Heart Disease

What is Heart Disease?

Heart disease, also called cardiovascular disease, is a group of conditions that affect the heart and blood vessels. The most common type is coronary artery disease, in which plaque builds up in the arteries that feed the heart muscle and limits blood and oxygen supply.^[1] Other types include heart failure, abnormal heart rhythms, valve disease and heart muscle disease. Coronary artery disease is the leading cause of death worldwide.^[1]

Common symptoms

Symptoms depend on the type. Coronary artery disease often causes chest pain or pressure with exertion (angina), shortness of breath and fatigue, and it can also be silent.^[1] Heart failure typically brings breathlessness, tiredness and swelling in the legs or ankles. Rhythm problems can cause palpitations, dizziness or fainting.

Causes and risk factors

Plaque in the arteries is the main cause of coronary disease. Risk factors that cannot be changed include age, sex and family history. Modifiable ones include high blood pressure, high cholesterol, diabetes, obesity, smoking, poor diet, inactivity and stress.^[2] Blood pressure is a major contributor to the rising risk with age.^[1]

How it is diagnosed and treated conventionally

Diagnosis rests on a physical examination, blood tests, an electrocardiogram, imaging such as echocardiography, stress testing and sometimes catheter angiography. These tests are directed by a physician.

Treatment combines lifestyle change, medicines and, when needed, procedures. Supervised cardiac rehabilitation, with exercise training, risk-factor management and psychological support, is recommended for many people with established heart disease and has been shown to reduce hospital stays and cardiovascular deaths.^[3] Medicines commonly include blood pressure drugs, statins, blood thinners and rhythm medicines. Stents, bypass surgery, pacemakers and valve repair are used for selected patients.

Why Heart Disease calls for a whole-person approach

Heart disease rarely has one cause, so good care usually addresses several things at once. Blood pressure, cholesterol, blood sugar, weight, activity and mood all influence risk and recovery.^{[2, 3]}

This is why people with heart disease are often supported by more than one professional. Our role is limited to supportive care for stress, sleep, fatigue and well-being, alongside your cardiology team.

Stress, depression and anxiety

Depression and anxiety are common in people with coronary heart disease, heart failure or atrial fibrillation, with reported rates around 40 percent, and they are linked to a poorer outlook.^[4] A Cochrane review of 21 trials found that psychological interventions probably moderately reduce depression and anxiety in coronary heart disease and heart failure, though they probably do not lower mortality.^[4]

Sleep, fatigue and low mood

A 2024 review proposes that insomnia, fatigue and loss of enjoyment may themselves predict cardiac events in people with coronary heart disease, and it calls for research on treating them.^[5] These are symptoms that supportive care can reasonably address.

Autonomic nervous system balance

Heart rate variability, a measure of how the autonomic nervous system regulates the heart, is reduced in stable ischemic heart disease and has been linked to sudden cardiac death.^[6] This is one reason researchers have tested acupuncture for its effect on autonomic function.

Cholesterol and blood sugar

Disordered fat and sugar metabolism are important drivers of coronary disease.^[7] These are managed mainly with diet, exercise and prescribed medicines.

Acupuncture as supportive care in Heart Disease

What the research shows

The research is limited and does not show that acupuncture treats the underlying disease. Most trials are small, many are from China, and many have weaknesses in design.

For angina, a meta-analysis of 24 trials with 1,916 patients found that adding acupuncture to standard treatment raised the rate of marked symptom improvement, but the rate of moderate improvement was not significantly different.^[8] A meta-analysis of 7 trials with 1,042 patients found electroacupuncture plus usual drugs improved angina symptoms and quality-of-life scores compared with drugs alone. The authors noted few high-quality studies and a likely publication bias.^[9]

In a sham-controlled trial of 151 people with stable ischemic heart disease, 12 weeks of real acupuncture was followed by higher markers of parasympathetic tone during mental stress than sham. There were no differences in blood pressure, lipids, inflammation markers or psychological measures.^[6]

In heart failure, a review of 7 trials found most had considerable flaws and called the evidence inconclusive.^[10] A placebo-controlled pilot study of 17 patients found longer six-minute walk distance with real acupuncture but no change in ejection fraction.^[11]

A review of 18 trials in coronary heart disease found acupuncture added to standard care was associated with lower LDL cholesterol and HbA1c, although the LDL effect did not hold in one subgroup analysis. The authors called for larger, longer trials.^[7]

How acupuncture may work

Researchers have proposed that acupuncture may shift autonomic balance toward greater parasympathetic activity. This idea comes from small trials of heart rate variability in stable ischemic heart disease and heart failure.^{[6, 11]} It is a proposed explanation, not a settled fact.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at selected points, usually left in place for about 20 to 40 minutes. Care is given as a course of several visits with reassessment. The sham-controlled ischemic heart disease trial used three treatments a week for 12 weeks.^[6]

In prospective studies, about 9 in 100 patients had a minor reaction such as soreness, bleeding or bruising at a needle site, and serious events occurred in about 1 in 10,000 patients.^[12] Tell the practitioner first if you take blood thinners, have a bleeding disorder, are pregnant, or have a pacemaker or implanted defibrillator, since electroacupuncture is generally avoided with such devices.

Ayurvedic medicine as supportive care in Heart Disease

The Ayurvedic view

Ayurveda describes heart conditions under the heading of hridroga, disorders of the heart, and understands them as imbalances of the doshas together with accumulated metabolic residue (ama) and blocked channels. These are traditional categories, not biomedical diagnoses.

Therapies that may be used

Care is individualized and may include diet and daily routine, stress-calming practices such as breathing exercises and gentle yoga, and herbs prescribed individually. Warm oil massage may be used for relaxation. Panchakarma is not appropriate in heart failure, after a recent cardiac event, during acute illness, in pregnancy or in frailty. Nor is it appropriate for anyone whose cardiac condition is unstable. Guggul resin is traditionally used for heart and cholesterol problems,^[13] and quality matters, since about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[14]

What the research shows

The research on Ayurveda for heart disease is limited. Terminalia arjuna, a bark traditionally used as a heart tonic in India, is the best-studied herb. A systematic review of its use in chronic stable angina found studies of poor methodological design and no significant difference from standard treatment in the outcomes that could be pooled. The authors concluded that the evidence was insufficient to draw conclusions for or against it.^[15]

Yoga, which comes from the same tradition, has been reviewed. A systematic review of 7 randomized trials with 624 patients found very low to low-quality evidence that yoga reduced angina episodes and improved exercise capacity in coronary heart disease. It made only weak recommendations for yoga as an add-on.^[16]

Herbal medicine as supportive care in Heart Disease

Herbs and formulas that have been studied

Most research on herbs in heart disease comes from China. It includes formulas traditionally used to promote circulation and remove blood stasis for angina, the capsule formula Tong-xin-luo for people after stenting, and the capsule formula Qili Qiangxin for heart failure. Guggul, an Ayurvedic resin, has been studied for cholesterol and atherosclerosis.^[13]

What the research shows

A meta-analysis of 9 studies with 824 patients found that Chinese medicines that promote circulation, added to standard treatment, improved angina outcomes and lowered attack frequency, with no obvious effect on blood lipids.^[17] A Cochrane review of Tong-xin-luo after stenting found low-quality evidence of fewer cardiovascular events, and rated most of the 16 trials as high risk of bias.^[18]

The strongest result is for Qili Qiangxin. In a placebo-controlled trial of 3,110 patients with heart failure with reduced ejection fraction in 133 Chinese hospitals, adding it to standard therapy lowered the combined rate of heart failure hospitalization and cardiovascular death, with similar adverse events to placebo. Death from any cause did not differ significantly between the groups.^[19] It is one trial, in one country, of one product, and does not apply to other herbs. A review of guggul concluded that larger, longer clinical studies are needed.^[13]

Safety and herb-drug interactions

Herbs can interact with the medicines many heart patients take. Case reports describe bleeding or clotting problems when warfarin was combined with herbs including dan shen (Salvia miltiorrhiza), dang gui (Angelica sinensis), ginkgo, ginseng and garlic.^[20] Because heart patients often take anticoagulants, antiplatelets, blood pressure drugs, rhythm medicines and statins, herbs must be reviewed against your full medication list first.

In one study, about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[14] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, or have liver or kidney disease.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine often describes angina as blood stasis or obstruction of qi in the chest. Researchers studying related treatments look at blood vessel function, inflammation, lipids and autonomic regulation of the heart.^{[6, 17]}

Ayurveda's idea of ama and blocked channels is sometimes compared with plaque and impaired circulation. No study has shown that these traditional concepts correspond to specific biological processes.

How this care fits with your medical care

Supportive care is not a substitute for cardiology. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Do not stop or change any prescribed medicine, device follow-up, cardiac rehabilitation or procedure without your prescriber.

We do not diagnose or manage heart disease. Please bring your diagnosis, recent test results such as ECG or echocardiogram reports, and a full list of medicines and supplements.

When to seek urgent medical care

Heart disease can cause a medical emergency without warning.

• Chest pain, pressure or tightness lasting more than a few minutes, or spreading to the arm, jaw, neck or back
• Sudden shortness of breath, or breathlessness at rest or when lying flat
• Fainting, near-fainting or a racing or irregular heartbeat with dizziness
• Sudden weakness, trouble speaking or facial drooping
• Rapid weight gain or new swelling in the legs with worsening breathlessness

If any of these occur, call 911 or go to the nearest emergency department.