---
title: "Stable angina"
url: "https://acuiq.com/wiki/evidence/stable-angina"
updated: 2026-10-17
last_verified: 2026-10-17
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-17"
reading_minutes: 8
sources: 12
---

# Stable angina

_What four systematic reviews, an umbrella review, a four-arm sham-controlled trial, smaller trials and the NICE, American and European guidelines report on acupuncture added to anti-anginal drugs._

Stable angina is chest pain from myocardial ischaemia, too little blood reaching the heart muscle, that comes on with exertion or emotional stress, in the definition [DeVon and colleagues](https://doi.org/10.1177/09645284211055754) gave in 2022; they add that up to 30% of people on guideline-directed drugs still have pain that is not well relieved. The trials on this page ask whether acupuncture added to anti-anginal drugs changes how often attacks come. Most measure attacks with a diary that patients keep, and some add nitroglycerin use, an exercise test or the Seattle Angina Questionnaire, a standard score of how angina limits daily life. The control decides what a result can show: sham acupuncture made to resemble the real thing, the drugs alone, or a wait list. [Reading an acupuncture trial](/wiki/research/reading-an-acupuncture-trial) explains how to tell these apart.

## Is there a Cochrane review?

Cochrane has no review of acupuncture for angina or coronary heart disease. A PubMed search of the Cochrane Database of Systematic Reviews in October 2026 for acupuncture with angina, coronary, cardiac or ischaemic terms returned reviews of stroke, labour, neonatal brain injury and pain, and none on the heart.

## Systematic reviews

Four reviews have pooled randomised trials of acupuncture for angina. They draw on overlapping trials, so they are not independent confirmations of one another.

| Review | Searched to | Trials (people) | Comparison | Pooled result | Certainty |
| --- | --- | --- | --- | --- | --- |
| Yu 2015 | January 2013 | 25 (2,058) | Acupuncture alone against anti-anginal drugs; acupuncture added to drugs against drugs alone | Fewer people without relief and fewer without ECG improvement as an add-on; no difference between acupuncture alone and drugs | Trials rated low quality; evidence called very low |
| Yang 2021 | August 2018 | 17 (1,516) | Acupuncture against sham, or added to standard care against standard care alone | Fewer attacks, a mean difference of 4.91; lower anxiety and depression scores; no difference in pain intensity or nitroglycerin use | Authors call the evidence low quality |
| Kong 2025 | November 2023 | 46 (3,976) | Network comparison of acupuncture-based combinations, all on top of anti-anginal drugs | Acupuncture added to drugs ranked first for fewer attacks | Not stated in the abstract |
| Huang 2025 | October 2024 | 16 (1,240) | Acupuncture against placebo, and against standard care | Fewer attacks against placebo and against standard care; no difference in adverse events | Very low to moderate |

[Yu and colleagues](https://doi.org/10.1186/s12906-015-0586-7), at Liaoning University of Traditional Chinese Medicine, found that only four of their 25 trials mentioned adverse effects. [Yang and colleagues](https://doi.org/10.1177/2047487319876761), at the University of Hong Kong and Chengdu University of Traditional Chinese Medicine, published in the European Society of Cardiology's prevention journal; they pooled with a fixed-effect model, which assumes every trial measures one shared effect, and rated the trials at unclear to high risk of selection or performance bias. Their authors include Liang Fanrong, senior author of the 2019 trial described below. [Kong and colleagues](https://doi.org/10.3389/fcvm.2025.1463170) ranked treatments by how likely each was to come out best, which is not the same as showing one beats another. [Huang and colleagues](https://doi.org/10.2147/JPR.S489880), the most recent review, sorted trials into low, moderate and high dose by points, sessions, frequency and whether deqi, the needling sensation, was sought, and found a significant effect only in the moderate-dose group. The difference from standard care was larger than from placebo, and its heterogeneity, the share of variation between trials not explained by chance, was 92%.

An [umbrella review](https://doi.org/10.3389/fcvm.2021.732144) by Shen and colleagues in 2021 appraised seven earlier reviews of acupuncture for stable angina with AMSTAR-2, a checklist for how well a review was done: two rated moderate and five very low. Of 18 outcomes it graded on GRADE, the scale reviews use to say how far a result can be trusted, 4 were high, 8 moderate, 3 low and 3 very low.

## The 2019 JAMA Internal Medicine trial

The [largest sham-controlled trial](https://doi.org/10.1001/jamainternmed.2019.2407), by Zhao and colleagues at Chengdu University of Traditional Chinese Medicine, ran at five hospitals in China from October 2012 to September 2015 and was published in JAMA Internal Medicine in 2019. It randomised 404 people aged 35 to 80 with chronic stable angina and at least two attacks a week to four arms, all of whom stayed on guideline anti-anginal drugs:

- acupuncture at [`PC06`](/points/pc06) (Neiguan) and [`HT05`](/points/ht05) (Tongli) on both sides, points on the meridians traditionally linked to the heart;
- acupuncture at [`LU09`](/points/lu09) (Taiyuan) and [`LU06`](/points/lu06) (Kongzui), points on a meridian not linked to the heart;
- sham acupuncture, needles at two fixed non-acupoints without seeking deqi;
- a wait list with no acupuncture during the 16-week study.

The three needled arms had 12 sessions of 30 minutes over 4 weeks, with electrical stimulation at 2 Hz in each, sham included. Patients in those arms were treated in one room and not told which method they received, and outcome assessors were blinded. Over the 4-week baseline, attacks averaged about 13. By week 16 they had fallen by 7.96 with heart-meridian acupuncture, 3.89 with lung-meridian acupuncture, 2.78 with sham and 2.33 on the wait list; the heart-meridian arm had 5.18 fewer attacks than sham and 5.63 fewer than the wait list. The authors list as limitations that people with a previous heart attack or heart failure were excluded, and that any effect beyond 16 weeks is unknown.

## Earlier and smaller trials

Two Danish trials by Ballegaard and colleagues compared acupuncture with sham needling in the same spinal segments but away from the meridians. In [26 people whose angina resisted drug treatment](https://doi.org/10.1111/j.0954-6820.1986.tb02770.x), published in 1986, acupuncture raised cardiac work capacity, measured as heart rate multiplied by blood pressure during an exercise test, more than sham did, with no significant difference in attack rate or nitroglycerin use. In [49 people with moderate angina](https://doi.org/10.1111/j.1365-2796.1990.tb00114.x), published in 1990, the trial found no significant difference between real and sham acupuncture on any measure; attacks and nitroglycerin use fell by a median of half in both groups. In Chicago, the 2022 pilot by DeVon and colleagues gave 24 people, mostly Black and Hispanic, acupuncture twice a week for 5 weeks or an attention control; it was designed to test feasibility, and pain and functional status scores came out better with acupuncture.

## Safety

In the Zhao trial, 8 of 16 reported adverse events were judged related to acupuncture: 5 people had bleeding under the skin where a needle went in and 3 had tingling, all mild or moderate. One person on the wait list died of a heart attack before receiving any acupuncture. Yang 2021 found no increase in adverse events with acupuncture across its trials. [Bleeding and anticoagulants](/wiki/safety/bleeding-and-anticoagulants) covers needling in people taking antiplatelet drugs such as aspirin.

## What guidelines say

NICE's guideline on [stable angina management](https://www.nice.org.uk/guidance/cg126/chapter/Recommendations), CG126, published in July 2011 and last reviewed in August 2016, recommends against offering acupuncture to manage stable angina, alongside transcutaneous electrical nerve stimulation (TENS) and enhanced external counterpulsation. NICE says it will review the guideline if new evidence is likely to change its recommendations. The [2023 AHA/ACC guideline](https://doi.org/10.1161/CIR.0000000000001168) on chronic coronary disease, by Virani and colleagues for the American Heart Association, the American College of Cardiology and four other bodies, updates the 2012 stable ischaemic heart disease guideline and its 2014 focused update; its full text does not mention acupuncture. The [2024 ESC guideline](https://doi.org/10.1093/eurheartj/ehae177) on chronic coronary syndromes, by Vrints and colleagues for the European Society of Cardiology, does not mention it either; for angina that persists after drugs and revascularisation, it names enhanced external counterpulsation and the coronary sinus reducer device. No newer version of either had been published by October 2026. [Clinical guidelines](/wiki/evidence/clinical-guidelines) compares other bodies' positions.

## What the reviews could not settle

The trials count angina attacks and symptom scores over weeks; the abstracts of the reviews above report no result for heart attack, hospital admission or death. The largest sham-controlled trial followed people for 16 weeks and excluded those with a previous heart attack or heart failure. Much of the pooled evidence adds acupuncture to drugs without a sham, and the two Danish sham-controlled trials found little difference from sham on attack rate. Huang 2025 found an effect only in its moderate-dose group, so the number of points and sessions a trial chooses may change its result. [Atrial fibrillation](/wiki/evidence/atrial-fibrillation) reports the reviews for another heart condition.

AcuiQ's [stable angina](/symptoms/angina-stable), [angina pectoris](/symptoms/angina-pectoris), [coronary heart disease](/symptoms/coronary-heart-disease), [chest pain](/symptoms/chest-pain) and [chest tightness](/symptoms/chest-tightness) pages list the protocols individual studies prescribed, each with its citation.

### Sources

1. Zhao L, Li D, Zheng H, et al., Acupuncture as adjunctive therapy for chronic stable angina: a randomized clinical trial, JAMA Internal Medicine 2019 — https://doi.org/10.1001/jamainternmed.2019.2407
2. Yu C, Ji K, Cao H, et al., Effectiveness of acupuncture for angina pectoris: a systematic review of randomized controlled trials, BMC Complementary and Alternative Medicine 2015 — https://doi.org/10.1186/s12906-015-0586-7
3. Yang M, Sun M, Du T, et al., The efficacy of acupuncture for stable angina pectoris: a systematic review and meta-analysis, European Journal of Preventive Cardiology 2021 — https://doi.org/10.1177/2047487319876761
4. Kong X, Gu Y, Qiu Z, Acupuncture combined with multiple therapies for angina pectoris: a systematic review and network meta-analysis, Frontiers in Cardiovascular Medicine 2025 — https://doi.org/10.3389/fcvm.2025.1463170
5. Huang D, Li Y, Zheng X, et al., Acupuncture dosage and its correlation with effectiveness in patients with chronic stable angina: a systematic review and meta-analysis of randomized controlled trial, Journal of Pain Research 2025 — https://doi.org/10.2147/JPR.S489880
6. Shen M, Huang J, Qiu T, Quality of the evidence supporting the role of acupuncture for stable angina pectoris: an umbrella review of systematic reviews, Frontiers in Cardiovascular Medicine 2021 — https://doi.org/10.3389/fcvm.2021.732144
7. Ballegaard S, Jensen G, Pedersen F, Nissen VH, Acupuncture in severe, stable angina pectoris: a randomized trial, Acta Medica Scandinavica 1986 — https://doi.org/10.1111/j.0954-6820.1986.tb02770.x
8. Ballegaard S, Pedersen F, Pietersen A, Nissen VH, Olsen NV, Effects of acupuncture in moderate, stable angina pectoris: a controlled study, Journal of Internal Medicine 1990 — https://doi.org/10.1111/j.1365-2796.1990.tb00114.x
9. DeVon HA, Uwizeye G, Cai HY, et al., Feasibility and preliminary efficacy of acupuncture for angina in an underserved diverse population, Acupuncture in Medicine 2022 — https://doi.org/10.1177/09645284211055754
10. National Institute for Health and Care Excellence, Stable angina: management (CG126), 2011, last reviewed 2016 — https://www.nice.org.uk/guidance/cg126/chapter/Recommendations
11. Virani SS, Newby LK, Arnold SV, et al., 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease, Circulation 2023 — https://doi.org/10.1161/CIR.0000000000001168
12. Vrints C, Andreotti F, Koskinas KC, et al., 2024 ESC guidelines for the management of chronic coronary syndromes, European Heart Journal 2024 — https://doi.org/10.1093/eurheartj/ehae177