The uptake of complementary and alternative medicine (CAM) is common, especially among patients with chronic illness. However, the use of CAM by women with cardiovascular disease and how this influences the interface with conventional medicine is poorly understood. To examine the relation between heart disease, hypertension, and diabetes and the use of CAM and conventional medicine in a cohort of women, data were taken from the 2010 survey (n = 9,748) of the 1946 to 1951 cohort of the Australian Longitudinal Study on Women’s Health (ALSWH). Analyses focused on women who had been diagnosed or treated for heart disease, diabetes, and/or hypertension. The outcome measures were the use of conventional or CAM treatments in the previous year. Most women had hypertension only (n = 2,335), and few (n = 78) reported having heart disease, hypertension, and diabetes. Women with hypertension were less likely (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.74 to 0.91) to consult with a CAM practitioner and less likely (OR 0.86, 95% CI 0.77 to 0.97) to use self-prescribed CAM, while women with diabetes were also less likely (OR 0.66, 95% CI 0.54 to 0.81) to consult with a CAM practitioner and less likely (OR 0.68, 95% CI 0.55 to 0.83) to use self-prescribed CAM. In conclusion, compared with studies conducted on CAM use and other chronic illness groups, the use of CAM by women with heart disease, hypertension, and/or diabetes in this study was lower, and future research is needed to explore patients’ perceptions of cardiovascular risk and the role of CAM in their self-management in the community, among other issues.
We still know relatively little about the use of complementary and alternative medicine (CAM) among cardiovascular patients. In response, we provide a detailed examination of conventional and CAM practitioner consultations as well as the use of self-prescribed CAM among women who have been diagnosed with heart disease, diabetes, and hypertension.
Methods
This research was conducted as part of the Australian Longitudinal Study on Women’s Health (ALSWH), which was designed to investigate multiple factors affecting the health and well-being of women over a 20-year period. Women in 3 age groups (young, 18 to 23 years of age; middle age, 45 to 50 years of age; and older, 70 to 75 years of age) were randomly selected from the national Medicare database. Australia has a nationalized medical care system (Medicare), funded directly through the taxation system, under which all citizens and permanent residents, including refugees and immigrants, receive medical and public hospital care at minimal cost. This system is centrally administered by the Health Insurance Commission, which maintains records of Australians’ health care use as well as of all registered providers of medical services. Under Medicare, all Australians are eligible to claim benefits for family doctor and specialist medical services, and almost all women residing in Australia are registered with Medicare. The focus of the present analysis was on women from the middle-age cohort. The baseline survey, comprising 14,099 women, was conducted in 1996, and the respondents have been shown to be broadly representative of the national population of women in the target age groups. Analyses for this research were focused on the most recent postal survey, which was conducted in 2010, when the women were aged 59 to 64 years.
Postal code of residence at the time of the baseline survey was used to classify area of residence as urban or nonurban. Women were asked about their current marital status and the highest educational qualification they had completed. The women were also asked about income and whether they had private health insurance with ancillary coverage.
Women were asked how often they experienced a list of symptoms in the previous 12 months. The list included allergies or hay fever or sinusitis, indigestion, chest pain, headaches or migraines, severe tiredness, stiff or painful joints, back pain, hemorrhoids, other bowel problems, hot flashes, night sweats, and leaking urine. Women were also asked whether a doctor had ever told them that they had any of the following chronic medical conditions: arthritis, diabetes, heart disease, hypertension, low iron level, asthma, anxiety disorder, depression, and cancer (except skin cancer). Responses to questions about history of smoking and alcohol use were also included.
The women were asked about their frequency of use in the previous 12 months of general practitioners (GPs) and specialist doctors. In addition, they were asked if they had consulted with a range of conventional providers (i.e., physiotherapists, counselors, nurses, optometrists, dieticians, and podiatrists) and CAM practitioners (i.e., massage therapists, naturopaths or herbalists, chiropractors, osteopaths, acupuncturists, and other alternative health practitioners), as well as their consumption of self-prescribed CAM (i.e., vitamins and minerals, yoga and meditation, herbal medicines, aromatherapy oils, Chinese medicine, and other alternative therapies) in the previous 12 months.
Chi-square tests were used to examine the associations between categorical variables. Logistic regression models were used to examine the association between health care use (i.e., CAM practitioners, allied health care practitioners, and self-prescribed CAM use) and heart disease status, hypertension status, and diabetes status. For each logistic regression model, the odds ratios were adjusted for all the demographic, symptom, and diagnosis variables listed earlier. Poisson regression models were used to examine the association between consultations with a doctor (i.e., GP or specialist) and heart disease, hypertension, and diabetes status. For each Poisson regression model, the risk ratios were adjusted for all the demographic, symptom, and diagnosis variables listed earlier. In response to the large sample size, a p value <0.005 was adopted for statistical significance. All analyses were conducted using SAS (SAS Institute Inc., Cary, North Carolina).
Results
In 2010 (i.e., survey 6), 9,748 women returned completed questionnaires (an 80.4% response rate). There were 428 women (4.4%) who had been diagnosed or treated for heart disease (i.e., myocardial infarction or angina), 750 women (7.7%) who had been diagnosed or treated for diabetes, and 2,945 (30.2%) women who had been diagnosed or treated for hypertension. Few women (n = 78 [0.8%]) reported having heart disease, hypertension, and diabetes. In addition to these conditions, the women had been diagnosed or treated for, on average, 0.9 ± 1.1 other conditions and had experienced an average of 3.6 ± 2.3 different symptoms. Most of the women were nonsmokers (91.1%), with 8.9% being current smokers. In terms of alcohol consumption, 8.4% of women were nondrinkers, 84.5% low-risk drinkers, and 7.2% risky or high-risk drinkers.
Table 1 lists the distribution of consultations with CAM practitioners among women with heart disease, hypertension, and diabetes. Women with diabetes were 0.82 (95% confidence interval [CI] 0.65 to 1.04) times less likely to consult with massage therapists, 0.68 (95% CI 0.50 to 0.92) times less likely to consult with chiropractors, 0.36 (95% CI 0.21 to 0.70) times less likely to consult with osteopaths, and 0.66 (95% CI 0.54 to 0.81) times less likely to consult with CAM practitioners in general. In addition, women with hypertension were 0.79 (95% CI 0.70 to 0.89) times less likely to consult with massage therapists, 0.79 (95% CI 0.65 to 0.95) times less likely to consult with naturopaths or herbalists, and 0.82 (95% CI 0.74 to 0.91) times less likely to consult with CAM practitioners in general. There were no statistically significant associations between heart disease and any of the CAM practitioner groups.
| Condition | Consultations With CAM Practitioners in the previous 12 months | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Massage Therapist | Naturopath / Herbalist | Chiropractor | Osteopath | Acupuncturist | Other AH Practitioner | Total CAM | ||||||||
| Yes n=2454 | No n=7014 | Yes n=858 | No n=8516 | Yes n=1489 | No n=7941 | Yes n=408 | No n=8954 | Yes n=546 | No n=8833 | Yes n=583 | No n=8650 | Yes n=3934 | No n=5634 | |
| Heart Disease | 4% | 4% | 4% | 5% | 4% | 4% | 4% | 5% | 4% | 5% | 4% | 4% | 4% | 5% |
| Odds Ratio ∗∗ | 1.00 | 0.79 | 1.05 | 0.65 | 0.65 | 0.86 | 0.93 | |||||||
| (95% CI) | (0.76, 1.32) | (0.51, 1.24) | (0.76, 1.47) | (0.32, 1.31) | (0.37, 1.15) | (0.51, 1.44) | (0.73, 1.19) | |||||||
| Hypertension ∗ , † , ¶ | 28% | 32% | 26% | 32% | 30% | 31% | 28% | 31% | 29% | 31% | 28% | 31% | 29% | 32% |
| Odds Ratio ∗∗ | 0.79 | 0.79 | 0.95 | 0.80 | 0.88 | 0.81 | 0.82 | |||||||
| (95% CI) | (0.70, 0.89) | (0.65, 0.95) | (0.82, 1.10) | (0.601, 1.06) | (0.70, 1.11) | (0.65, 1.02) | (0.74, 0.91) | |||||||
| Diabetes Mellitus ∗ , ‡ , § , ‖ , ¶ | 6% | 9% | 6% | 8% | 6% | 8% | 4% | 8% | 8% | 8% | 5% | 8% | 6% | 9% |
| Odds Ratio ∗∗ | 0.82 | 0.61 | 0.68 | 0.36 | 0.92 | 0.60 | 0.66 | |||||||
| (95% CI) | (0.65, 1.04) | (0.41, 0.92) | (0.50, 0.92) | (0.21, 0.70) | (0.60, 1.42) | (0.37, 0.96) | (0.54, 0.81) | |||||||
∗ statistically significant association with massage therapist (p<0.005).
† statistically significant association with naturopaths/herbalists (p<0.005).
‡ statistically significant association with chiropractors (p<0.005).
§ statistically significant association with osteopaths (p<0.005).
¶ statistically significant association with Total CAM (p<0.005).
‖ statistically significant association with other AH practitioners (p<0.005).
∗∗ adjusted for level of education, area of residence, marital status, income, health insurance, comorbidities, symptoms, smoking status, and alcohol consumption.
The distribution of self-prescribed CAM among women with heart disease, hypertension, and diabetes are presented in Table 2 . Women with diabetes were 0.68 (95% CI 0.55 to 0.82) times less likely to consume vitamins and minerals, 0.59 (95% CI 0.43 to 0.79) times less likely to use yoga and meditation, and 0.68 (95% CI 0.55 to 0.83) times less likely to use CAM in general. Women with hypertension were 0.78 (95% CI 0.68 to 0.90) times less likely to use yoga and meditation, 0.87 (95% CI 0.78 to 0.98) times less likely to use herbal medicines, and 0.67 (95% CI 0.55 to 0.82) times less likely to use other alternative therapies. There were no statistically significant (adjusted) associations between heart disease and any of the self-prescribed CAM.
| Condition | Use of self-prescribed CAM treatments in the previous 12 months | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Vitamins / Minerals | Yoga / Meditation | Herbal Medicines | Aroma- therapy Oils | Chinese Medicine | Other Alter. Therapies | Total CAM | ||||||||
| Yes n=6681 | No n=2981 | Yes n=1702 | No n=7775 | Yes n=2606 | No n=6898 | Yes n=1434 | No n=8045 | Yes n=365 | No n=9088 | Yes n=813 | No n=8585 | Yes n=7332 | No n=2385 | |
| Heart Disease § | 5% | 4% | 5% | 4% | 4% | 5% | 6% | 4% | 4% | 5% | 5% | 4% | 5% | 4% |
| Odds Ratio ∗∗ | 1.05 | 1.08 | 0.84 | 1.25 | 0.72 | 0.93 | 1.08 | |||||||
| (95% CI) | (0.80, 1.37) | (0.79, 1.47) | (0.64, 1.10) | (0.92, 1.68) | (0.36, 1.45) | (0.61, 1.43) | (0.81, 1.45) | |||||||
| Hypertension † , ‡ , ‖ | 30% | 32% | 26% | 32% | 29% | 31% | 32% | 31% | 27% | 31% | 25% | 32% | 30% | 32% |
| Odds Ratio ∗∗ | 0.89 | 0.78 | 0.87 | 0.99 | 0.75 | 0.67 | 0.86 | |||||||
| (95% CI) | (0.79, 0.99) | (0.68, 0.90) | (0.78, 0.98) | (0.87, 1.15) | (0.56, 0.99) | (0.55, 0.82) | (0.77, 0.97) | |||||||
| Diabetes Mellitus ∗ , † , ¶ | 7% | 10% | 5% | 9% | 7% | 8% | 8% | 8% | 6% | 8% | 7% | 8% | 7% | 10% |
| Odds Ratio ∗∗ | 0.68 | 0.59 | 0.86 | 0.88 | 0.65 | 0.81 | 0.68 | |||||||
| (95% CI) | (0.55, 0.82) | (0.43, 0.79) | (0.69, 1.08) | (0.68, 1.15) | (0.36, 1.19) | (0.56, 1.19) | (0.55, 0.83) | |||||||
∗ statistically significant association with vitamins/minerals (p<0.005).
† statistically significant association with yoga/meditation (p<0.005).
‡ statistically significant association with herbal medicines (p<0.005).
§ statistically significant association with aromatherapy oils (p<0.005).
¶ statistically significant association with Total CAM (p<0.005).
‖ statistically significant association with other alternative therapies (p<0.005).
∗∗ adjusted for level of education, area of residence, marital status, income, health insurance, comorbidities, symptoms, smoking status, and alcohol consumption.
Table 3 lists the distribution of consultations with doctors among women with heart disease, hypertension, and diabetes. Women with diabetes were 1.13 (95% CI 1.06 to 1.20) times more likely to consult with a GP and 1.14 (95% CI 1.03 to 1.25) times more likely to consult with a specialist. Women with hypertension were 1.22 (95% CI 1.18 to 1.27) times more likely to consult with a GP and 1.10 (95% CI 1.04 to 1.17) times more likely to consult with a specialist. Women with heart disease were 1.13 (95% CI 1.05 to 1.21) times more likely to consult with a GP and 1.35 (95% CI 1.22 to 1.51) times more likely to consult with a specialist.
| Condition | Number of consultations with doctors in the previous 12 months | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| General Practitioner (GP) | Specialist | |||||||||||||
| 0 n=454 | 1 – 2 n=3047 | 3 – 4 n=3030 | 5 – 6 n=1683 | 7 – 12 n=1021 | 13 – 24 n=361 | 25+ n=101 | 0 n=4528 | 1 – 2 n=3171 | 3 – 4 n=1011 | 5 – 6 n=372 | 7 – 12 n=200 | 13 – 24 n=52 | 25+ n=34 | |
| Heart Disease ∗ , † | 1% | 2% | 3% | 6% | 11% | 15% | 15% | 2% | 5% | 9% | 13% | 10% | 12% | 10% |
| Risk Ratio ‡ | 1.13 | 1.35 | ||||||||||||
| (95% CI) | (1.05, 1.21) | (1.22, 1.51) | ||||||||||||
| Hypertension ∗ , † | 6% | 18% | 34% | 41% | 45% | 49% | 58% | 27% | 32% | 38% | 42% | 37% | 30% | 47% |
| Risk Ratio ‡ | 1.22 | 1.10 | ||||||||||||
| (95% CI) | (1.18, 1.27) | (1.04, 1.17) | ||||||||||||
| Diabetes Mellitus ∗ , † | 2% | 2% | 8% | 11% | 15% | 21% | 23% | 5% | 8% | 13% | 13% | 17% | 20% | 24% |
| Risk Ratio ‡ | 1.13 | 1.14 | ||||||||||||
| (95% CI) | (1.06, 1.20) | (1.03, 1.25) | ||||||||||||
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