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      Efficacy of acupuncture for lifestyle risk factors for stroke: A systematic review

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          Abstract

          Background

          Modifications to lifestyle risk factors for stroke may help prevent stroke events. This systematic review aimed to identify and summarise the evidence of acupuncture interventions for those people with lifestyle risk factors for stroke, including alcohol-dependence, smoking-dependence, hypertension, and obesity.

          Methods

          MEDLINE, CINAHL/EBSCO, SCOPUS, and Cochrane Database were searched from January 1996 to December 2016. Only randomised controlled trials (RCTs) with empirical research findings were included. PRISMA guidelines were followed and risk of bias was assessed via the Cochrane Collaboration risk of bias assessment tool. The systematic review reported in this paper has been registered on the PROSPERO (#CRD42017060490).

          Results

          A total of 59 RCTs (5,650 participants) examining the use of acupuncture in treating lifestyle risk factors for stroke met the inclusion criteria. The seven RCTs focusing on alcohol-dependence showed substantial heterogeneity regarding intervention details. No evidence from meta-analysis has been found regarding post-intervention or long-term effect on blood pressure control for acupuncture compared to sham intervention. Relative to sham acupuncture, individuals receiving auricular acupressure for smoking-dependence reported lower numbers of consumed cigarettes per day (two RCTs, mean difference (MD) = -2.75 cigarettes/day; 95% confidence interval (CI) = -5.33, -0.17; p = 0.04). Compared to sham acupuncture those receiving acupuncture for obesity reported lower waist circumference (five RCTs, MD = -2.79 cm; 95% CI: -4.13, -1.46; p<0.001). Overall, only few trials were considered of low risk of bias for smoking-dependence and obesity, and as such none of the significant effects in favour of acupuncture interventions were robust against potential selection, performance, and detection bias.

          Conclusions

          This review found no convincing evidence for effects of acupuncture interventions for improving lifestyle risk factors for stroke.

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          Most cited references74

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          Executive Summary: Heart Disease and Stroke Statistics—2015 Update: A Report From the American Heart Association

          Dariush Mozaffarian, Emelia Benjamin, Alan S Go … (2015)
          Article 0 comments Cited 137 times – based on 0 reviews     Review now
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            Randomized trial of acupuncture to lower blood pressure.

            Frank Flachskampf, Joachim Gallasch, Olaf Gefeller … (2007)
            Arterial hypertension is a prime cause of morbidity and mortality in the general population. Pharmacological treatment has limitations resulting from drug side effects, costs, and patient compliance. Thus, we investigated whether traditional Chinese medicine acupuncture is able to lower blood pressure. We randomized 160 outpatients (age, 58+/-8 years; 78 men) with uncomplicated arterial hypertension in a single-blind fashion to a 6-week course of active acupuncture or sham acupuncture (22 sessions of 30 minutes' duration). Seventy-eight percent were receiving antihypertensive medication, which remained unchanged. Primary outcome parameters were mean 24-hour ambulatory blood pressure levels after the treatment course and 3 and 6 months later. One hundred forty patients finished the treatment course (72 with active treatment, 68 with sham treatment). There was a significant (P<0.001) difference in posttreatment blood pressures adjusted for baseline values between the active and sham acupuncture groups at the end of treatment. For the primary outcome, the difference between treatment groups amounted to 6.4 mm Hg (95% CI, 3.5 to 9.2) and 3.7 mm Hg (95% CI, 1.6 to 5.8) for 24-hour systolic and diastolic blood pressures, respectively. In the active acupuncture group, mean 24-hour ambulatory systolic and diastolic blood pressures decreased significantly after treatment by 5.4 mm Hg (95% CI, 3.2 to 7.6) and 3.0 mm Hg (95% CI, 1.5 to 4.6), respectively. At 3 and 6 months, mean systolic and diastolic blood pressures returned to pretreatment levels in the active treatment group. Acupuncture according to traditional Chinese medicine, but not sham acupuncture, after 6 weeks of treatment significantly lowered mean 24-hour ambulatory blood pressures; the effect disappeared after cessation of acupuncture treatment.
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              Prevention of stroke: a strategic global imperative.

              Gregory Roth, Jennifer L Foltz, Mary G. George … (2016)
              The increasing global stroke burden strongly suggests that currently implemented primary stroke prevention strategies are not sufficiently effective, and new primary prevention strategies with larger effect sizes are needed. Here, we review the latest stroke epidemiology literature, with an emphasis on the recently published Global Burden of Disease 2013 Study estimates; highlight the problems with current primary stroke and cardiovascular disease (CVD) prevention strategies; and outline new developments in primary stroke and CVD prevention. We also suggest key priorities for the future, including comprehensive prevention strategies that target people at all levels of CVD risk; implementation of an integrated approach to promote healthy behaviours and reduce health disparities; capitalizing on information technology to advance prevention approaches and techniques; and incorporation of culturally appropriate education about healthy lifestyles into standard education curricula early in life. Given the already immense and fast-increasing burden of stroke and other major noncommunicable diseases (NCDs), which threatens worldwide sustainability, governments of all countries should develop and implement an emergency action plan addressing the primary prevention of NCDs, possibly including taxation strategies to tackle unhealthy behaviours that increase the risk of stroke and other NCDs.
              Article 0 comments Cited 76 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                David Sibbritt:
                ORCID: http://orcid.org/0000-0003-3561-9447
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Wenbo Peng: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Romy Lauche: Role: Data curationRole: Formal analysisRole: Writing – review & editing
                Caleb Ferguson: Role: Data curationRole: Writing – review & editing
                Jane Frawley: Role: Data curation
                Jon Adams: Role: ConceptualizationRole: Funding acquisitionRole: Writing – review & editing
                Qinhong Zhang: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 26 October 2018
                Publication date Collection: 2018
                Volume: 13
                Issue: 10
                Electronic Location Identifier: e0206288
                Affiliations
                [1 ] Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
                [2 ] Nursing Research Centre, Western Sydney University & Western Sydney Local Health District, Blacktown Clinical & Research School, Blacktown Hospital, Sydney, New South Wales, Australia
                Stanford University School of Medicine, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-3561-9447
                Article
                Publisher ID: PONE-D-17-43008
                DOI: 10.1371/journal.pone.0206288
                PMC ID: 6203376
                PubMed ID: 30365567
                SO-VID: 711b81b6-233f-480f-bfec-137f1ba8cd6a
                Copyright © © 2018 Sibbritt et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 7 December 2017
                Date accepted : 10 October 2018
                Page count
                Figures: 1, Tables: 4, Pages: 30
                Funding
                Funded by: Nancy and Vic Allen Stroke Prevention Fund
                Award Recipient :
                ORCID: http://orcid.org/0000-0003-3561-9447
                This work was supported by the Nancy and Vic Allen Stroke Prevention Fund. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Complementary and Alternative Medicine
                Subject: Acupuncture
                Subject: Medicine and Health Sciences
                Subject: Pain Management
                Subject: Acupuncture
                Subject: Biology and Life Sciences
                Subject: Physiology
                Subject: Physiological Parameters
                Subject: Body Weight
                Subject: Obesity
                Subject: Medicine and Health Sciences
                Subject: Physiology
                Subject: Physiological Parameters
                Subject: Body Weight
                Subject: Obesity
                Subject: Biology and Life Sciences
                Subject: Psychology
                Subject: Behavior
                Subject: Habits
                Subject: Smoking Habits
                Subject: Social Sciences
                Subject: Psychology
                Subject: Behavior
                Subject: Habits
                Subject: Smoking Habits
                Subject: Medicine and Health Sciences
                Subject: Epidemiology
                Subject: Medical Risk Factors
                Subject: Biology and Life Sciences
                Subject: Physiology
                Subject: Physiological Parameters
                Subject: Body Weight
                Subject: Body Mass Index
                Subject: Medicine and Health Sciences
                Subject: Physiology
                Subject: Physiological Parameters
                Subject: Body Weight
                Subject: Body Mass Index
                Subject: Medicine and Health Sciences
                Subject: Vascular Medicine
                Subject: Blood Pressure
                Subject: Hypertension
                Subject: Medicine and Health Sciences
                Subject: Neurology
                Subject: Cerebrovascular Diseases
                Subject: Stroke
                Subject: Medicine and Health Sciences
                Subject: Vascular Medicine
                Subject: Stroke
                Subject: Biology and Life Sciences
                Subject: Nutrition
                Subject: Diet
                Subject: Medicine and Health Sciences
                Subject: Nutrition
                Subject: Diet
                Custom metadata
                Data Availability All relevant data are within the paper and its Supporting Information files.

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