Integrative patient care in cardiovascular disease

According to a 2005 poll from the German Institute of Demoscopy, the majority of Germans are in favour of integrative medicine, combining mainstream, complementary and mind/body medicine. The popularity of healing methods increases patient compliance, but the question is: What is the evidence and can patients with cardiovascular disease profit from integrative care? A large part of the damage to the cardiovascular system results from an increased allostatic load (McEwen), which causes increased oxidative stress, heightened inflammatory activity and platelet reactivity. There is increasing evidence that stress and lifestyle factors play an important role in the pathogenesis of cardiovascular disease through their effect on oxidative stress, cytokine activity and platelet reactivity. Dean Ornish and Herbert Benson were the first cardiologists to show that mind/body medicines, including concepts of lifestyle modification and stress reduction, have beneficial effects on cardiovascular diseases. The National Institutes of Health define mind/body medicine as follows: “Interventions that use a variety of techniques designed to facilitate the mind's capacity to affect bodily function and symptoms”. The single elements of mind/body medicine are the “relaxation response”, cognitive restructuring, omega-3-fatty-acid-rich healthy food, daily exercise, sleep hygiene and social support. “The Essen Model” in addition includes self-help strategies with methods of complementary medicine, which includes mainly the naturopathy according to Kneipp and traditional healing methods of Chinese and Indian Medicine. Multiple studies have already pointed to the beneficial effects of mind–body interventions in the treatment of cardiovascular diseases. Furthermore, recent work has showed the beneficial effects of eliciting the “relaxation response” on genomic expression and oxidative stress. Besides this, there is also evidence for hydrotherapy, herbal treatment and elements of Asian medicine, such as acupuncture, to be effective as medical interventions and taiji, qigong and yoga as self-help strategies.

In summary, there is convincing evidence for integrative patient care in cardiovascular disease. As the methods are time-consuming to practice on a regular basis, it is important for future research strategies to elucidate whether the combination of methods has additive effects and what the role of mindfulness as a basic principle in integrative care plays. One theory for the effectiveness of mindfulness for cardiac patients is that it builds awareness for self-care, meaning patients are more likely to adhere to new lifestyle strategies even when the program ends.

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