Temporal Trends in Use of Complementary Therapies Among Patients With Cardiovascular Disorders.

This study aimed to evaluate the use and frequency of complementary and integrative medicine (CIM) therapies in an outpatient cohort with cardiovascular disease (CVD) and compare trends over time. This cross-sectional point-of-care prospective study assessed patients attending a cardiology outpatient clinic. As in our 2009 cohort, data were collected with a 17-question survey on demographic characteristics, CVD history, current use and future interest in CIM. In total, 964 patients completed the survey. CIM use continues to be high (2009 vs 2018, 83.4% vs 81.8%) (p = 0.34), with dietary supplements the most common therapy (75% in both studies). We observed increased use of mind-body therapies (28.5% vs 23.9%, p = 0.02), especially meditation, yoga, and tai chi. Of the patients receiving CIM therapies, 41.9% reported using CIM for heart-related symptoms. Relaxation, stress management, and meditation were the top three mind-body therapies for CVD-related symptoms in both cohorts. Reporting of CIM use to clinicians is low (15%) and interest on future use is high (47%). In conclusion, CIM is highly used in cardiology patients-4 of 10 patients use CIM for CVD-related symptoms. Most take dietary supplements, with an increased use of mind-body therapies. Our data highlight the importance of documenting CIM use in practice and the need for research to document efficacy.

Viewpoint: Role of Mind-body Therapies in the Management of Cardiovascular Disorders.

Cardiovascular disorders (CVD) are the leading cause of death across the globe. The estimated cost to the National Health Service and UK economy is £30 billion. These costs continue to escalate despite major advances in pharmacotherapy and devices, which, in part, is due to improved survival, but also greater resource utilisation per patient. Hence, there is a need to develop cost-effective adjunctive therapies beyond conventional strategies. Mind-body therapies- including mindfulness and meditation, emotional regulation, practicing 'heartfelt' emotions including gratitude and compassion- may be novel low-cost approaches to reduce morbidity and mortality in CVD.

Bibliotherapy to decrease stress and anxiety and increase resilience and mindfulness: a pilot trial.

INTRODUCTION: Interventions to decrease stress and enhance resiliency and mindfulness are more likely to be widely implemented if they can be offered without the need for in-person training. The purpose of this study was to assess effectiveness of a self-directed Stress Management and Resiliency Training (SMART) program delivered using only written material for improving stress, resiliency, and mindfulness. METHODS: A total of 37 employees at a large medical center were recruited and given written material on the SMART program. Subjects were instructed to practice the skills presented in the written materials without any additional training. The skills included education about the neuropsychology of stress and resilience, training attention to focus in the present moment, and refining interpretations. Primary outcome measures assessed resilience, perceived stress, anxiety, and quality of life. RESULTS: Out of 37 employees, 34 (89%) enrolled subjects completed the study and provided the baseline and follow-up data. A statistically significant improvement in perceived stress, resilience, mindfulness, anxiety, and quality of life was observed at 12 weeks. CONCLUSION: This study demonstrated that a brief, self-directed program to decrease stress and enhance resilience and mindfulness provided excellent short-term effectiveness for enhancing resilience, mindfulness and quality of life, and decreasing stress and anxiety.

Patterns of complementary and alternative medicine use in children with common neurological conditions.

BACKGROUND: Recent literature suggests that one in nine children in the United States uses some type of complementary and alternative medicine (CAM). Children with challenging neurological conditions such as headache, migraine, and seizures may seek CAM in their attempts at self-care. Our objective was to describe CAM use in children with these conditions. METHODS: We compared use of CAM among children aged 3 to 17 years with and without common neurological conditions (headaches, migraines, seizures) where CAM might plausibly play a role in their self-management using the 2007 National Health Interview Survey (NHIS) data. RESULTS: Children with common neurological conditions reported significantly more CAM use compared to the children without these conditions (24.0% vs 12.6%, P<.0001). Compared to other pediatric CAM users, children with neurological conditions report similarly high use of biological therapies and significantly higher use of mind-body techniques (38.6% vs 20.5%, P<.007). Of the mind-body techniques, deep breathing (32.5%), meditation (15.1%), and progressive relaxation (10.1%) were used most frequently. CONCLUSIONS: About one in four children with common neurological conditions use CAM. The nature of CAM use in this population, as well as its risks and benefits in neurological disease, deserve further investigation.

Characteristics of exclusive users of mind-body medicine vs. other alternative medicine approaches in the United States.

CONTEXT: Persons using one group of complementary and alternative medicine (CAM) may differ in important ways from users of other CAM therapies. OBJECTIVES: The aim of this study was to characterize the United States (US) adult population using exclusively mind-body medicine (MBM) and to determine if their characteristics differed from those using exclusively non-vitamin natural products. DESIGN/SETTING: Using the 2007 National Health Interview Survey (NHIS) and its periodic supplement on CAM use, descriptive characteristics of exclusive MBM users, as well as those using exclusively non-vitamin natural products were identified. PATIENTS: A total of 75,764 persons completing the 2007 NHIS with adults aged 18 years and older. MAIN OUTCOME MEASURES: Characteristics of MBM users, prevalence of MBM use, and characteristics of exclusive MBM users compared to exclusive non-vitamin natural product users. RESULTS: Among CAM users (N = 83,013,655), 21.8% of the adult population (age 18 or older) reported using exclusive MBM therapy. In multivariate models, exclusive MBM use was associated with female gender, higher educational attainment, younger age, residing in Northeast US, being Asian or black race, and a current smoker compared to those using exclusive non-vitamin natural products. Using bivariate comparisons, individuals that exclusively used MBM were more likely to be white females (60.5%), in a younger age category (18-39 years), educated beyond high school (68.3%), and more likely from the Southern US (32.4%). A greater level of depression in MBM users was noted compared to non-vitamin natural product users (6.6%).

Use of complementary therapies in cardiovascular disease.

The aim of the present study was to assess the use of complementary and alternative medicine (CAM) treatments in outpatients with cardiovascular disease and their interest in future use. The increasing popularity of CAM therapies highlights the need to explore their use among patients with cardiovascular disease. Data were collected with a prospective, point-of-care, anonymous, 17-question survey about basic medical information and previous use and interest in the future use of dietary supplements and other CAM interventions among patients undergoing outpatient cardiology evaluation at a Midwestern tertiary care center. The survey was completed by 1,055 patients (655 men, 351 women; mean age 63.5 years) of whom 98.1% were white. Of these, 36.8% had cardiac symptoms for >10 years, 48.2% had coronary artery disease, and 82.5% reported use of CAM therapies. Of these patients, 75.4% reported using dietary supplements, 31.5% chiropractic therapy, 23.9% mind-body therapies, and 19.2% massage. Only 14.4% had discussed the use of CAM treatments with their physicians. The top 4 treatments used for cardiac symptoms were relaxation techniques, stress management, meditation, and guided imagery. Also, 48.6% were interested in participating in a future clinical trial of an alternative treatment. The great majority of patients seen in current practice use CAM therapies, and a large proportion expressed an interest in participating in research with CAM therapies. In conclusion, research directed with an integrative approach to cardiovascular care might prove beneficial when designing future studies.

S-adenosyl-L-methionine (SAMe) for smoking abstinence: a randomized clinical trial.

OBJECTIVES: S-Adenosyl-L-methionine (SAMe) is a dietary supplement commonly used to treat depression. SAMe facilitates dopamine and norepinephrine synthesis in the central nervous system. This study investigated the efficacy of SAMe for increasing tobacco abstinence among cigarette smokers. DESIGN: A randomized, blinded, placebo-controlled, three-arm, dose-ranging clinical trial was conducted. Subjects were randomly allocated to receive SAMe 1600 mg or 800 mg by mouth every day or a matching placebo for 8 weeks. All subjects received a behavioral smoking cessation intervention. Self-reported smoking abstinence was biochemically confirmed with exhaled-air carbon monoxide. SUBJECTS: Subjects in the study comprised 120 adults. RESULTS: One hundred and twenty (120) subjects with a mean age of 40.0±14.0 (SD) years were enrolled. Participants smoked an average of 19.6±8.6 cigarettes per day for 21±13.2 years. The study dropout rate was high (42.5%). By intention-to-treat analysis, no significant differences were observed in abstinence rates at 8 and 24 weeks between SAMe dose groups and placebo. SAMe did not attenuate withdrawal symptoms among abstinent subjects. Rates of gastrointestinal side-effects were higher with SAMe 1600 mg/d compared to placebo. CONCLUSIONS: SAMe did not increase smoking abstinence rates. Abstinence and tobacco withdrawal data from this clinical trial suggest that SAMe holds little promise for the treatment of tobacco dependence.

Effect of a single-session meditation training to reduce stress and improve quality of life among health care professionals: a "dose-ranging" feasibility study.

PRIMARY STUDY OBJECTIVE: The primary aim of the study was to assess the feasibility of incorporating a single-session meditation-training program into the daily activities of healthy employees of a tertiary-care academic medical center. The study also assessed the most preferred duration of meditation and the effect of the meditation program on perceived stress, anxiety, and overall quality of life (QOL). POPULATION: Seventeen healthy clinic employees were recruited for this study. INTERVENTION: After an initial group instruction session covering basic information about meditation, Paced Breathing Meditation (PBM) was taught to the participants. Participants were instructed to self-practice meditation with the help of a DVD daily for a total of 4 weeks. The DVD had three different programs of 5, 15, and 30 minutes with a menu option to choose one of the programs. OUTCOME MEASURES: (1) Patient diary, (2) Perceived Stress Scale (PSS), (3) Linear Analogue Self-Assessment (LASA), (4) Smith Anxiety Scale (SAS). Primary outcome measures were compared using the paired t-test. RESULTS: All participants were female; median age was 48 years (range 33-60 y). The 5-minute meditation session was practiced by 14 participants a total of 137 times during the 4-week trial period, the 15-minute session by 16 participants a total of 223 times, and the 30-minute session by 13 participants 71 times. The median number of days practiced was 25 (range 10-28 d); the average total time practiced was 394 minutes (range 55-850 min). After 4 weeks of practice, the scores of the following instruments improved significantly from baseline: PSS (P < .0001), SAS (P = .0005), LASA (P = .0005). No relationship was noted between the length of time practiced and improvement of PSS, SAS, and LASA scores. CONCLUSION: This pilot study indicates the feasibility of teaching meditation in a single training session to health care employees. The study shows that 15 minutes once or twice a day is the most feasible duration of meditation practice. The study also provides promising preliminary efficacy data of this program for improving stress, anxiety, and QOL.

Patients' preferences about participation in clinical trials studying complementary and alternative medicine.

CONTEXT: Patients' unwillingness to participate in clinical research is one of the main challenges that researchers face today. In Complementary and Alternative Medicine (CAM) research, a pertinent yet understudied question is the attitude of potential participants toward clinical trials that test CAM interventions. OBJECTIVES: To assess patients' attitudes and preferences regarding participation in clinical trials which test CAM rather than conventional treatments. DESIGN: A 78-question, pencil-and-paper survey was conducted in collaboration with the Survey Research Center located in the Division of Biomedical Statistics and Informatics in the Department of Health Sciences Research at Mayo Clinic in Rochester, Minnesota. SETTING: The study took place at Mayo Clinic, an academic medical center for tertiary care in Rochester, Minnesota, USA. PATIENTS OR OTHER PARTICIPANTS: Participants were patients undergoing a general medical evaluation at the Division of General Internal Medicine in the Department of Internal Medicine at Mayo Clinic. INTERVENTION: The researchers designed a cross-sectional, point-of-care survey. The study coordinator approached patients and invited them to participate. OUTCOME MEASURES: The study summarized the data for categorical variables, identifying numbers of participants and percentages and comparing two proportions using the Fisher exact test. RESULTS: Out of 485 patients asked to participate, 400 (82%) completed the survey. Respondents were equally as interested in participating in clinical trials testing CAM as they were in trials testing conventional treatments (79% vs 69%, P = .09). For all participants, 107 (27%) were in favor of participating in CAM clinical trials and 118 (30%) were in favor of participating in conventional clinical trials. CONCLUSION: Respondents were interested equally in participating in clinical trials testing CAM vs conventional treatments.

Impact of mind body therapies on vascular endothelial dysfunction and implications for cardiovacular disease management.

Mind body therapies appear to reduce morbidity and mortality in patients with cardiovascular diseases, but there is limited understanding of the mechanisms that mediate this effect. Vascular endothelial dysfunction is a central feature of atherogenesis that is adversely impacted by mental stress. We conducted a systematic review and meta-analysis of the effect of mind body therapies on peripheral endothelial function in patients with and without established cardiovascular disease. The search included Medline, Cochrane Library, Scopus and Embase to identify studies up to November 2009. Eligible studies were randomized controlled trials that compared the effects of mind body therapies and placebo on endothelial function. Two reviewers extracted data on study characteristics, methods, and outcomes. Disagreement was resolved by consensus. Three eligible trials enrolled a total of 258 patients. Sixty one (24 percent) were women and 53 percent had established cardiovascular disease. The trials had good methodological quality. Meta-analysis using random-effects model showed a non significant improvement of endothelial function by mind body therapies (standardized mean difference 0.15; 95% CI, -0.36 to 0.67, P=0.56). The analysis was underpowered due to small sample size. Circumstantial evidence indicates that mind body therapies may have a therapeutic benefit on endothelial dysfunction, however, the aggregate data from the three small randomized trials to date do not support this hypothesis. This biologically plausible effect requires additional investigation in adequately powered studies.

A randomized clinical trial of St. John's wort for smoking cessation.

INTRODUCTION: St. John's wort (SJW) is a widely used herbal supplement. The predominant mechanism(s) accounting for the activity of SJW in vivo are, however, unclear. The purpose of this study was to investigate the efficacy of SJW for smoking cessation. METHODS: We conducted a randomized, blinded, placebo-controlled, three-arm, dose-ranging clinical trial. A total of 118 subjects were randomly allocated to receive SJW 300 mg, 600 mg, or a matching placebo tablet 3 times a day combined with a behavioral intervention for 12 weeks. Self-reported smoking abstinence was biochemically confirmed with expired air carbon monoxide. RESULTS: Mean age of the study participants was 37.6 +/- 12.4 years; they smoked an average of 20.0 +/- 6.6 cigarettes per day for 20 +/- 12.1 years. The study dropout rate was high (43%). By intention-to-treat analysis, no significant differences were observed in abstinence rates at 12 and 24 weeks between SJW dose groups and placebo. SJW did not attenuate withdrawal symptoms among abstinent subjects. Abstinence rates did not differ by study group among subjects who took at least 75% of their study medication. No significant side-effects were noted with SJW. CONCLUSIONS: In this randomized trial, SJW did not increase smoking abstinence rates. Our data, in combination with data from other studies, suggest that SJW has little role in the treatment of tobacco dependence.

Convergent evolution of a 2-methylbutyryl-CoA dehydrogenase from isovaleryl-CoA dehydrogenase in Solanum tuberosum.

The potato cDNAs Solanum tuberosum isovaleryl-CoA dehydrogenases 1 and 2 (St-IVD1 and St-IVD2) encode proteins that are 84% identical to each other and 65 and 64% identical to human IVD, respectively. St-IVD2 protein was previously partially purified from potato tubers and confirmed to be an IVD. The function of St-IVD1 is unknown. In these experiments, both proteins were expressed in Escherichia coli and purified as intact homotetramers. The substrate preference profile of the St-IVD2 protein was similar to that of human IVD. However, recombinant St-IVD1 had maximal activity with 2-methylbutyryl-CoA, which in humans is dehydrogenated by short/branched-chain acyl-CoA dehydrogenase (SBCAD). Whereas molecular modeling predicts that the 2-methylbutyryl-CoA dehydrogenase (2MBCD) and IVD substrate binding pockets are nearly identical, 2MBCD has amino acid substitutions at five residues that are invariant among all of the known and putative IVDs. Site-directed mutagenesis was used to match the human IVD active site with that of potato 2MBCD. The resulting mutant IVD had detectable activity with 2-methylbutyryl-CoA and no activity with isovaleryl-CoA. The 2MBCD active site was compared with that of human SBCAD using molecular modeling. Residues Met-361 and Ala-365 of 2MBCD appear to partially substitute for the function of Tyr-380 in human SBCAD, binding the methyl branch linked to C2 of 2-methylbutyryl-CoA, whereas residues Val-88, Val-92, and Val-96 appear to bind the distal C4 methyl group. The presence of a 2MBCD in potato that is highly homologous to IVD is an example of convergent evolution within the acyl-CoA dehydrogenase family, leading to the independent occurrence of two enzymes (SBCAD and 2MBCD) specific for 2-methylbutyryl-CoA.