Aditi Nerurkar, MD
is a primary care physician with Beth Israel Deaconess Medical Center’s
Health Care Associates
and Assistant Medical Director of the
CHENG-TSUI Integrated Health Center
The Center was founded in 2011 to offer evidence-based integrative
healing practices in conjunction with conventional medicine. Examples
include acupuncture, integrative nutrition, massage therapy,
meditation, tai chi and yoga. Heartmail spoke with Dr. Nerurkar about
integrative practices that can help patients with cardiovascular
Q. For which heart and vascular conditions is there evidence that
integrative therapies are helpful?
There’s preliminary evidence supporting the use of mind-body therapies for
certain cardiovascular conditions. ‘Mind-body therapies’ is a broad term
that encompasses things like meditation, yoga, tai chi, progressive muscle
relaxation, guided imagery and other relaxation therapies. A
study published recently
in Circulation found a 48 percent risk reduction in mortality
among patients with cardiovascular disease who meditated. That’s an
impressive finding! And we have prior data to show that tai chi may benefit
patients with congestive heart failure through improvements in their
quality of life and capacity to exercise.
Also, integrative medicine includes things like exercise, nutrition and
stress reduction in its definition. And through
Dr. Dean Ornish’s work
, we know that these two interventions can prevent the progression, and in
some cases even reverse, coronary artery disease. So the evidence is there
to support to use of integrative therapies, and mind-body therapies in
particular, for patients with cardiovascular disease.
Q. Are there integrative practices that actually cure cardiovascular
disease, or are they used mainly to address symptoms and increase comfort?
I’d say a bit of both. In one sense, integrative medicine can help improve
existing cardiovascular disease, and in other cases, prevent its
development. But it’s important to point out that integrative medical
therapies, by definition, are used in conjunction with conventional medical
care, not necessarily in place of it. That’s the key with integrative
medicine, and what differentiates it from “alternative medicine.” In
integrative medicine, there’s a partnership between the patient, their
physician and their integrative medicine provider.
Essentially, integrative medicine emphasizes a healthy lifestyle — eating a
diet rich in whole foods and plants, getting adequate cardiovascular
exercise, and managing stress. We know these practices have a positive
impact on blood pressure, cholesterol, and obesity — three of the most
significant risk factors for developing heart disease. So by adopting a
more integrative approach early on, patients may be able to prevent
cardiovascular disease downstream. And patients who have cardiovascular
disease may benefit in particular from the Ornish Model, which has been
shown to reverse heart disease.
Q. How much research remains to be done in assessing the effectiveness of
We’ve come a long way in the field, but have much further to go. Most of
the research in integrative medicine has been funded by the
National Center for Complementary and Alternative Medicine
(NCCAM), which became part of the National Institutes of Health in 1998.
And one of the reasons it was established was to answer this very question
– what is the scientific evidence behind what, at that time, was called
‘complementary and alternative medicine’ and today we call ‘integrative
medicine?’ Under NCCAM, scientists began studying these therapies in a way
similar way to conventional treatments with rigorous, randomized,
And while there’s more work to be done, we do know from prior data that
these therapies, particularly mind-body therapies, are becoming more
mainstream. We were trying to answer this question: What is the role of
mind-body therapies in the conventional setting? We
published our findings
in the Archives of Internal Medicinein 2011. We found that 41
million Americans used mind-body therapies, and 6.5 million Americans used
them on the recommendation of their conventional medical provider. That’s
like saying for every 30 people in a yoga class, one person is there
because their doctor told them to go. That’s much higher than we
When we dug a little deeper, we found that people who were referred for a
mind-body therapy by a physician had more medical conditions and used the
health care system, suggesting that physicians are recommending these
therapies as a last resort to their sickest patients, when other
conventional options have been used up. And this made us wonder: What if we
were offered these therapies earlier; would we see a bigger impact on
medical outcomes? I think the jury is still out on that, but we’ll
eventually get there.
Q. Using a broad brush, which alternative practices are of greatest
interest to doctors and patients in the realm of cardiovascular medicine?
I would say mind-body therapies like yoga, meditation, tai chi, and stress
reduction have the most clinical applicability in cardiology, along with
nutrition and exercise therapy.
Q. Some physicians question whether emotional stress can cause heart
attacks, strokes and other forms of cardiovascular disease. Can you comment
on this issue and whether integrative practices can be used to help
I don’t think there’s much controversy about stress and disease. The
evidence is there. And it's mounting for stress and heart disease in
particular, and that goes for both acute and chronic stress.
in Circulation by
Dr. Murray Mittleman
’s group found a 21-fold increase in the incidence of a heart attack in
patients who had undergone acute stress. And chronic stress has been shown
in several studies to be a risk factor for cardiovascular disease, even
after controlling for traditional risk factors. There’s also a condition
called Takotsubo cardiomyopathy, a reversible form of heart failure that
includes an acute life stressor as a diagnostic criteria for diagnosing the
So there is evidence to link stress to heart disease. Unfortunately,
physicians rarely counsel patients about stress, only 3 percent of the
time, to be specific. It’s actually the least common type of physician
counseling offered. And again, it’s being offered to complex patients,
which tells us that stress management isn’t being done as prevention, but
rather as a downstream intervention for our sickest patients. Those
findings are from
a paper we published
recently in the Archives of Internal Medicine.
Integrative therapies, especially mind-body therapies, are pretty effective
stress busters. And we have enough research that supports the use of these
therapies for stress management purposes.
Q. How do you deliver integrative care at the Cheng and Tsui Center? Are
integrative therapies ever covered by health insurance?
Our center is the first in the U.S. to incorporate integrative medical
therapies into primary care within an academic medical center. We have
primary care physicians seeing patients, and in the next room there is a
massage therapist seeing a patient, working next to an acupuncturist, and
an integrative nutritionist, etc. It’s a new and innovative model of care.
We know from prior research that patients use integrative medical therapies
on their own and don’t share their use with their doctor. On the other
hand, a doctor who might want their patient to use an integrative medical
therapy often doesn’t know where to send the patient to start acupuncture
or yoga or learn meditation. We are creating a direct path. At our center,
we’ve already vetted our integrative medical practitioners for our doctors.
Another neat thing about our center is the coordination of care. Since our
integrative practitioners write notes in the patient’s medical chart,
physicians can follow up on what was done.
Our center also offers integrative physician visits for integrative sleep,
mind-body medicine and stress management. And we will soon be offering
classes for yoga, tai chi, meditation, and exercise. Right now, our
integrative physician visits are covered by insurance, but the rest of our
services are out-of-pocket. We’ve tried to keep the cost below market
rates, so they’re affordable for patients.
Q. Can you give an example of a patient with a cardiovascular condition who
benefitted from the integrated approach?
I have lots of patient stories of how integrative medicine has helped. One
pretty memorable story is a patient I had with hypertension on a three-drug
regimen. She wanted to learn how to meditate. So I taught her a few
breathing exercises and she did them consistently. After about a year and a
half, we had her down to one medication. In her case, I think meditation
helped her get a better handle on her stress. This in turn helped her make
better food choices and got her motivated to exercise. Meditation was the
catalyst. It was the ripple effect, and sometimes, enough ripples can add
up to a wave. That’s the power of integrative medicine.
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Dr. Aditi Nerurkar »
Above content provided by the CardioVascular Institute at Beth Israel
Deaconess Medical Center. For advice about your medical care, consult