Integrating Complementary Medicine Into Cardiovascular Medicine
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View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Journal of the American College of Cardiology Vol. 46, No. 1, 2005 © 2005 by the American College of Cardiology Foundation ISSN 0735-1097/05/$30.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2005.05.031 ACCF COMPLEMENTARY MEDICINE EXPERT CONSENSUS DOCUMENT Integrating Complementary Medicine Into Cardiovascular Medicine A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (Writing Committee to Develop an Expert Consensus Document on Complementary and Integrative Medicine) WRITING COMMITTEE MEMBERS JOHN H. K. VOGEL, MD, MACC, Chair STEVEN F. BOLLING, MD, FACC BRIAN OLSHANSKY, MD, FACC REBECCA B. COSTELLO, PHD KENNETH R. PELLETIER, MD(HC), PHD ERMINIA M. GUARNERI, MD, FACC CYNTHIA M. TRACY, MD, FACC MITCHELL W. KRUCOFF, MD, FACC, FCCP ROBERT A. VOGEL, MD, FACC JOHN C. LONGHURST, MD, PHD, FACC TASK FORCE MEMBERS ROBERT A. VOGEL, MD, FACC, Chair JONATHAN ABRAMS, MD, FACC SANJIV KAUL, MBBS, FACC JEFFREY L. ANDERSON, MD, FACC ROBERT C. LICHTENBERG, MD, FACC ERIC R. BATES, MD, FACC JONATHAN R. LINDNER, MD, FACC BRUCE R. BRODIE, MD, FACC* ROBERT A. O’ROURKE, MD, FACC† CINDY L. GRINES, MD, FACC GERALD M. POHOST, MD, FACC PETER G. DANIAS, MD, PHD, FACC* RICHARD S. SCHOFIELD, MD, FACC GABRIEL GREGORATOS, MD, FACC* SAMUEL J. SHUBROOKS, MD, FACC MARK A. HLATKY, MD, FACC CYNTHIA M. TRACY, MD, FACC* JUDITH S. HOCHMAN, MD, FACC* WILLIAM L. WINTERS, JR, MD, MACC* *Former members of Task Force; †Former chair of Task Force The recommendations set forth in this report are those of the Writing Committee and do not necessarily reflect the official position of the American College of Cardiology Foundation. When citing this document, the American College of Cardiology Foundation Copies: This document is available on the World Wide Web site of the American College would appreciate the following citation format: Vogel JHK, Bolling SF, Costello RB, of Cardiology (www.acc.org). Reprints of this document may be purchased for $10 each by Guarneri EM, Krucoff MW, Longhurst JC, Olshansky B, Pelletier KR, Tracy CM, calling 1-800-253-4636, ext. 694, or by writing to the American College of Cardiology, Vogel RA. Integrating complementary medicine into cardiovascular medicine: a Educational Services, 9111 Old Georgetown Road, Bethesda, MD 20814-1699. report of the American College of Cardiology Foundation Task Force on Clinical Permissions: Multiple copies, modification, alteration, enhancement, and/or dis- Expert Consensus Documents (Writing Committee to Develop an Expert Consensus tribution of this document are not permitted without the express permission of the Document on Complementary and Integrative Medicine). J Am Coll Cardiol American College of Cardiology Foundation. Please direct requests to: 2005;46:184–221. [email protected]. JACC Vol. 46, No. 1, 2005 Vogel et al. 185 July 5, 2005:184–221 ACCF Complementary Medicine Expert Consensus Document TABLE OF CONTENTS practitioners, payers, and other interested parties of many Preamble....................................................................................185 evolving areas of clinical practice and/or technologies asso- I. Introduction.......................................................................185 ciated with this topic that are widely available or new to the Organization of Committee and Evidence Review ......185 practice community. Topics chosen for coverage by CECD Background....................................................................186 are so designated because the evidence base and experience Purpose of This CECD ................................................186 II. Nutrition and Supplements...............................................187 with technology or clinical practice are not considered Nutrition........................................................................187 sufficiently well developed to be evaluated by the formal Bioactive Components in Foods ...................................188 American College of Cardiology/American Heart Associa- Vitamin and Mineral Supplements ...............................191 tion (ACC/AHA) Practice Guidelines process. Often, the Herbal Preparations.......................................................194 topic is the subject of considerable ongoing investigation. Herb-Drug Interactions: What We Need to Know.....196 The Task Force on CECDs recognizes that considerable Related Alternative Therapy .........................................199 debate exists regarding the clinical utility of alternative III. Mind/Body and Placebo....................................................200 The Mind/Body Relationship and its Correlation medicine practices. By their nature, alternative medicine to CVD..........................................................................200 practices differ widely in their scientific support. Despite Impact of Stress on CVD Risk Factors........................201 this varying evidence base, these practices are widely em- Depression and the Development of CVD ..................202 ployed by patients, including those with CVD. Many Placebo...........................................................................203 practitioners are not familiar with many alternative medi- IV. Acupuncture.......................................................................203 cine techniques. Thus, the reader should view this CECD V. Bioenergetics (Energy Medicine)......................................205 as the best attempt of the ACCF to inform and guide Methods to Study Bioenergy ........................................205 clinical practice in an area where rigorous evidence is not yet Forms of Bioenergetics..................................................206 Caveats...........................................................................207 available or the evidence to date is not widely accepted. Recommendations..........................................................207 Where feasible, CECDs include indications or contraindi- VI. Spirituality/Intentionality ..................................................207 cations. The ACC/AHA Practice Guidelines Committee Spirituality in Cardiovascular Applications...................207 may subsequently address some topics covered by CECDs. Compendia ....................................................................208 The Task Force on Clinical Expert Consensus Docu- Review Articles and Meta-Analyses..............................208 ments makes every effort to avoid any actual or potential Specific Reports of Spirituality and conflicts of interest that might arise as a result of an outside Cardiovascular Care.......................................................208 Key Issues in Spirituality Applied to relationship or personal interest of a member of the writing Cardiovascular Care.......................................................209 panel. Specifically, all members of the writing panel are Delivery Roles, Accreditation, and Certification asked to provide disclosure statements of all such relation- Standards .......................................................................210 ships that might be perceived as real or potential conflicts of Summary and General Recommendations....................210 interest. These statements are reviewed by the parent task Staff ...........................................................................................210 force and updated as changes occur. Please see Appendix I Appendix I: Relationships With Industry ................................210 for the relationship with industry information pertinent to Appendix II: Glossary...............................................................210 this document. The following additional appendices are located on www. Robert A. Vogel, MD, FACC acc.org only: Chair, ACCF Task Force on Clinical Expert Appendix III: Internet Sources for Complementary Medicine Consensus Documents Information Appendix IV: Review of the Literature for Cardiovascular-Related Integrative Medicine I. INTRODUCTION Appendix V: Dietary Supplement Intake Form Organization of Committee and Evidence Review Appendix VI: Books and Compendia on Spirituality in Cardio- vascular Applications The Writing Committee consisted of acknowledged experts Appendix VII: Structured Reviews and Meta-Analyses of Spiritual in the field of complementary, alternative, and integrative Descriptors and Therapies and Their Correlations With medicine. Both the academic and private sectors were (Noncardiology) Clinical Outcomes represented. The document was reviewed by five official reviewers nominated by the ACCF, representatives from PREAMBLE the American Association of Critical Care Nurses, AHA, This document was commissioned by the American College American Nurses Association, Preventive Cardiovascular of Cardiology Foundation (ACCF) Task Force on Clinical Nurses Association, and the Society of Thoracic Surgeons, Expert Consensus Documents (CECDs) to provide a per- as well as 20 content reviewers nominated by the Writing spective on the current state of complementary, alternative, Committee. This document will be considered current until and integrative medical therapies specifically as they relate the Task Force on CECDs revises or withdraws it from to cardiovascular diseases (CVDs). It is intended to inform publication. 186 Vogel et al. JACC Vol. 46, No. 1, 2005 ACCF Complementary Medicine Expert Consensus Document July 5, 2005:184–221 Background