Acupuncture decreased the risk of coronary heart disease in patients with fibromyalgia in Taiwan: a nationwide matched cohort study
Wu et al. · Arthritis Research & Therapy · 2017
Evidence Level
STRONGOBJECTIVE
Investigate whether acupuncture reduces the risk of coronary heart disease in patients with fibromyalgia
WHO
117,798 Taiwanese patients with fibromyalgia, predominantly women, mean age 44 years
DURATION
Mean follow-up of 3-4 years (2000-2011)
POINTS
Points not specified — population-based study from a database
🔬 Study Design
Acupuncture group
n=58899
Manual acupuncture or electroacupuncture
Control group
n=58899
No acupuncture
📊 Results in numbers
Reduction in risk of coronary heart disease
Coronary heart disease incidence (acupuncture)
Coronary heart disease incidence (control)
Statistical significance
Percentage highlights
📊 Outcome Comparison
Coronary heart disease incidence rate (per 1,000 person-years)
This study shows that patients with fibromyalgia who received acupuncture had a 57% lower risk of developing heart disease compared with those who did not undergo acupuncture. This means that acupuncture may have an important protective effect on the heart in people with fibromyalgia.
Article summary
Plain-language narrative summary
This Taiwanese population-based study analyzed data from nearly 118,000 patients with fibromyalgia to investigate whether acupuncture could reduce the risk of developing coronary heart disease. Fibromyalgia is a condition characterized by chronic widespread pain, frequently accompanied by fatigue, sleep disturbances, depression, and other symptoms that significantly affect quality of life. Previous studies had already shown that patients with fibromyalgia have a higher risk of developing cardiac problems, including myocardial infarction, compared with the general population. The researchers used the Taiwan National Health Insurance Research Database, which contains information from the country's entire health system, allowing for long-term follow-up without selection bias.
Between 2000 and 2010, patients newly diagnosed with fibromyalgia were identified. Those who received acupuncture treatment were compared with patients who never received this treatment. To ensure fair comparisons, the researchers used advanced statistical techniques (propensity score matching) to balance the groups in terms of age, sex, comorbidities, and medications used. The main result was striking: during the follow-up period, 4,389 patients in the acupuncture group developed coronary heart disease, compared with 8,133 in the control group.
This represents a 57% reduction in the risk of developing cardiac problems in patients who received acupuncture. The protection was observed regardless of age, sex, or the presence of other diseases such as diabetes and hypertension. The mechanisms by which acupuncture may exert this protective effect include reduction of inflammation, improvement of sleep quality, antidepressant effects, and modulation of the autonomic nervous system. Acupuncture may also act on specific receptors in the central nervous system that are involved in both pain perception and cardiovascular function.
This study has important clinical implications, suggesting that acupuncture may offer benefits beyond pain relief in patients with fibromyalgia. However, some limitations should be considered, including the absence of information on the severity of fibromyalgia, the specific acupuncture points used, and lifestyle factors such as smoking and body mass index.
Strengths
- 1Very large sample with low risk of selection bias
- 2Long-term follow-up with complete population data
- 3Use of propensity score matching to reduce confounders
- 4Consistent results across different subgroups
Limitations
- 1Absence of data on fibromyalgia severity
- 2Lack of information on specific acupuncture points
- 3Limited data on lifestyle (smoking, alcohol, BMI)
- 4Retrospective nature does not allow definitive causality
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Fibromyalgia is not merely a centralized pain syndrome — it carries an inflammatory and autonomic phenotype that substantially raises cardiovascular risk. This Taiwanese cohort with nearly 118,000 patients documented coronary heart disease incidence rates of 38.36 versus 17.44 per 1,000 person-years in the control and acupuncture groups, respectively, with a 57% risk reduction (p < 0.001) and mean follow-up exceeding three years. For pain specialist practice, this repositions acupuncture from a symptomatic intervention to a strategy with potential impact on a hard outcome. Patients with fibromyalgia who already accumulate cardiovascular risk factors — dysautonomia, nonrestorative sleep, metabolic syndrome — become priority candidates for treatment, and discussion with the cardiologist about including acupuncture in the interdisciplinary plan becomes clinically justifiable on robust population-based data.
▸ Notable Findings
What stands out in this work is not only the magnitude of the reduction — 57% is a striking number for any cardiovascular prevention intervention — but the consistency of the finding across different subgroups: protection was maintained regardless of age, sex, or presence of diabetes or hypertension. This suggests the effect is not mediated by a specific patient profile but by broader and likely multipathway mechanisms. Biologic plausibility is solid: modulation of the autonomic nervous system, reduction of inflammatory markers, improvement of sleep quality, and antidepressant effects are all documented mechanisms for acupuncture and all contribute to reducing atherosclerotic risk. The convergence between known mechanisms of action of the technique and the pathophysiologic pathways of cardiovascular risk in fibromyalgia gives the finding a mechanistic coherence that goes beyond epidemiologic association.
▸ From My Experience
In my practice with fibromyalgia patients, the profile that responds best to acupuncture is precisely the one with the greatest autonomic burden: fragmented sleep, reduced heart rate variability, resting tachycardia, and well-established central sensitization syndrome. I usually see the first responses — improved sleep and reduced pain intensity — between the third and fifth session, but clinical stabilization typically requires 12 to 16 sessions in an initial cycle, followed by monthly maintenance. I routinely combine supervised aerobic exercise and structured sleep hygiene, since the synergistic effect on vagal tone is clinically perceptible. I do not indicate acupuncture in isolation when there is suspicion of an uninvestigated organic cause for pain or when adherence to multimodal treatment is nonexistent. What this study confirms — and what I have informally observed over the years — is that treating fibromyalgia well probably protects the heart, and acupuncture is part of this therapeutic equation more meaningfully than we used to consider.
Full original article
Read the full scientific study
Arthritis Research & Therapy · 2017
DOI: 10.1186/s13075-017-1239-7
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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