only ever stood for a cleaning substance in my mind up to now! In simple terms, variability can appear to increase with an increase in the mean, without there actually being more variability, so VIM adjusts for this by dividing the SD by the mean (adjusted with a scaling component).
Regular acupuncture consistently did better than less regular acupuncture, but both were associated with reduced mortality (both all cause and cardiovascular mortality).
Acupuncture users differed from non-acupuncture users. They were younger and more female but had higher levels of disability and cardiovascular risk. The unadjusted HR comparing 667 acupuncture users with 9198 conventional users was 0.58 (all-cause mortality) and 0.38 (cardiovascular mortality). The aHR (model 4 – full adjustment for everything you can imagine) was 0.71 (all-cause mortality) and 0.54 (cardiovascular mortality). If the acupuncture was regular, then these HRs came down from 0.38 to 0.35 and from 0.54 to 0.51.
So, regular acupuncture following a new diagnosis of IHD was associated with a halving of the risk of cardiovascular mortality in the subsequent 5 years.
Despite adjusting for a host of different factors, it was not possible in this analysis (due to data limitations) to adjust for some health behaviours. There was a slightly increased proportion of current smokers and drinkers in the conventional group and higher BMIs in the acupuncture group. These were between 3% and 6% in different directions of risk, so unlikely to have a big impact on a 49% risk reduction, but a reminder that this sort of retrospective analysis, whilst compelling, is no substitute for prospective research when it comes to definitive attribution of causal relationships.
References
1 Jun H, Park D, Kim H, et al. Early acupuncture exposure and mortality in older adults with ischemic heart disease: A nationwide cohort study in Korea. Integr Med Res. 2026;15:101252. doi: 10.1016/j.imr.2025.101252
2 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
3 Jun H, Jin H, Kim H, et al. Association between acupuncture treatment exposure and mortality in patients with heart failure: a nationwide cohort study. Front Cardiovasc Med. 2025;12:1461302. doi: 10.3389/fcvm.2025.1461302
4 Safiri S, Karamzad N, Singh K, et al. Burden of ischemic heart disease and its attributable risk factors in 204 countries and territories, 1990-2019. Eur J Prev Cardiol. 2022;29:420–31. doi: 10.1093/eurjpc/zwab213
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