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14. Other Treatments for Angina

Most other treatments for angina have no scientifically proven benefit. That said, many people with angina do better with attention and encouragement.

Complementary therapies which encourage relaxation may be useful if you are stressed. In the 1930s it was shown that even placebo (inactive) tablets could be helpful, relieving pain in a third of people with angina. Any effects with unproven treatment may therefore be the results of the placebo effect.

As long as complementary treatment – be it herbs, acupuncture or reflexology – does no harm, feel free to try it. Bear in mind that, if the treatments were really proven to be useful, all doctors would be recommending them!

People who recommend these treatments tend to deride the scepticism sometimes shown by doctors but, even so, often do not provide the proof of success or submit the therapy to scientific validation. If someone could prove to me that massaging your right big toe was safe and relieved angina, I’d be the first to recommend it. I would have to advise you on the evidence (called evidence-based medicine) and there is none so far.

Lots of people started using beta carotene for heart disease and cancer. Proper clinical trials have shown no benefit for this but did raise anxieties about adverse effects. If you want to try an alternative approach, first be sure it is safe, then ask what proof there is. Always remember that isolated dramatic cases could be the result of the placebo factor.

I am not too sure what the ‘placebo factor’ means. Can you explain this to me?

Placebo translated from Latin means ‘I will please’. A placebo effect is a benefit that cannot be explained by chemical actions from drugs or any scientific form of treatment. The benefit may be due to your belief (hope) that a treatment will work or just your total confidence in the doctor or alternative medicine practitioner (‘This doctor is good; he will make me better’). Doctors use placebos to act as controls for their scientific preparations. Typically, they will test a new drug for angina and compare it with a placebo in such a way that neither you nor your doctor knows which preparation is being taken.

This is known as a ‘double blind trial’ and is a means of making sure that a new drug really does convey a benefit.

Could alternative medicine with acupuncture, homeopathy or herbal therapy just be a placebo effect?

You have put your finger on the problem! Alternative therapies have not undergone the rigorous testing that doctors would like to see. However, it is difficult to study alternative therapies as there is little motivation from large drug companies to fund such studies, since herbs cannot be patented. Alternative medicine practitioners believe there is no need for this sort of study, as they feel the ideas have been practised for many years.

What types of alternative therapy are available for people with heart problems?

Acupuncture uses needles at various points of the body to release energy (chi) and this is believed to be essential to good health. Homeopathy uses minute quantities of substances which produce similar symptoms to those experienced by people with heart problems, in the belief that resistance will develop. Herbalism uses plant-based preparations (often in an alcohol base) believed to restore good health. Herbal medicine is known as phytotherapy (plant therapy) and is quite separate from homeopathy.

I have heard that herbs can be helpful in heart disease and angina. Can you give me some advice?

Any alternative therapy (such as herbs) should not replace an accurate conventional diagnosis but only be tried once the diagnosis has been made and the safety of that treatment established.

Some of the effects that have been claimed for herbs and other plants include:

• Breakdown of plaques in arteries (alfalfa, garlic, hawthorn, mistletoe);

• Relaxation (lemon balm, lily-of-the-valley, St John’s wort, valerian);

• Relief of anginal symptoms (pineapple);

• Lowering of hypertension (bugle, hawthorn, mistletoe, skullcap, yarrow);

• Relief of stress and anxiety (camomile, skullcap, St John’s wort);

• Circulation stimulation (cayenne, ginger, hawthorn);

• Diuretic (dandelion, lily-of-the-valley, yarrow);

• Antioxidant (garlic);

• Lowering of cholesterol (ginger, motherwort, onion);

• Reduction of clotting (gingko, onion);

• Relief of palpitations (motherwort).

None of the claims for these herbs has reliably passed scientific scrutiny, yet a whole   industry exists based on the assertions made. Only garlic has been studied in any depth and, whilst there seems to be some benefit, it should be considered a supplement not an alternative. In other words, don’t stop your medication, which has been scientifically proved to help, but do try complementary treatments that can be bought in reputable chemists’ shops if you want to, following the advice on the information leaflets.

You keep emphasising the importance of going to reputable shops to buy herbal medicine. Isn’t all the information we need on the label?

Not necessarily! A recent study looked at 30 different boxes of feverfew, used to help migraine and arthritis. Only two preparations contained any feverfew at all. The problem is that medications are rigorously checked but herb preparations are not (currently) regulated. Drugs on the Internet are totally uncontrolled.

Are Chinese herbs the same as our herbal medicines and can they help?

Chinese herbal medicine is based on a different philosophy and uses different preparations and diagnostic techniques to those in the West, so it is considered a separate branch of herbal medicine. Again, many claims are made, but there is little scientific evidence available. When I studied one Chinese herb recommended for angina, compared to placebo all it did was to cause more headaches!

Are you in favour or against alternative methods of treatment?

If any treatment makes you feel better and does no harm, I cannot be against it. You must, however, have a full medical history and examination to make sure that nothing is being missed. Herbal medicine is slow-acting and best for chronic conditions, so it may help angina. Certain herbs in excess can lead to side effects – parsley in very large quantities can cause liver damage, celery and angelica can cause the skin to be sensitive to sunlight, and many other herbs can because stomach upsets. Some are even poisonous!

This means that you should go only to a qualified medical herbalist who knows how to handle the herbs and select the right ones for you. The same goes for homeopathy and acupuncture – only go to accredited people.

 I thought alternative medicine practitioners were all trained. Isn’t this so?

No. Anyone can set up as a specialist in complementary or alter - native medicine and there are no government requirements for training. These mean that in the wrong hands, you could be harmed or have a medical condition missed. Always check if the    practitioner is registered, has qualifications, is insured and is well established in practice in the area. Do not use the Internet unless it is a reputable pharmacy.

Why are doctors so sceptical about alternative medicine?

Doctors, and for that matter nurses and other trained medical people, have to qualify to certain standards and practise their craft following strict guidelines and codes of ethics. They are naturally suspicious of those who do not have to follow these rigorous rules and can make claims which are not or cannot be scientifically proven. Doctors are now being urged to practise only ‘evidence-based medicine’ which is medicine absolutely proven to be of benefit. They obviously wonder why others are not strictly policed.

 Do you think there is place then for alternative medicine or should I ignore it?

Yes there is a place for alternative medicine, provided that a full medical assessment has been performed on you and that the practitioner is fully qualified. Quality of life can be improved by many things, including a placebo. Provided that there is no evidence of harm, alternative treatments can be tried. There is no evidence that alternative medicine will lengthen your life, so if your life is threatened by heart disease, conventional medicine will be essential for your protection.

Can complementary therapies do any harm?

The short answer is yes – so always go to your doctor if you are taking these products; if you have a heart condition, check before you try them. Here are some reported dangers.

• Ma huang (Ephedra) used for weight loss and energy enhancement may cause stroke, heart attacks and sudden death.

• Chelation has killed some patients.

• Siberian ginseng can falsely elevate digoxin drug levels, leading to incorrect decisions.

• Gingko inhibits clotting and may increase the effect of warfarin (ginger, garlic and ginseng do this also).

St John’s wort and gingko can deepen the effects of anaesthetics, cause blood pressure problems and bleeding. St John’s wort can cause a fatal irregularity of the heartbeat – avoid it!

I have read in the paper about laser surgery. This sounds exciting – is it being used everywhere?

The word ‘laser’ sells newspapers and excites the reader. Laser balloons have come and gone because of a lack of benefit. The technique of transmyocardial laser revascularisation (doctors like long names!) is a treatment using lasers to create tiny channels in the heart muscle from the inside. It can be done by opening the chest (surgically) or via the arteries, like a catheter procedure. Patients for whom angioplasty or bypass surgery are not suitable can undergo this procedure, the idea being that blood from the inside of the ventricle (pump) feeds the muscle via the channels.

The results vary a lot and it is still experimental. So, if this procedure is offered to you, make sure that there are no other options (if need be, get a second opinion), and that the centre has ethical approval and a lot of experience. (There are cowboy doctors as well as cowboy builders!)

 What drugs should I be on to help stop my angina problems coming back?

All patients with coronary disease should be taking:

• Apirin (or clopidogrel);

• A statin (dose increased to get LDL 2.0 mmol/litre or less);

• A beta-blocker (such as bisoprolol 2.5–5 mg or atenolol 50 mg daily); and

• An ACE inhibitor (such as perindopril up to 8 mg, ramipril 5–10mg daily) or an AII inhibitor (such as valsartan, candesartan, losartan, irbesartan) providing there are no specific contraindications or side effects. If you are not on one of these drugs, ask why.

Drugs are much cheaper on the Internet – is it safe to buy them?

If you buy drugs this way you have no idea what you are taking. There is no control over the content of the tablets, or of the ‘vehicle’ which is used to keep the drug in the tablet, which may be a banned substance. In addition, the content may clash with your prescribed drugs. So only buy from a reputable online pharmacy and not ‘Dave’ who can sell you Viagra for 50p a tablet.

 

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