Click here to download

Integrated approach for the treatment of coronary artery disease
Journal Title: PNEI REVIEW 
Author/s: Carlo Dal Lin, Raffaele Migliorini, Marco Silvestro, Sabino Iliceto, Francesco Tona 
Year:  2017 Issue: Language: Italian 
Pages:  10 Pg. 71-80 FullText PDF:  1197 KB
DOI:  10.3280/PNEI2017-002007
(DOI is like a bar code for intellectual property: to have more infomation:  clicca qui   and here 

The integrated approach for the treatment of atherosclerotic coronary artery disease involves the recognition of factors hindering the patient’s healing process and the definition of a therapeutic pathway that meets the patient’s needs. Alongside conventional therapy, we must provide adequate information on lifestyle: smoking and alcohol use cessation; proper diet (Mediterranean diet) with low consumption of saturated fats, fried foods and refined carbohydrates; aerobic physical activity (30 minutes walk per day); use mindbody techniques for proper stress management. In case of refractory angina or clinical instability, it’s paramount to not delay patient hospitalization and discontinue taking phytotherapy (such as garlic or ginkgo biloba) that could increase the patient’s hemorrhagic risk.
Keywords: Integrative medicine, phytotherapy, coronary artery disease, stress, cardiovascular prevention, cardiovascular rehabilitation.

  1. Bairey C.N., Krantz D.S., DeQuattro V., Berman D.S. and Rozanski A. (1991). Effect of betablockade on low heart rate-related ischemia during mental stress. J. Am. Coll. Cardiol., 17(6): 1388-1395., DOI: 10.1016/S0735-1097(10)80152-
  2. Bangalore S., Pursnani S., Kumar S. and Bagos P.G. (2013). Percutaneous coronary intervention versus optimal medical therapy for prevention of spontaneous myocardial infarction in subjects with stable ischemic heart disease. Circulation, 127: 769-781., DOI: 10.1161/CIRCULATIONAHA.112.13196
  3. Bergh C., Udumyan R., Fall K., Almroth H. and Montgomery S. (2015). Stress resilience and physical fitness in adolescence and risk of coronary heart disease in middle age. Heart, 101(8): 623-629., DOI: 10.1136/HEARTJNL-2014-30670
  4. Boden W.E., O’Rourke R.A., Teo K.K., Maron D.J., Hartigan P.M., Sedlis S.P., Dada M., Labedi M., Spertus J.A., Kostuk W.J., Berman D.S., Shaw L.J., Chaitman B.R., Mancini G.B.J. and Weintraub W.S. (2009). Impact of optimal medical therapy with or without percutaneous coronary intervention on long-term cardiovascular end points in patients with stable coronary artery disease (from the COURAGE Trial). Am. J. Cardiol., 104(1): 1-4., DOI: 10.1016/J.AMJCARD.2009.02.05
  5. Bottaccioli F. e Bottaccioli A.G. (2017). Psiconeuroendocrinoimmunologia e scienza della cura integrata. Il Manuale. Milano: Edra.
  6. Brieger D.B. and Redfern J. (2013). Contemporary themes in acute coronary syndrome management: from acute illness to secondary prevention. Med. J. Aust., 199(3): 174-178., DOI: 10.5694/MJA12.1122
  7. Camm A.J., Luscher T.F. and Serruys P.W. (2009). ESC Textbook of Cardiovascular Medicine Second Edition., Oxford: Oxford University Press.
  8. Castelli W.P. (1996). Lipids, risk factors and ischaemic heart disease. Atherosclerosis, 124 [Suppl]: S1-S9., DOI: 10.1016/0021-9150(96)05851-
  9. Castillo-Richmond A., Schneider R.H., Alexander C.N., Cook R., Myers H., Nidich S., Haney C., Rainforth M. and Salerno J. (2000). Effects of stress reduction on carotid atherosclerosis in hypertensive African Americans. Stroke, 31: 568-573., DOI: 10.1161/01.STR.31.3.56
  10. Dal Lin C., Marinova M., Rubino G., Gola E., Brocca A., Pantano G., Brugnolo L., Sarais C., Cucchini U., Volpe B., Cavalli C., Bellio M., Fiorello E., Scali S., Plebani M., Iliceto S. and Tona F. (2017). Thoughts modulate the expression of inflammatory genes and may improve the coronary blood flow in patients after a myocardial infarction. J. Tradit. Complement. Med., epub ahead of print., DOI: 10.1016/J.JTCME.2017.04.01
  11. Dal Lin C., Poretto A., Scodro M., Perazzolo Marra M., Iliceto S. and Tona F. (2015a). Coronary microvascular and endothelial function regulation: Crossroads of psychoneuroendocrine immunitary signals and quantum physics [Part A]. J. Integr. Cardiol., 1(5): 132-163., DOI: 10.15761/JIC.100013
  12. Dal Lin C., Poretto A., Scodro M., Perazzolo Marra M., Iliceto S. and Tona F. (2015b). Coronary microvascular and endothelial function regulation: Crossroads of psychoneuroendocrine immunitary signals and quantum physics [Part B]. J. Integr. Cardiol., 1(5): 164-188., DOI: 10.15761/JIC.100013
  13. Dal Lin C., Poretto A., Scodro M., Perazzolo Marra M., Iliceto S. and Tona F. (2015c). Coronary microvascular and endothelial function regulation: Crossroads of psychoneuroendocrine immunitary signals and quantum physics [Part C]. J. Integr. Cardiol., 1(5): 189-209., DOI: 10.15761/JIC.100013
  14. Dal Lin C., Tona F. and Osto E. (2015d). Coronary microvascular function and beyond: The crosstalk between hormones, cytokines, and neurotransmitters. Int. J. Endocrinol., ID 312848., DOI: 10.1155/2015/31284
  15. De Lorgeril M., Renaud S., Mamelle N., Salen P., Martin J.L., Monjaud I., Guidollet J., Touboul P. and Delaye J. (1994). Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet, 343(8911): 1454-1459., DOI: 10.1016/S0140-6736(94)92580-
  16. De Lorgeril M., Salen P., Martin J.L., Monjaud I., Delaye J. and Mamelle N. (1999). Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation, 99: 779-785., DOI: 10.1161/01.CIR.99.6.77
  17. Dimsdale J.E. (2008). Psychological stress and cardiovascular disease. J. Am. Coll. Cardiol., 51(13): 1237-1246., DOI: 10.1016/J.JACC.2007.12.02
  18. El-Hayek G., Messerli F., Bangalore S., Hong M.K., Herzog E., Benjo A. and Tamis-Holland J.E. (2014). Meta-analysis of randomized clinical trials comparing short-term versus longterm dual antiplatelet therapy following drug-eluting stents. Am. J. Cardiol., 114(2): 236-242., DOI: 10.1016/J.AMJCARD.2014.04.03
  19. Estruch R., Ros E., Salas-Salvadó J., Covas M.-I., Corella D., Arós F., Gómez-Gracia E., Ruiz-Gutiérrez V., Fiol M., Lapetra J., Lamuela-Raventos R.M., Serra-Majem L., Pintó X., Basora J., Muñoz M.A., Sorlí J.V., Martínez J.A. and Martínez-González M.A. (2013). Primary prevention of cardiovascular disease with a Mediterranean diet. N. Engl. J. Med., 368: 1279-1290., DOI: 10.1056/NEJMOA120030
  20. Falk E., Shah P.K. and Fuster V. (1995). Coronary plaque disruption. Circulation, 92: 657-671., DOI: 10.1161/01.CIR.92.3.65
  21. Fani Marvasti F. and Stafford R.S. (2012). From Sick Care to Health Care – Reengineering Prevention into the U.S. System. N. Engl. J. Med., 367: 889-891., DOI: 10.1056/NEJMP120623
  22. Fioranelli M., editor (2017). Integrative Cardiology. 1st ed., Cham: Springer International Publishing., DOI: 10.1007/978-3-319-40010-
  23. Fioranelli M., Bianchi M., Di Nardo V. and Roccia M.G. (2016). Effects of Arnica comp.- Heel® on reducing cardiovascular events in patients with stable coronary disease. Minerva Cardioangiol., 64(1): 34-40.
  24. Giltay E.J., Kamphuis M.H., Kalmijn S., Zitman F.G. and Kromhout D. (2006). Dispositional optimism and the risk of cardiovascular death: the Zutphen Elderly Study. Arch. Intern. Med., 166(4): 431-436., DOI: 10.1001/ARCHINTE.166.4.43
  25. Go A.S., Mozaffarian D., Roger V.L., Benjamin E.J., Berry J.D., Borden W.B., Bravata D.M., Dai S., Ford E.S., Fox C.S., Franco S., Fullerton H.J., Gillespie C., Hailpern S.M., Heit J.A., Howard V.J., Huffman M.D., Kissela B.M., Kittner S.J., Lackland D.T., Lichtman J.H., Lisabeth L.D., Magid D., Marcus G.M., Marelli A., Matchar D.B., McGuire D.K., Mohler E.R., Moy C.S., Mussolino M.E., Nichol G., Paynter N.P., Schreiner P.J., Sorlie P.D., Stein J., Turan T.N., Virani S.S., Wong N.D., Woo D. and Turner M.B. (2013). Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation, 127(1): e6-e245., DOI: 10.1161/CIR.0B013E31828124A
  26. Gould K.L., Ornish D., Scherwitz L., Brown S., Edens R.P., Hess M.J., Mullani N., Bolomey L., Dobbs F. and Armstrong W.T. (1995). Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification. JAMA, 274(11): 894-901., DOI: 10.1001/JAMA.1995.0353011005603
  27. Lloyd-Jones D., Adams R.J., Brown T.M., Carnethon M., Dai S., De Simone G., Ferguson T.B., Ford E., Furie K., Gillespie C., Go A., Greenlund K., Haase N., Hailpern S., Ho P.M., Howard V., Kissela B., Kittner S., Lackland D., Lisabeth L., Marelli A., McDermott M.M., Meigs J., Mozaffarian D., Mussolino M., Nichol G., Roger V.L., Rosamond W., Sacco R., Sorlie P., Stafford R., Thom T., Wasserthiel-Smoller S., Wong N.D. and Wylie-Rosett J. (2010). Executive summary: heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation, 121: 948-954., DOI: 10.1161/CIRCULATIONAHA.109.19266
  28. Madanmohan Udupa K., Bhavanani A.B., Shatapathy C.C. and Sahai A. (2004). Modulation of cardiovascular response to exercise by yoga training. Indian J. Physiol. Pharmacol., 48(4): 461-465.
  29. Nabi H., Kivimäki M., Batty G.D., Shipley M.J., Britton A., Brunner E.J., Vahtera J., Lemogne C., Elbaz A. and Singh-Manoux A. (2013). Increased risk of coronary heart disease among individuals reporting adverse impact of stress on their health: The Whitehall II prospective cohort study. Eur. Heart J., 34(34): 2697-2705., DOI: 10.1093/EURHEARTJ/EHT21
  30. Ornish D., Brown S.E., Scherwitz L.W., Billings J.H., Armstrong W.T., Ports T.A., McLanahan S.M., Kirkeeide R.L., Brand R.J. and Gould K.L. (1990). Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet, 158(2): 264-267., DOI: 10.1192/BJP.158.2.26
  31. Ornish D., Scherwitz L.W., Billings J.H., Brown S.E., Gould K.L., Merritt T.A., Sparler S., Armstrong W.T., Ports T.A., Kirkeeide R.L., Hogeboom C. and Brand R.J. (1998). Intensive lifestyle changes for reversal of coronary heart disease. JAMA, 280(23): 2001-2007., DOI: 10.1001/JAMA.280.23.200
  32. Piterà F. (2000). Compendio di gemmoterapia clinica. Meristemoterapia, 3rd ed. Genova: De Ferrari.
  33. Pizzorno J.E. and Murray M.T. (2013). Textbook of Natural Medicine. 4th Edition. St. Louis: Churchill Livingston Elsevier.
  34. Pizzorno J.E., Murray M.T. and Herb J.B. (2008). The Clinician’s Handbook of Natural Medicine. 2nd Edition. St. Louis: Churchill Livingston Elsevier.
  35. Rakel D. (2012). Integrative Medicine. 3rd Edition. Philadelphia: Elsevier Saunders.
  36. Schneider R.H., Grim C.E., Rainforth M. V., Kotchen T., Nidich S.I., Gaylord-King C., Salerno J.W., Kotchen J.M. and Alexander C.N. (2012). Stress reduction in the secondary prevention of cardiovascular disease: Randomized, controlled trial of transcendental meditation and health education in blacks. Circ. Cardiovasc. Qual. Outcomes, 5: 750-758., DOI: 10.1161/CIRCOUTCOMES.112.96740
  37. Steptoe A. and Brydon L. (2005). Associations between acute lipid stress responses and fasting lipid levels 3 years later. Health Psychol., 24(6): 601-607., DOI: 10.1037/0278-6133.24.6.60
  38. Steptoe A. and Kivimäki M. (2012). Stress and cardiovascular disease. Nat. Rev. Cardiol., 9(6): 360-370., DOI: 10.1038/NRCARDIO.2012.4
  39. Tanasescu M., Leitzmann M.F., Rimm E.B., Willett W.C., Stampfer M.J. and Hu F.B. (2002). Exercise type and intensity in relation to coronary heart disease in men. JAMA, 288(16): 1994-2000., DOI: 10.1001/JAMA.288.16.199
  40. Thomas S., Gokhale R., Boden W.E. and Devereaux P.J. (2013). A meta-analysis of randomized controlled trials comparing percutaneous coronary intervention with medical therapy instable angina pectoris. Can. J. Cardiol., 29(4): 472-482., DOI: 10.1016/J.CJCA.2012.07.01
  41. Wei J., Pimple P., Shah A.J., Rooks C., Bremner J.D., Nye J.A., Ibeanu I., Murrah N., Shallenberger L., Raggi P. and Vaccarino V. (2014). Depressive symptoms are associated with mental stress-induced myocardial ischemia after acute myocardial infarction. PLoS One, 9(7): e102986., DOI: 10.1371/JOURNAL.PONE.010298
  42. Yeung A., Kiat H., Denniss A.R., Cheema B.S., Bensoussan A., Machliss B., Colagiuri B. and Chang D. (2014). Randomised controlled trial of a 12 week yoga intervention on negative affective states, cardiovascular and cognitive function in post-cardiac rehabilitation patients. BMC Complement. Altern. Med., 14: 411., DOI: 10.1186/1472-6882-14-41
  43. Yusuf S., Hawken S., Ounpuu S., Dans T., Avezum A., Lanas F., McQueen M., Budaj A., Pais P., Varigos J. and Lisheng L. (2004). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet, 364(9438): 937-952., DOI: 10.1016/S0140-6736(04)17018-

Carlo Dal Lin, Raffaele Migliorini, Marco Silvestro, Sabino Iliceto, Francesco Tona, Integrated approach for the treatment of coronary artery disease in "PNEI REVIEW" 2/2017, pp. 71-80, DOI:10.3280/PNEI2017-002007


FrancoAngeli is a member of Publishers International Linking Association a not for profit orgasnization wich runs the CrossRef service, enabing links to and from online scholarly content