Stroke, Heart Attack, Atherosclerosis and DVT

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Cardiovascular maintenance, not cholesterol level, is the key factor in assessing cardiovascular risk

While high cholesterol has some oblique association with atherosclerotic plaque, we now know that it is certainly not responsible for the buildup of arterial plaques as a component of lipoprotein complexes. High cholesterol itself produces no symptoms, and is not a disease mechanism. There is an association between persons with a high total cholesterol in circulation and cardiovascular disease, but many experts question whether this association points to a shared underlying disease mechanism rather than high cholesterol as a cause of cardiovascular disease. Low cholesterol, on the other hand, may be a disease mechanism. Children born with a genetic defect that prevents adequate mevalonic acid metabolism and results in low cholesterol, have many related health problems, including mental handicaps, poor growth, anemia, acidosis, immune problems, and cataracts.The focus on lowering cholesterol to very low levels to decrease cardiovascular risk modestly, when there are now proven ways to restore cholesterol and lipoprotein homeostasis, as well as holistic protocols to dramatically reduce cardiovascular risk, is not the sensible protocol for most patients.

We now know that the narrow-minded focus in cardiovascular health has overlooked many important factors that contribute to cardiovascular risk of stroke, heart attack and other vascular pathologies. An embarrassing aspect of this systemic narrowed focus was the fact that the research and treatments created over the last 5-6 decades concerned male cardiovascular health and heart attack, and all this time female cardiovascular disease was increasing in incidence until now it is the number one cause of female death in the United States. In recent years research has revealed that there are profound differences in the pathologies of male and female cardiovascular disease, but an assumption that the coronary artery disease and narrowing, or stenosis, seen most often in men with heart attacks, was the only worthwhile focus, both created treatment guidelines based on coronary artery stenosis and atherosclerosis, and may have sent many women with the signs and symptoms of a heart attack home with no explanation. We now see that many women have syndromes of Stress Cardiomyopathy that does not involve coronary artery disease, and that a cycle of dysfunction related to hormonal imbalances affecting the vagal and sympathetic cardiac reflexes often create abnormalities such as Takotsubo Syndrome, an enlargement of the inferior aspect of the left ventricle that leads to a heart attack induced by stress, either emotional or physical. As research expands we find that these one-size-fits-all assumptions about cardiovascular health and disease have led to an alarming problem with the number one health problem in the population, and have hindered the progress with improving cardiovascular health more than we have. A narrow focus on cholesterol, stents, and a cocktail of hypertension medications that have been shown to have poor results and much noncompliance has prevented us from progressing with a more holistic and individualized treatment protocol that integrates safe and effective Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM).

Cholesterol is the most abundant steroid hormone in our bodies. Cholesterol, as a steroid hormone, plays many important roles in the body, including maintenance of brain function. Besides being a precursor to the sexual steroid hormones, cholesterol is also a precursor to all of the adrenal glucocorticoid hormones, which include cortisol, an important mediator of stress and inflammation, as well as a precursor to Vitamin D3, cholecalciferol, the prohormone precursor to the Vitamin D3 hormone that so many people are now deficient in. Despite a reluctance to study the relationship between hormone Vitamin D deficiency and statin drug use, this is now evident, and low hormone Vitamin D and cholecalciferol D3 levels have been linked to symptoms of muscle pain, diabetes and vascular disease that are now part of warnings of adverse effects of statin drug use. In addition, statin drug inhibition of the mevalonic acid pathway of cholesterol also inhibits the production of prenylated proteins, which include G-proteins, a subject of much research in recent years related to neurodegenerative disease, mood disorders, subclinical hypothyroid conditions, and immune disorders. Finally, an important antioxidant chemical found in all cells, ubiquitone, or Coenzyme Q10, is also inhibited when the mevalonic acid pathway is inhibited by statin drugs, and CoQ10 deficiency is linked to heart disease. In recent years studies found that for patients with Metabolic Syndrome, that long term use of statin drugs was associated with a higher risk of developing a true diabetes. In 2012, a reluctant U.S. FDA issued warnings that statin drug use held significant risks for onset of diabetes, muscle damage with weakness and pain, memory loss from CNS degeneration, and liver damage, yet continued to support the widespread prescription of statin drugs. The FDA also noted that concurrent prescription of other medications that use the same metabolic, or catabolic, pathway as statin drugs often increased the actual circulating dose of statins, increasing these risks. The reasons for a reconsideration of cholesterol lowering as the main, or only, therapy to counter atherosclerosis and cardiovascular disease are mounting. The question is not one of an "alternative" approach, but of a sensible holistic protocol that includes Complementary and Integrative Medicine (CIM). Large groups of medical doctors and researchers around the world are now heavily questioning a cholesterol emphasis in cardiovascular health, but change is slow.

In 2011, researchers at the University of Texas Southwestern Medical School, and the Cooper Institute in Dallas, Texas, released data from long term studies that shows that cardiovascular maintenance, not cholesterol levels, is the key factor in assessing future cardiovascular risk. A comprehensive and holistic strategy to maintain cardiovascular health is needed, involving dietary changes, exercise and activity routines, and smart use of Complementary and Integrative Medicine (CIM).

Two reports, published in the medical journals Circulation and the Journal of the American College of Cardiology, found that the level of aerobic cardiovascular fitness maintained between the ages of 40 and 50, was the greatest indicator of cardiovascular risk. A person in the higher realm of cardiovascular fitness during this phase of life had a 10 percent lifetime risk, while those that fell into the lower realm of cardiovascular fitness had a 30 percent lifetime risk. Those persons in the higher realm of fitness were not always high level athletes, as any man that could run an 8 or 9 minute mile was in the moderate to high level of cardiovascular fitness, and this was mainly maintained by increased walking and stair climbing, and general daily activity. The recommendations were not to start running miles as fast as you can, the lead researchers stated, which could lead to strain and injury, but to increase the daily aerobic activities, get up from the desk and the couch, use the stairs, walk to work, and start a weekly routine of modest exercise. This may be the reason why populations, such as those mentioned in Spain, had such a lower incidence of cardiovascular disease. In addition to these lifestyle changes, dietary improvements, especially concerning healthier fats, whole grains and beans, and a more plant-based diet, as well as the utilization of health maintenance in the form of herbal and nutrient medicine, acupuncture and physiotherapy, are the keys to a simple but dramatic decrease in overall cardiovascular risk. While the standard prescription of statin drugs and hypertension medications do produce lower risk of cardiovascular events, the level of lowered risk is not nearly as great as this simple holistic protocol. Studies have shown that since the introduction of statin drugs that the percentage of Americans that are sedentary, or deficient in normal daily physical activity, has increased dramatically, as well as patients with overweight and obesity, and patients with Metabolic Syndrome and type 2 diabetes. More and more studies have shown us that there is a relationship between the adverse effects of statin drug and hypertension medication such as beta-adrenergic inhibitors, which include muscle pain and easy fatigue, and this increase in sedentary lifestyles. Modern medicine has ignored these connections.

In 2013, researchers at the London School of Economics, Harvard Pilgrim Health Care Institute at Harvard Medical School, and Stanford University School of Medicine, led by Huseyin Naci M.H.S., a visiting fellow at Harvard Medical School in Population Medicine, performed a meta-review of all published scientific study concerning the effects of structured exercise compared to drug regimens for cardiovascular disease. They found 57 randomized human clinical trials testing the long-term effects of structured exercise on cardiovascular disease mortality in 4 areas of prevention, coronary heart disease (heart attacks), rehabilitation from stroke, treatment of heart failure, and prevention of Type 2 diabetes or Metabolic Syndrome, involving some 14,000 patients. They also analyzed 305 randomized controlled human clinical trials involving 339,274 individuals in total. The studies compared disease outcomes with statins (cholesterol-lowering drugs), blood thinners (anti-coagulants), diuretics, and biguanides like Glucophage and Metaglip commonly prescribed for diabetes, Metabolic syndrome and cardiovascular disease prevention. These studies showed that there was either no difference in prevention of death from cardiovascular disease and Metabolic Syndrome, or in the the case of stroke prevention, better outcomes with structured exercise than standard drug regimens. The study was published in the British Medical Journal (BMJ) online, but received little note in standard medical journals. The authors, at 3 of the most prestigious University Medical Schools in the United States and the United Kingdom, noted that patients should be more aware that simple lifestyle changes have been proven to be effective in the treatment of cardiovascular disease, high blood pressure, depression and arthritis of the knee, and a lack of emphasis on this treatment protocol by their Medical Doctors is preventing substantial gains in disease prevention and prevention of cardiovascular deaths.

While the many potential adverse effects of chronic statin drug use are not dramatic, and occur slowly over time, with chronic use, they still are a large concern for many patients, once these effects are studied. Statin drugs not only affect the pathway of expression of cholesterol in the liver, but exert cellular effects as well. While these peripheral cellular effects have generated interest in statin drugs to treat peripheral diseases, as always, there are two sides to this subject, the good and the bad. Statin drugs have been shown to induce changes in cell shape and actin/myosin cytoskeletal organization in peripheral cells (Song et al, Duke University School of Medicine). While this is touted as a potential treatment for such diseases as glaucoma, the implications for statin drugs affecting musculoskeletal function and cell health imply that the chronic side effects of musculoskeletal pain may be tied to more than just accumulation of protein fragments in tissues. To see a recent analysis of the doubts of benefits of widespread statin prescription, click on this link: http://healthjournalclub.blogspot.com/2010/06/statins-and-myoglobin-how-muscle-pain.html. Of course, research on statins is producing both support for increased use of the drugs as more physiological mechanisms are found, as well as a healthy skepticism of the use or need for the drugs for most patients. In the end, the choice is an individual one that each patient makes.

Cardiovascular Risk: A Reality Check

The questions concerning the effectiveness and benefits, as well as the long adverse effects, or risks, associated with cholesterol lowering statin drugs are legitimate. As the long-term studies on hypertensive drug protocol have revealed, such as the ALLHAT study of the NIH's National Heart, Lung and Blood Institute, the benefits and effectiveness of hypertensive drugs may also be limited, and the adverse effects in the long term with multiple drug regimens may be greater than the benefits (see the articles on High Blood Pressure and Cholesterol and Lipid Imbalance on this website). Intelligent patients, as well as an increasing number of medical doctors, are finally taking a serious look at the reality of our present standard protocol to reduce cardiovascular risk, and finding that we are not doing enough to decrease risk and improve the cardiovascular health. The false sense of security that is promoted with the standard drug protocol is not real. Another article on this website explores current scientific study of cardiovascular risk and the implications of improved biomarkers of cardiovascular risk.

Another aspect of the standard cardiovascular protocol that is widely overlooked, both by patients and prescribing doctors, is the increased risks of cardiovascular ill health from other commonly prescribed medications. Assessment of individual cardiovascular risk and avoidance of medications that increase this risk is not being performed. Instead, patients are being led to believe that when they are taking drugs that increase cardiovascular risk, they are safe as long as they take cholesterol and hypertensive medications with these drugs. The scientific data does not support this attitude, and a growing but reluctant set of warnings are being issued for overprescription of medications and the implications. Clearly, the integration of Complementary Medicine and better public health protocols are needed. Standard medicine sees no profit in this plan, though, and the impetus for change must come from the patient population and a more proactive attitude.

Which drugs do we take that may increase the risk of cardiovascular disease and poor maintenance of cardiovascular health? Most people do not realize that the most commonly prescribed medications dramatically increase cardiovascular risk. Non-steroidal anti-inflammatory drugs for chronic pain (NSAIDs), synthetic hormonal drugs in the form of contraceptives and hormone replacement regimens, and even some of the newer drugs to treat diabetes are all linked to a higher risk of cardiovascular death and disease. FDA warnings have been issued concerning the high cardiovascular risks of the sulfonylurea drugs to treat diabetes, including Glyburide, Glipizide, Tolazamide, Diabinase and Orinase. Actos, or pioglitazone, was withdrawn from the market or banned in Europe due to concerns of cardiovascular risk, and its competitor Avandia has faced similar criticisms and warnings, with updated FDA warnings on 11/4/2011 requiring healthcare providers to enroll in a medicines access program if they wish to prescribe these rosiglitazone medications to outpatients or nursing homes, because of the high cardiovascular risk.

Large studies by the NIH and the Women's Health Initiative found that a greater than one year use of progestin estrogen combination drugs increased cardiovascular risk by 29 percent, and the NIH halted a large study in 2002 because of the concerns of high cardiovascular risk. Newer forms of synthetic hormonal contraceptives were touted as carrying less cardiovascular risk, and instead, long term studies prompted an FDA warning that the risk of embolisms and thromboses from greater than one year of use of these drugs was almost double that of the prior class of hormonal contraceptives, increasing risk increases of as much as 79 percent! A large study by Hull York Medical School in the UK, released in 2011 (PMID: 21980265), prompted by the large number of randomised studies highlighting cardiovascular risks of NSAIDs, used a systematic analysis of all published studies to determine which of these pain relievers had the lowest and highest risk of cardiovascular death. The results revealed that the highest risks were seen with rofecoxib (Vioxx), diclofenac (Cambia, Cataflam, Voltaren, Voltarol, Zipsor), celecoxib (Celebrex), and the lowest with Naproxen. Of course, Vioxx was removed from the American market due to high incidence of cardiovascular deaths, and the ensuing study of NSAIDs prompted warnings on all of these medications. Studies find that the risk of cardiovascular disease and injury is associated with higher dosage and prolonged use.

A number of weight loss drugs prescribed for patients with cardiovascular risk due to overweight conditions and obesity have been withdrawn from the market because of evidence of serious cardiovascular risk with long-term use. Fenfluramine (Fen-Phen) was withdrawn from the market due to unacceptable cardiovascular risk and enormous evidence of patient harm. In 2007, experts at the Institute University of Cardiology and Pneumology, in Quebec City, Quebec, released a report on this subject and concluded that "the effect of these molecules (newer pharmaceutical weight loss medications) on CVD (cardiovascular disease) risk factors has been studied and reported, but information regarding their impact on the cardiovascular system is sparse" (PMID: 17696568). In other words, most weight loss drugs not only have a poor track record of success, but standard medicine consistently downplays their cardiovascular risk despite evidence. Today, one of the chemicals in Fen-Phen has been repackaged with an anti-depressant chemical and again approved for weight loss. in 2008, Rimonabant, a cannabinoid CB1 antagonist approved for weight loss, was withdrawn from the market for cardiovascular and metabolic risks as well as neuropsychiatric adverse effects. Aminorex, Ephedrine, Sibutramine, phenylpropanolamine and other weight loss drugs have been withdrawn or banned due to cardiovascular risks. The most popularly prescribed weight loss drug in Europe, Mediator, a diabetic medication, was ordered off the market in 2009 due to evidence of cardiovascular risk after it was prescribed to over 5 million patients. While weight loss is important in cardiovascular care, there are effective programs that integrate individualized protocols into a holistic package of weight loss that are both effective and healthy, but not as popular as just popping a single pill and not doing the work.

Besides these very commonly prescribed medications, a number of other medications come with cardiovascular risks as well. The combination of drugs with cardiovascular risk needs to be considered in the overall assessment of risk versus benefit as well. Concurrent prescription of medications is very high today, especially in the aging population, with many patients prescribed 5 to 10 medications concurrently. This aging population is also at a higher risk of cardiovascular disease, events and death. Is the treatment protocol designed to achieve the healthiest outcomes for these patients, or is it driven by a medical system where monetary rewards are tied to increased drug prescription? If true healthcare reform occurred in the form of rewarding outcomes of therapy rather than the amount of expensive drugs and other protocols prescribed and performed, this practice might be changed, and more attention might be paid to the risk versus benefit assessment overall. Finally, in 2012, serious consideration is being given to limiting the amount of prescription medications given to the elderly, and considering the whole equation of risk versus benefit of the combinations of drugs.

Medications with less cardiovascular risk, but still a significant concern, include antidepressants, where ventricular arrhythmias and sudden cardiac deaths have drawn attention, and numerous studies have produced varied results evaluating overall risk of ischemic disorders due to inhibition of platelet function. Some studies have shown increased overall risk of stroke and heart attack, while others have shown modest decrease in risk with antidepressant use. The findings of inhibition of platelet activity by SSRI antidepressant medications has been used as a potential reason for increased prescription to patients with cardiovascular disease. Patients are beginning to question such logic. All of these studies are documented with links to the study summaries in the section of this article entitled Additional Information.

One of the most popularly prescribed drugs in the world today is the type 5 phosphodiesterase (PDE5) inhibitors for erectile dysfunction (ED), such as Viagra, Cialis, Levitra et al, and after a large study (SSRC-PM) found that nearly 93 percent of men diagnosed with ischemic heart disease were diagnosed with erectile dysfunction, alarms went off at the offices of the European Society of Urology. Warnings were issued that changes in life style and other health corrections needed to be made before prescription of drugs to treat erectile dysfunction. The cardiovascular ramifications for these drugs involves sudden drops in blood pressure and heart function, exemplified by severe warnings for concurrent use of nitrate drugs for angina. Other studies have now explored the role in common hypertension medications that come with a significant percentage of patients experiencing erectile dysfunction as a side effect, particularly beta-adrenergic blockers and angiotensin converting enzyme inhibitors (ACE inhibitors). In other words, medical doctors have been increasing the prescriptions of drugs that cause or contribute to erectile dysfunction, and then adding prescriptions of drugs to correct erectile dysfunction that come with significant cardiovascular risk. The response in standard medicine to this dilemma has not been what you would expect, and not what is recommended by leading health researchers.

The Mount Sinai School of Medicine showed that there was a clear and indisputable connection between erectile dysfunction (ED) and atherosclerosis (CVD), and recommended an evaluation of inflammatory markers, endothelial function, and cardiac stress testing before prescribing any erectile dysfunction drugs. Instead, standard medicine has recommended prescribing erectile dysfunction drugs more often to men with ischemic heart disease, marketed under the guise that ED is highly associated with heart disease. The fact that treatment with the ED drugs does not address the underlying inflammatory and oxidative stresses, or the endothelial health considerations and calcifications causing these pathologies is not made clear. Prescribing protocols run counter to the patient welfare and only mask the health problems and treat superficial symptoms. This appears to be standard practice. The increasing use of Viagra and Cialis as a recreational drug presents a number of unaddressed health problems as well. Studies released in 2013 showed evidence that for young men taking these drugs for recreational use, that there is a chance that erectile dysfunction will be created, and a dependency on these drugs for erectile function. As these patients approach their medical doctors with a problem of ED, the most likely therapy will be antihypertensives and anti-depressants that may increase or contribute to sexual dysfunction, as well as a prescription for testosterone replacement. The continued dependency on phosphodiesterase inhibitors to achieve erection now combined with cardiovascular drugs presents increased risk, and does nothing to actually restore the health and function of the patient. The out-of-pocket costs as well as the costs to our inflated healthcare expenditures and the price of insurance policies and government healthcare expenditures is also a consideration. In the last few years, this unhealthy scenario has resulted in the steady and astounding increase in the prescription of testosterone replacement, again citing the connection between cardiovascular disease and hypogonadism to promote this overprescription for "Low T", although actual tests for real hypogonadism are rarely performed. Of course, studies now are finally revealing the adverse health effects from chronic testosterone replacement, with U.S. FDA warnings that testosterone replacement is clearly associated with increased cardiovascular risk, as well as neurohormonal imbalances. All of these findings should be alarming the public, and their treating medical doctors, yet this amazing scenario is being taken lightly.

This problem of ignoring the overall risks versus benefits for pharmaceutical prescription, especially concerning cardiovascular risk, has become an enormous problem in public health. In February of 2012, the FDA finally issued a warning that these erectile dysfunction drugs that come with considerable long-term cardiovascular risk, are now being sold as natural herbal supplements for erectile dysfunction, aids to better sexual enjoyment, and even promoters of increased size of the penis. A list of over 100 of these now common herbal sex aids was provided by the FDA, with a warning that all of them contained a PDE5 drug, unlisted on the label. Herbal medicine was coopted to fool the public into believing that these products for sexual enhancement were safe. The resulting profits were enormous, eclipsing the total profits of the professional herbal medicine field. Our government failed to stop this public health threat to cardiovascular health with a wink and a nod, and instead allowed the advertisment of these products on the television and in print to become ubiquitous. Even though our most respected health authorities have recommended that the public address the underlying health of their cardiovascular system to improve the sexual function, this advice is largely ignored. The public is finally learning that it is up to them to turn to Complementary Medicine and integrate this with standard health care to solve these common health problems, restore the cardiovascular health, and achieve a better quality of life.

The Actual Risk of Cardiovascular Mortality from Tachycardia and Atrial Fibrillation

Atrial fibrillation (AF) is a common type of abnormal heartbeat in which the rhythm is fast and irregular, usually occurring in short episodes, and caused by fibrillation of the muscles of the atrium of the heart when the neural signal regulating heart rhythm does not originate only in the sinus atrial node (SA), or pacemaker located in the right atrium of the heart tissue, but is interfered with by signals that are believed to be associated with the roots of the pulmonary veins in a majority of cases. Paroxysmal AF may last from minutes to days, while permanent AF occurs all the time. Atrial fibrillation does not cause symptoms in a majority of patients, but noticeable symptoms, such as shortness of breath, palpitations, and dizziness, may be alarming. The condition is estimated to affect over 1 percent of the population of the United States, and 5 percent of the population over age 65 (Journal of the American Heart Association 2001).

The underlying causes of atrial fibrillation are still poorly understood, but are believed to be related to fibrosis, inflammatory processes, and loss of atrial muscle mass due to lack of aerobic exercise. Myocardial infarction and cardiothoracic surgery precede about half of the patients with acute atrial fibrillation, but over half of the patients with paroxysmal chronic atrial fibrillation have no obvious clinical cause. Structural abnormalities of the heart atrium may occur in a small percentage of cases, and may have genetic or epigenetic components. Adrenal hypertension, and sustained excess of angiotensin type 2, may result in atrial fibrosis as well. Atrial fibrillation is thought to be progressive, with prolonged fibrillation correlated with increasingly prolonged recovery time of the sinoatrial node, and may lead to problems as well in the atrioventricular node (AV node), eventually producing sick sinus syndrome. The signals that interfere with the normal heart rhythm from the pulmonary veins, or large veins from the lungs, are believed to be related to enhanced automaticity, triggered activity, and microreentry from myocardial sleeves inside these pulmonary vein roots. The reasons why these pulmonary vein root tissues acquire these problems is still poorly understood.

The Mayo Clinic reported in 2011 that the risk of heart attack is not increased due to atrial fibrillation, only ventricular fibrillation, which usually occurs only in diseased hearts. Occasionally, the rapid heart beat, or tachycardia, associated with atrial fibrillation can result in chest pain or discomfort because of reduced blood flow to the heart muscle, but this is different from chest pain, or angina, associated with a heart attack. A heart attack, or myocardial infarction (heart muscle blood flow obstructed), is almost always attributed to a blockage of blood flow to the heart muscle by a moving clot (thrombus), or narrowing of the vessels (stenosis) from atherosclerotic plaque. Atrial fibrillation is associated with increased risk of stroke, but only when other factors of risk were present, such as hypertension and atherosclerosis. Atrial fibrillation may impact the quality of life, and have deleterious effects on the heart over a long time period, such as enlargement of the left atriumbut current studies in 2013 are not clear on the asscociation with increased risk of death from cardiovascular or other causes.

Acupuncture and herbal/nutrient medicine may be a safer method of treating atrial fibrillation that the current pharmaceutical and surgical treatments. Current pharmaceutical treatments include blood thinners (anticoagulants) such as warfarin and heparin, rate controlling drugs such as beta-blockers (atenolol, metoprolol), calcium-channel blockers (verapamil, diltiazam), and anti-arrhythmic (cardioversion) agents such as amiodarone. If the more benign drugs are not effective, amiodarone is prescribed. Amiodarone comes with an FDA warning, issued in 2008, for significant risk of rhabdomyolysis, or accumulation of damaged muscle proteins that may cause organ failure in severe cases. This accumulation of muscle proteins also comes from the use of cholesterol lowering statin drugs, and the warnings involve concurrent use of statins. Amiodarone is also very inhibiting of the cyotchrome P450 liver enzyme metabolism, altering the circulating levels of many other drugs, creating potentially harmful effects. Some drugs that are contraindicated with amiodarone are simvastatin, warfarin, viagra (sildenafil), procainamide (another anti-arrhythmic agent), digoxin, cyclosporin, quinidine, and theophylline (treating COPD and asthma), some of which may be used, or previously used, to treat the atrial fibrillation and cardiovascular or respiratory problems. But other common drugs that use the P450 metabolism and may alter the circulating level of amiodarone or be altered themselves in this way include NSAIDS, caffeine, estradiol and progestins (birth control or hormone replacement), cortisones, naproxen and other NSAIDS, glipizides and tolbutamide (diabetic medications), sulfonylureas (diabetic medications and other uses), diazepam and benzodiazepines (anti-anxiety), antidepressants, antipsychotics, macrolide antibiotics, tamoxifen, codeine and cocaine.

Because of the poor results in treatment with pharmaceuticals the medical profession has adopted cardiac ablation (radiofrequency ablation), as the preferred treatment in many cases now. A type of treatment called electrical cardioversion, with clinical treatments using electrical shocks, has a success rate in various types of atrial fibrillation of over 75 percent, but in a small percentage of cases may result in worsened arrhythmias. The 2012 Radiofrequency Ablation for Atrial Fibrillation Trial (RAAFT 2) indicated in a multicenter trial that ablation may be superior to rhythm control drugs such as amiodarone, for a variety of reasons, but long-term efficacy of ablation is still unclear. Another 2012 study, the Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF), published in the New England Journal of Medicine, showed that in patients with low-risk but bothersome atrial fibrillations that the success rates for ablation was 85 percent compared to 71 percent with drugs, but more than a third of patients needed a second surgical procedure to stop the fibrillation within 2 years, and more than 8 percent needed more than 2 surgical ablations. Overall rates of success were evaluated in 2012 by the University of Adelaide, in Australia, and this meta-review was published in the Journal of the American Heart Association, showing that patients with atrial fibrillation getting a single cardiac ablation has a 53 percent return of atrial fibrillation in 2-5 years, with patients with paroxysmal AF successfully avoiding a return of atrial fibrillation only 54 percent of the time. The 80 percent success rate involved patients with multiple cardiac ablations. The review noted that only one study so far has evaluated patients beyond 5 years, and long-term success is still completely unknown.

A couple of studies in Europe in 2012 evaluated the success of acupuncture integrated into treatment protocols to treat atrial fibrillation, and found that this treatment worked as well as treatment with the anti-arrhythmic drug amiodarone. A study at the University of Milan, Italy (Frederico Lomabardi et al) was published in the World Journal of Cardiology in March of 2012 and found that a simple treatment with 10 acupuncture sessions using just 3 points, P6, the ear point Shenmen, and the heart shu point UB15, once per week, in patients with paroxysmal atrial fibrillation, and persistent AF patients who had undergone cardioversion, produced a similar anti-arrhythmic effect to the long-term use of amiodarone that was sustained.

Another study at the Universita degli Studi di Milano, Italy (A Lomuscio et al) showed that patients with persistent atrial fibrillation that had undergone cardioversion, and still experienced fibrillation and tachycardia, and received 10 acupuncture sessions with the above points showed a 65 percent success rate after 12 months, similar to those that were prescribed Amiodarone as an anti-arrhythmic, but without the risks and adverse effects of this drug (PMID: 20807278). Clearly, many experts in the field in Europe are starting to understand that acupuncture presents an effective complementary and integrative treatment strategy that is without risks and adverse effects and costs very little. Since both paroxysmal and persistent atrial fibrillation presents with no risk of a heart attack, and only a long-term increased risk of stroke when combined with hypertension or atherosclerosis, trying the acupuncture treatment first in this integrated protocol seems a sensible and conservative treatment strategy, perhaps avoiding the potentially problematic drugs and/or ablation. If the patient has a persistent atrial fibrillation, a session of electrical cardioversion should be administered first, then the short course of acupuncture, herbal and nutrient medicine. The added benefits of the acupuncture include those that are gotten from a more skilled treatment, and broader effects from a larger point protocol than in these studies, as well as the beneficial effects from professional herbal and nutrient medicines prescribed by the acupuncturist. The only side effects are better overall health and prevention of future health problems.

Herbal and nutrient medicine may also provide significant proven benefits in the treatment of atrial fibrillation and tachycardia. For example, a 2014 study at Wuhan University and the Cardiovascular Research Institute, in Wuhan, Hubei, China, found that a key herbal chemical studied for the treatment of heart health and function, Berberine, decreased the rate of firing of heart pacemaker cells and the rate of diastolic depolarization in study animals with induced atrial fibrillation and tachycardia (PMID: 25017321). These scientists found that these effects were accomplished by modifying the human hyperpolarization-activated cyclic nucleotide-gated 4 (hHCN4) channels in a manner that was dose-dependent, but consistent with standard concentration of berberine in circulation when using a standardized herbal extract. Today, such herbal berberine extracts are available, and combined with the amino acid Taurine, Siberian ginseng extract, Sophora herbal extract (Ku shen), and Magnesium taurinate, all studied and found to aid heart health and function, and control vagal stimulation of tachycardia and atrial fibrillation. This formula, CardioRhythm, is available from Vitamin Research Products. Trying a course of this inexpensive herbal and nutrient formula, coordinated with short courses of acupuncture, provides patients with a potential and proven means of controlling atrial fibrillation and tachycardia, without a lifelong dependency on harsh pharmaceutical drugs with serious chronic adverse effects, and also provides the patient with other benefits of improved overall cardiovascular health, neurovascular health, and potential benefits for improved sleep quality.