The Use of CAM Among Filipinos with Cardiovascular Disease

Question

The Use of CAM Among Filipinos

Summary

Background: Among the Asian population, complementary alternative medicine (CAM) therapy is one of the most common supplemental, treatments of cardiovascular disease (CVD). Some studies have been done within the Philippine population.

Objective: The purpose of this descriptive study was to examine the use of Complementary Alternative Medicine (CAM) among Filipinos with CVD and to describe their perceived opinions regarding CAM therapy.

Method: This study used descriptive statistical methods to address this concern. A total of 30 participants participated in this study and filled out a survey containing 26 questions.

Results: The results of this research showed, of those who have used CAM, the most common forms of CAM used were Diet Modification/Changes, and the use of Vitamins & Minerals. The use of these methods, in turn, assisted in lowering blood pressure and cholesterol levels. The majority of participants had limited knowledge of CAM therapy; however, the influence of family and friends who have used CAM may contribute towards more Filipinos accepting CAM therapy.

Conclusion: Although CAM is prevalent among Asians, the Filipino population that was sampled had limited knowledge of what CAM therapy was. Those who noted the use of CAM mainly modified their diets and used vitamin supplements as their use of therapy which, in turn, produced results. However, further education through primary care providers, family, and friends who have taken CAM therapy is necessary.

Introduction

Complementary alternative medicine is a kind of holistic treatment that differs from the systems of traditional health, medical care, medications, and practices. CAM methods include a variety of healing methods such as yoga, Tai Chi, Reiki, acupuncture, osteopathy, nutritional supplements, herbal medicine, diet programs, massage, and homeopathy among others (National Center for Complementary and Alternative Medicine (NCCAM), 2012). To date, CAM is widely used for the treatment of cancer and chronic conditions including cardiovascular disease (CVD).

Increasingly, CAM methods and dietary supplements are being marketed “over the counter” to reduce the symptoms and risks of CVD. CAM is also sought to decrease the psychological stress that comes with the disease. Various studies have reported CAM therapy among various patient populations (Artz et al., 2006; Decker et al., 2007; Leung, Tamim, Stewart, Arthur, & Grace, 2008; Yeh, Davis & Philip, 2006).

Mao, Farrar, Xie, Bowman, and Armstrong (2007) found that CAM use led to symptom relief in individuals with CVD. The popularity of these approaches has increased and is being extensively used by people with CVD and for these individuals using CAM may provide both benefits and risks.

People with CVD regularly use CAM for treating and preventing the disease. On this background, the risk of drugs that are administrated by herb interaction increases (Barnes, Bloom & Nahin, 2008). That is why it is very important to comprehend the CAM detriments in patients with CVD. For example, coenzyme Q10 supplements have shown positive effects on patients with heart failure whereas Qigong provides a favorable impact on patients with hypertensive disease (Pepe et al., 2007; Lee, Pittler, Guo, & Ernst, 2007). However, a variety of biological therapies, such as either herbal medicine, or dietary supplements have been revealed to interfere with the administrated medications and may cause potentially harmful indirect side effects (Sood et al., 2008). Herbal drug interactions are critical for patients with CVD because there is a narrow restorative window once the herbal drug is taken and a variety of cardiac remedies that the patient takes for his or her illness.

Asian Americans are a small, heterogeneous group, which comprises 5% of the U.S. population. Yet they are also the fastest-growing minority population in the U.S. They use CAM more than other American groups (Misra, Balagopal, Klatt, & Geraghty, 2010). Hsiao et al. (2006) showed that almost three-quarters of Asian Americans had utilized at least one CAM treatment over the last year, which was considerably higher than the nationwide occurrence rate. Filipinos are one of the major Asian American subgroups that utilize CAM, especially biologically-based therapy (alternative treatments that use substances found in nature). The most commonly used CAM treatments are bodywork therapies, mind-body therapies, herbal remedies, biologically based therapies, alternative systems, and spiritual remedies (Trinh-Shevrin, Islam & Rey, 2009).

According to the National Health Interview Survey (NHIS) (2007), the CAM therapies used among Asian American adults were higher than among African Americans but less than American Indian or Alaskan Natives. Americans of European descent had a rate of 43.1%. The research works of the last decades also revealed that of the overall sample, the use rate of CAM was highest among Asian American women, 30-69 years old, those who were more educated, former smokers, wealthy people, people who lived in Western states, and those hospitalized over the past year. In general, more than 30% of Americans use CAM regularly (Barnes et al., 2004).

CVD is the number one cause of death among Asian Americans (92.8%) (American Heart Association, 2007). It is also the main cause of death for Filipinos, with 32% succumbing to it (National Institutes of Health, 2012). In addition, 25% of Filipinos in the U.S. report high blood pressure. Due to a large number of Asian American adults with CVD and increased use of CAM among this population, it is important to examine the detriments that this therapy has on them. While some CAM methods greatly benefit persons with CVD, some hurt the patient's condition.

Problem Statement

CAM has become increasingly popular over time and has been found to have various benefits. However, there are also detriments for persons with CVD. This has led to the increased need to understand the nature and prevalence of CAM use among various groups to promote useful complementary medicine and to deter possible herb-drug interactions that can negatively impact morbidity for people with such chronic diseases as CVD. There is very limited information on the use of complementary as well as alternative medication among Asians with CVD, Filipinos among them. As a result, it is important to focus on the use of CAM methods used by individuals with CVD among the Asian minority group; in this case, the focus will be specifically on the Filipino population living in the U.S.

Research Purpose

The purpose of this quantitative descriptive study is to examine the use of CAM treatments among Filipinos who have Cardiovascular Disease (CVD). Identifying the use of these medicines will help identify the CAM benefits among this group. The knowledge acquired in this study will be important in promoting useful therapies and discouraging harmful medicine, which has herb-drug interactions.

Research Questions

The following research questions will be addressed in this study:

1. What are the most commonly used CAM treatments used by Filipinos with CVD?
2. What health benefits do Filipinos with CVD experience from using CAM?
3. What are the personal opinions of patients who use CAM?

Conceptual Framework

The conceptual framework in the study is based on the “One Size Does Not Fit All: Aptitude x Treatment Interaction (ATI)” (Caspi & Bell, 2004). This framework evaluates the way outcomes are dependent on the match or difference between the particular attributes of a patient and the treatment received. It also examines the association between patients and treatment methods about results. The study serves to clarify the processes and mechanisms that make these different therapies useful. According to this model, different persons may go through qualitatively diverse (yet similarly valuable) outcomes when undergoing the same treatment (Caspi & Bell, 2004).

Aptitude treatment interaction provides important insight into the comprehensive care regimen usually delivered in modern medicine. Its methods are devised to thoroughly consider personal variations in treatment assessment. Depending on the patient circumstances, various care regimen elements may complement each other whereas others may counteract each other’s effects (Caspi & Bell, 2004). In the ATI model, “A” belongs to different factors that can moderate treatment (T) effects on an outcome (O). “T” refers to any treatment method from a single intervention to the entire (whole) therapy regimen. (Caspi & Bell, 2004).

It also refers not just to the intervention, but also to the environmental peculiarities where therapy occurs as well as to the qualifications of the physician. “I” refers to the interaction and is a statistical logic that moderates the impact of “A” on the relationship between “O” and “T”. According to this model, research should seek to determine questions such as “Who does and does not benefit from a specific treatment?”, “Would the patients who do not benefit from one mode of treatment benefit from another treatment?” “Would patients who do well under one treatment benefit less if assigned to another treatment?” and “Is treatment provided for well-matched patients more effective than treatment for poorly matched or randomly assigned patients?” (Caspi & Bell, 2004, p. 585).

By this theoretical model, this study will focus on the CAM that maximizes treatment effectiveness and efficacy. By identifying the components of CAM interventions that are less or more effective under dissimilar circumstances, the ATI research will help establish the sort of therapy that should be used to match the needs of Asian Americans and to increase the efficacy of care.

Review of Literature

The present literature review aims to discuss the available modern data on the health benefits of CAM among Filipinos suffering from CVD. The sources examined highlighted the advantages and disadvantages including side effects of CAM use on Asian Americans suffering from cardiovascular disease.

Types of CAM

Complementary and alternative medicine consists of a series of treatment methods directed not only in unison with the conventional methods of medical care but also on its progressive development aimed at the healthy existence of the person. An increasing number of doctors and scientists understand the significance of complementary and alternative (holistic) medicine to the rehabilitation and maintenance of a patient’s health (Epstein, Senzon & Lemberger, 2009). In CAM, we can define several types and directions of the patient’s treatment. In general, CAM may be divided into 5 different groups: whole medical systems, and energy medicine mind-body therapies, biologically-based therapies, manipulative and body-based therapies (Rabito & Kaye, 2013).

The most well known holistic treatments are the following:

1. Ayurveda is the ancient direction of holistic medicine that first appeared in India thousands of years ago. It is based on the interaction of five elements (ether, air, fire, water, and earth), which are combined with each person’s soul and which influence his/her well-being.
2. Acupuncture is a traditional Chinese medicine with a history of thousands of years. It is based on the needle’s influence on the energy meridians or energy channels along the body. These active points are linked with the inner organs and moderate their activity.
3. Reiki is a holistic healing practice developed by Dr. Mikao Usui.
4. Homeopathy was developed by Dr. Samuel Hahnemann in 1790 based on results obtained after investigating the healing properties and mechanisms of the cinchona tree bark. The main principle of homeopathy is the Law of Similars. The data of the European Central Council of Homeopathy show that near 30 percent of the EU’s population uses homeopathic remedies in everyday care.
5. Osteopathy, developed by Dr. Andrew Taylor Still, is a type of holistic medicine that considers the patient as a kind of entity and focuses on him/her as a whole. Osteopathy is based on manipulations with the musculoskeletal system, which forms the body's mechanical support. Osteopathy is based on the principle that the body has got its recovery system and that it is possible to mobilize and activate all the inner resources when it is necessary.
6. Acupressure uses finger pressure on active points along the body. It is usually used for the treatment of different aches, pains, tensions, stress, etc.
7. Aromatherapy is based on the usage of “essential oils” extracted from plants. It usually works with emotional disorders or in conjunction with acupuncture or massage.
8. Holotropic breathwork was developed by Stanislav Grof in the second half of the 20th century. It helps in self-exploration and revealing all the blocks from the perinatal period of life or transpersonal ones. Holotropic breathwork forms the basis of transpersonal psychology. This method helps to activate inner healing potential (Grof, 2006).

Among the other methods of holistic medicine, including chiropractors, colonics, psychotherapy, cupping, craniosacral therapy, dance therapy, dowsing, ear candling, hypnotherapy, hydrotherapy, kinesiology, use of multivitamins and minerals, massage therapy, and yoga (Navarra, 2004).

Cardiovascular Disease among Filipinos

Cardiovascular disease is a key cause of mortality and morbidity in the U.S. The 2008 National Health Information System report indicated that the rates for CVD among those aged 18 years and over was 2.9% for the cumulative Asian American groups corresponding to 6.5% for the Non-Hispanic white (Pleis, Lucas & Ward, 2009). Barnes, Adams, and Powell-Griner (2008) used NHIS data from 2004-2006 to evaluate nationwide stroke and heart disease among Asian Americans. Nonetheless, the NHIS statistics did not generate statistically significant estimations for stroke and heart disease due to the small amount of data from various Asian subgroups. Narayan et al. (2010) argued that the data collected by NHIS is derived from self-reported statistics and fails to incorporate medical records, which may underestimate the prevalence of CVD among the Asian population.

Presently, there is a lack of publicly obtainable data sources that are sufficiently large to offer CVD prevalence rates for Asian Americans. However, accurate prevalence rates of CVD and cardiac events might not be reflected in numbers presented by national datasets (Barnes, Adams & Powell-Griner, 2008).

As a result of inadequate statistics on CVD among Asian Americans, the increased risk for cardiovascular disease for various Asian subgroups may not be known. According to Palaniappan, Wang, and Fortmann (2004), epidemiological research in California has shown considerably higher mortality rates among the younger Asian American population relative to other ethnic or racial groups. Higher hospitalization rates for ischemic heart conditions indicate that Asian Indians have a relative risk of 3.7%, which is higher than that of the Chinese at 0.6%.

Some of the ethnic/racial differences in CVD prevalence rates relate to the variations in both accurately reporting their CVD and physiologic differences among Asian Americans in comparison with other ethnicities. The volume and mass of the left ventricle vary among Asian Americans in respect of other racial/ethnic groups (Natori et al., 2006). Numerous researchers have investigated the treatment patterns and the outcomes for cardiovascular disease among the aggregate Asian Americans groups.

Prevalence and Benefits of CAM among Filipinos

CAM methods are varied health and medical care practices, products, and/or systems, and are not regarded to be part of traditional Western medication. CAM encompasses a wide range of treatments such as herbal remedies, relaxation techniques, homeopathy, Ayurveda, slow-moving exercises (i.e. yoga, Tai Chi, Qigong), and acupuncture. Since herbal supplements are outside of mainstream medication, they do not require a prescription, are available over the counter, and are generally derived from a root, tree, vegetable, and natural fruit. They are regularly referred to as “dietary supplements” found widely in health food stores. On the other hand, prescription medicines are pharmacologic agents, which the patient only obtains after getting a prescription from a physician. Awareness of CAM treatments is critical for cardiovascular physicians because of their potential for interacting with prescription medicine.

According to the data of Sood et al. (2008), five main basic natural products have the potential for interacting with administrated medicines: Ginkgo biloba, kava-kava, garlic pills, St. John’s wort, and valerian. The four most general administrated medication groups with possible clinical interaction with alternative medicines are antithrombotic agents, anti-diabetic agents, antidepressants, and sedatives. Mehta et al. (2007) noted that CAM is frequently used among Asian Americans and that ethnic differences in their use were revealed as well. However, Asian Americans usually do not disclose the usage of CAM to their primary physicians. For most Asian Americans, the use of CAM treatment is common. Because of this, physicians and other specialists have to remember their probable usage of CAM even though they do not recommend any dietary supplements or alternative medication because of their potential for interference or interaction with prescription medicines.

CAM is relevant to cardiovascular disease. However, there are hazardous medications that pose a risk for patients with CVD. The NHS survey of 2007 indicated that there was an increase in the use of mind-body therapies from 2002 to 2007 among adults in the US. Generally, most patients use complementary methods for the treatment and prevention of diseases such as CVD (Yeh et al., 2006). Several kinds of the literature suggested that various approaches may be of benefit if used in addition to the medication used for managing cardiovascular disease; however, there are no facts that support their function as a key treatment method (Lee et al., 2007; Pepe et al., 2007). There are very limited statistics and limited systematic statistics on the impact of complementary and alternative medicine on significant clinical outcomes. Given that the chances are high for harmful interactions and effects with frequent medicine prescriptions used in the usual treatment of cardiovascular conditions, patients are advised to be aware of these possible interactions.

Effective CAM for Managing Cardiovascular Disease

Various CAM treatments are beneficial for people with cardiovascular disease, such as coenzyme Q10, Policonasol, Red rice yeast, L-carnitine, and EDTA chelation therapy. Coenzyme Q10 is fat-soluble, vitamin-like quinine highly concentrated in the mitochondria of the kidney, heart, and liver (Miller, Liebowitz & Newby, 2004). It plays a critical role in cellular mitochondrial respiration. It functions partly as a redox connection between cytochromes and flavoproteins that are required for the production of adenosine triphosphate (ATP) as well as oxidative phosphorylation. As a result, it is important in energy production and serves as both an antioxidant and a free radical scavenger that has the properties of membrane stabilization. CoQ10 is important in treating congestive heart failure (Miller, Liebowitz & Newby, 2004).

CoQ10 has been commonly used in Japan and Italy as it has been established to be reasonably safe. It is taken orally three times per day in a dose of 50 milligrams or twice a day in a 100-milligram dose. It has been hypothesized that CoQ10 depletion may cause heart failure (Miller, Liebowitz & Newby, 2004). The level of myocardial CoQ10 depletion is related to heart failure medical relentlessness. CoQ10 has also been efficient in preventing statin-induced myopathy. Its role in reducing cardiovascular condition as well as improving survival with lipid-lowering therapy has not been disputed (Miller, Liebowitz & Newby, 2004).

Its supplementation also leads to a reduction in low-density lipoprotein (LDL) cholesterol oxidation due to the antioxidant impact of its ubiquinol metabolite. This causes a decrease in the atherogenic molecules. CoQ10 also leads to mild progress over time to ST-segment despair as well a total exercise time in patients with the cardiovascular condition (Miller, Liebowitz & Newby, 2004).

Policosanol has been proven to have a positive impact on people with cardiovascular disease (Janikula, 2002). It is a naturally derived compound developed in Cuba and is sold in different countries in the Caribbean and South America to reduce low-density lipoprotein (LDL) as well as the total levels of cholesterol. Policosanol is a blend of aliphatic alcohols mostly acquired from sugarcane wax through hydrolytic cleavage means as well as subsequent purification (Janikula, 2002). Its other components include octacosanol, hexaconasole, and triacontanol. Policosanol improves the patients’ condition by inhibiting the biosynthesis of cholesterol in a phase between mevalonate and acetate and through an increase in lower-density lipoprotein processing (Janikula, 2002). Policosanol, thus, reduces total cholesterol and LDL levels (Janikula, 2002).

Red rice yeast is also used as a type of CAM that improves the condition of individuals with cardiovascular disease (Gordon & Becker, 2011). It is a staple food whose product lowers the total cholesterol and LDL levels and increases HDL cholesterol levels. Gugulipid, traditional Indian medicine also serves as a lipid reducing agent, which works by blocking nuclear hormone receptors, which are activated by bile acids. It reduces the total cholesterol levels, triglyceride levels, LDL cholesterol level, and total HDL cholesterol to total cholesterol ratio (Gordon & Becker, 2011).

Studies have theorized that EDTA (Ethylene DiamineTetraacetic Acid) chelation therapy works by directly eliminating the calcium in fatty plaques (National Institutes of Health, 2013). Another theory is that the chelation process stimulates the hormonal release, which in turn leads to the elimination of calcium from the plaque, leading to lower cholesterol levels. Thirdly, chelation therapy lessens the destructive impact of oxidative stress on the walls of blood vessels (National Institutes of Health, 2013). A study was carried out to validate the effectiveness and safety of chelation therapy, respectively. Most of the information that supports the research comes from case series and care reports.

Detrimental CAM in Cardiovascular Disease Management

Drug-to-drug interactions can cause significant harm to persons with cardiovascular conditions. As a result, the use of herbal medicine should be carried out with great caution for individuals who take prescription medicines for managing various cardiovascular disorders due to grave and possibly life-threatening treatment reactions that may result.

Various CAM methods also have adverse effects on the condition of individuals with CVD. As to antiplatelet therapy and Warfarin, most herbal products interact with Warfarin and change the platelets' function, which increases the risk of bleeding in individuals who have been treated with conventional antiplatelet therapy or Warfarin (Dans et al., 2013). Although the possibility of increased bleeding is theoretical, several case reports point to the increased risk in patients using herbal medicine with or without Warfarin-associated use. Owing to the existence of knowledge regarding the impact of the herbs on platelet functioning and coagulation markers, individuals using conventional antiplatelet therapy or those requiring Warfarin should not use herbs (Dans et al., 2013).

Echinacea is another drug with hepatotoxic effects, which can negatively affect persons with cardiovascular disease. It is mainly used in the treatment and prevention of uncomplicated tract infections like the common cold. Because of the hepatotoxic impacts associated with constant usage, patients should take caution when using Echinacea together with other potential hepatotoxic medicines like Amiodarone or other constantly taken agents such as statins, which could also, in uncommon instances, cause hepatotoxicity (Ernst, 2003).

Kava-containing compounds, which are used for the treatment of insomnia and anxiety, cause fulminant hepatic failure, which requires transplantation. As a result, the Food and Drug Administration (FDA) advises patients with underlying liver conditions not to use the drug and patients using potentially hepatotoxic medicine (Ernst, 2003). Various European countries have already removed kava-containing compounds from the market.

Digoxin, a conventional drug, is another medication that interacts with various substances and negatively affects individuals with cardiovascular disease. Various herbs contain digoxin-like- substances. Kyushu usually reacts with digoxin and may supposedly present digoxin-like characteristics (Ernst, 2003). Chinese silk vine is also herbal medicine, which interferes with digoxin tests. This test interference can lead to grave outcomes. St. John’s Wort, also known as hyperricumperforatum, reduced digoxin serum levels by inducing p-glycoprotein drug carriers (Ernst, 2003). Potential harmful effects of herbal medicines and therapy may also result from failure to standardize and regulate their preparation as well as their packaging. When it comes to digoxin interaction and reactions, it was discovered that plantain, which is commonly used as an herbal laxative, was contaminated with poisonous wooly foxglove (Ernst, 2003). This led to an FDA advisory as well as the removal of various medicines from the market.

Cyclosporine is another medicine subjected to numerous drug-to-drug interactions. This drug is used after orthotropic heart transplantation as an immunosuppressant. The dosage is usually reduced for patients who experience hypertension after undergoing heart transplantation when used with diltiazem (Ernst, 2003). The interaction with diltiazem leads to higher cyclosporine levels.

Thus, patients have been using CAM for preventing and treating a wide range of medical conditions including cardiovascular disease. Various approaches suggest the beneficial aspect of this mode of treatment when used to supplement conventional medicine for the management of cardiovascular disease. These medicines may also have adverse effects that can be harmful because of their potential for interacting with commonly prescribed conventional medicine for the management of cardiovascular disease (Ernst, 2003). However, there is limited literature regarding the benefits and adverse effects of the application of CAM on individuals living with cardiovascular disease, especially Filipinos. Because of this gap in the literature, there are many questions regarding the use and effectiveness of CAM.

Methodology

Design

The current study used a descriptive quantitative research design to investigate the use of CAM treatments on Filipinos with cardiovascular disease. This design was chosen because it allows the researcher to examine what types of CAM therapies are being used by this ethnic group and determine to what degree they are effective. This data can be used by practitioners to help them identify specific CAM methods that might be used by their Filipino patients and which methods improve the outcomes of patients with cardiovascular disease.

Sample Population and Size

This study used a convenience sampling method. Participants were selected from the Filipino community living in the Chicagoland area. Inclusion criteria for participants include: being of Filipino descent (male or female), ages 40 years and above, having a health history of cardiovascular disease (CVD) (meaning anyone with a current history of a cardiac event or has CVD risk factors), can understand English (either as a primary or secondary language), and is residing in the Chicagoland area. The reason for the specific age is because most individuals who suffer from cardiovascular disease are above 40 years of age (Driver, 2008). The target sample size was 30 participants.

Setting

The research setting was in Chicago, IL in a facility well known to Filipinos living there. The researcher made contact with the Board of Directors of the Filipino-American Council of Greater Chicago Volunteer Health Services (FACC) and agreed to grant permission for this research to take place at one of their free community health fairs that occurs during the last weekend of every month. Written authorization was requested and obtained. Once written authorization and IRB approval had been acquired, the researcher posted flyers on the Center’s bulletin board (Appendix A) asking for volunteers who fit the inclusion criteria to come to one of the healthcare fairs and take the survey.

Before beginning the survey, study participants were briefed on the details of the study to ensure that their participation was voluntary and confidential (Appendix B). They then proceeded to answer the questionnaire (Appendix C). The actual date of the data collection took place on the last Sundays of the month between October 2013 to February 2014 coinciding with their free community health fair.

Instrument

The researcher developed a three-part questionnaire with 25 questions. The first part of the questionnaire contained questions including age, ethnicity, gender, educational level, marital status, and current health condition. The second part of the questionnaire contains questions related to the use of CAM. Questions on the type of CAM and frequency of use were included. The third part contained questions on the participant’s attitude regarding CAM use. In the first two sections, the participant was asked to select the answer(s) from a list of responses.

The options that the subjects have to choose from were based on the literature on the most common CAM methods as well as basic nursing assessment interview questions the researcher developed and modified questions found on Likert scales. If the participant does not see an appropriate choice, they are free to write in their answer in the “Other” option. Questions for the third part of the questionnaire were measured using a five-point Likert scale. The five-point Likert scale ranges from 1 (CAM methods don’t work at all) to 5 (CAM has beneficial results). Questionnaires establish whether or not the participants see results (for instance, drop in blood pressure, cholesterol, etc.) when using CAM.

Data Analysis

After the final healthcare fair, the data obtained from the questionnaire were entered into and analyzed using the “Statistical Package for the Social Sciences (SPSS)”. Descriptive statistics, such as central tendency and measures of variability, were included in the analysis of data obtained from the questionnaires.

Results

Data Collection

After the site approval and institutional review board (IRB) approval, the researcher met with the Director of FACC to confirm that the data collection event would take place during the healthcare fairs from late October to the end of February. Next, the researcher was present at each of the healthcare fairs. Those individuals who had read the recruitment flyer and met the inclusion criteria arrived at one of the fairs. Participants did not need any prior preparations (other than the knowledge of their current health history and CVD diagnosis or risk factors) to take this survey. The researcher then sought agreement to participate in the subjects. Next, those who agreed to take part in the study were given a 26-question survey to complete. After completion, the participant placed the questionnaires in a locked dropbox where their answers to their surveys were kept confidential and anonymous. The locked dropbox was not opened until after the final healthcare fair had been completed.

Protection of Human Services

Before this research began, the Institutional Review Board (IRB) reviewed and approved the study. The researcher has completed human subjects CITI training. Participation in this study was free, voluntary, and confidential. Before the data collection process, the participants were provided an information sheet that detailed the purpose of the study, its confidentiality, their right to withdraw as well as the researcher’s contact information. The data obtained were safeguarded in a locked box and only the concerned parties were allowed to view the data. Once the study was complete, the questionnaires were shredded, and electronic data was destroyed.

Characterization of Patients

30 patients of 40 to 89 years old took part in the research; among them, there were 17 (56.7%) males and 13 (43.3%) females. Age was categorized as 40-49, 50-59, 60-69, 70-79, and 80-89 years old. The majority of patients (11 persons, or 36.7%) were 70-79 years old; 7 persons (23.3%) were 60-69 years old; 5 persons (16.7%) were 80-89 years old, 4 patients (13.3%) were 40-49 years old, and the minority (3 patients, or 10 %) were 50-59 years old.

In terms of their spiritual preferences, the majority of patients (17 persons, or 56.7%) were married, 9 persons (30%) were widowed. The other four patients pretty even split were single (2 patients) or divorced (2 patients). most (27 persons, 90%) were Catholics.

n terms of their educational level, the majority (22 persons, 73.3%) were graduates from college; four persons (13.3%) held a master's degree, one person (3.3%) had a Ph.D. degree; one person did not attend any college, and two patients (6.7%) attended but did not graduate from college.

25 patients did not have any health issues; five of them (16.7% of all patients) felt stated that they felt very good, and the rest (66.7%) simply felt good. Five participants felt fair. According to the distribution of patients based on their cardio-vascular disease condition, it was revealed that eight of the subjects (26.7%) suffered from coronary artery disease, in six participants (20%) hypertensive heart disease was diagnosed; in another eight patients (26.7%) congestive heart failure was determined; in three patients (10) the etiology of cardiovascular disease was unclear; in another three patients, a complex heart impairment was revealed: (hypertensive heart disease and congestive heart failure (one subject), coronary heart disease, hypertensive heart disease and congestive heart failure (one subject), coronary artery disease and hypertensive heart disease (1 subject). In one subject (3.3%) inflammatory heart disease was diagnosed.

In response to the question about annual income, more than a half of all (16 persons, 53.3%) preferred not to answer, eight (26,7%) were retired, two (6.7%) were unemployed and the incomes of the other participants varied from $ 10,000 - 24,000 per year (1 subject, 3.3%) to more than $ 100,000 per year (one subject, 3.3%).

11 subjects (36.7%) have never used any CAM. Nine (30%) have used cam for promoting current health, three persons (10%) have used CAM both for treating illness and promoting health, another three (10%) have used it for treating illness and for promoting current health, and an additional three (10%) have used CAM for preventing the onset of illness. 13 of the participants (43.3%) have used CAM with the treatment given by their primary physician, 5 persons (16.7%) have used CAM without treatment administrated by their primary physician.

As for the variety of CAMs used by the subjects, the most preferred treatment involved a combination of vitamins and minerals alone or on the background of a diet. These types of CAM were used by 4 participants (13.3%) for each kind of CAM. All of the other subjects that took part in the research individually used either herbal medicine (3.3%), or meditation (3.3%), chiropractors and massage therapy (3.3%), or different combinations of yoga, spiritual healing, diet, etc.

Among the participants who used CAM (16 persons, 53.3% of all the patients) 84.2% of them took natural health products daily. Of the remaining three subjects, one did not take natural health products at all, one took natural health products every week, and the other monthly. Among all the 19 subjects who used CAM, 12 persons (63,2%) did not see any CAM provider, 5 persons (26.3%) saw a CAM provider once a year, and one saw a CAM provider every week (5.3%) and the other saw a CAM provider every month (5.3%).

As for the effect of CAM on cardio-vascular diseases, it was revealed that its main effect was decreasing cholesterol level (4 respondents, 22.2% who used CAM), and improved blood pressure levels (4 subjects), or their combinations, which were revealed in 6 subjects (33.3% of the subjects, who used CAM).

Analysis of Questionnaire

Among the 24 participants who answered the questions concerning their opinions about CAM use, 8 persons (33.3%) agreed with the statement that CAM providers gave good information on maintaining a healthy lifestyle; the majority (15 persons) were neutral to this statement and only one person strongly agreed with it. The majority (18 persons), who answered the questionnaire did not think about the side effects of CAM treatment, and the rest six patients were sure about fewer side effects of natural remedies. 18 participants expressed a neutral opinion to the statement that CAM based on natural plants was healthier than taking drugs administrated by a physician; the other 20.8% were sure that CAMs were healthier than other drugs; one person disagreed with this statement.

Five subjects agreed and strongly agreed that Filipinos with CVD would be more likely to use CAM if there were more CAM clinics; one disagreed with this statement; the rest (18 persons) took a neutral position. The same distribution of the opinions was revealed during the analysis of the statement that Filipinos with CVD are more empowered when using CAM. Providers of CAM involve them in decisions regarding their health care treatments. 3 respondents were sure that CAM built up self-defense and promoted self-healing; the rest 87.5% simply did not think about this statement. Fifteen of the respondents believe that the more knowledge a Filipino with cardiovascular disease had about CAM, the more likely they were to use it; the other nine expressed a neutral attitude to this settlement.

62.5% of the respondents were sure that family could influence a person’s CAM use by exposing them to it; one person disagreed with this statement, all the rest were neutral in their attitude. Fourteen subjects believed that Filipinos with CVD would be more likely to use CAM if their friends were using it; 10 persons were neutral to this statement. 83.3% were not sure that Filipinos with CVD who believed in the physical, mental, and spiritual aspects of health were more likely to use CAM but the rest 16.6% were sure that this group would use CAM.

Discussion and Conclusion

CAM has been practiced since ancient times, however, it is a new branch of medicine in the United States in comparison to the other countries of the world (China, India, Countries of Middle and Eastern Asia, etc). Nowadays CAM is growing rapidly and widely used by patients with a variety of diseases. It is even turning into the “hidden Mainstream in American medicine”. The widespread use of complementary and alternative medicine is a common feature of modern society. The motivations for CAM use are various.

A great number of Americans, including American Asians, such as Filipinos, enthusiastically use CAM therapy even without any evidence-based scientifically approved data of their efficacy. As this research revealed, patients get their information from the Internet, neighbors, and friends. The main motivation for CAM use in the US is health promotion and disease prevention. For these purposes, CAM has been used for a long time (Eisenberg, et al., 1998). This motivation was also confirmed by the obtained results. As was shown 63.3% of all subjects who took part in the research in general used CAM for preventing the onset of illness, treating illness, and promoting health.

According to the data of Ruggie (2004), a growing interest in spirituality and a holistic approach to health also motivate CAM use. As for obtained data, it is possible to define that while the majority of patients (90%) were Catholics, they were neutral to the statement that growing spirituality is a key motivating factor for CAM use. Most of the respondents who took part in the research were predominantly educated; this data does not contradict the research performed by Ness et al. (2005).

Based on the obtained results, it is impossible to characterize the gender profile of CAM users because among all of the respondents the number of females was higher than males (56.7% and 43.3%, relatively), but there were no results concerning the proportion of males and females among patients who used CAM. According to the data of Ness et al. (2005), women usually use CAM more frequently than men. All the observed patients were predominantly of senior age (70-79 years old); this data does not contradict the findings by Ness et al. (2005), while the description of the age cohort of CAM users.

People suffering from chronic diseases such as back pain, insomnia, high blood pressure, etc., who were dissatisfied with the remedies administrated by primary physicians are common visitors of CAM providers (Ness et al., 2005). According to the obtained data, 63.2% of all the participants who used CAM had never visited CAM providers, and 26.3% visited one once a year. As the majority of Americans (Eisenberg et al., 1998), the Filipinos who took part in the research used CAM with treatments given by their primary physician.

Among a variety of CAMs (yoga, chiropractors, massage therapy, diet, herbal medicine, multivitamins, minerals, etc.) the most popular CAM among all researched patients were multivitamins and minerals (21.1%) and their combination with a diet (15.8%); these data correspond to data revealed by Ness J. et al. (2005).

A reduction of 5 mm Hg in systolic arterial blood pressure is correlated with a 7% reduction in all-cause mortality (Welton et al., 2002); so investigation of a low-cost, highly effective antihypertensive remedies with a low side effect is actual. CAM is very popular among patients with arterial hypertensive disease; this fact is confirmed by obtained data: 20% of all respondents who took part in the research suffered from hypertensive disease. Patients with the hypertensive disease usually prefer to use CMS, such as coenzyme Q10, slow breathing techniques, Qigong meditation, etc., as antihypertensive therapies (Nahas, 2008). Antihypertensive CAM was shown by Nahas (2008). This statement is confirmed by the results obtained during investigations of Filipinos with CVD on the background of CAM use. Rabito and Kaye (2013) also analyzed the positive effects of CAM on patients with CVD. According to the obtained data, the main effect of CAM use in Filipinos with CVD was improved blood pressure followed by lowered cholesterol level (33.3%), an isolated decrease of arterial blood pressure was detected in 22.2% of patients.

Although CAM use is prevalent among Asians, the Filipino population that was sampled had limited knowledge of what CAM therapy was. Those that noted the use of CAM mainly modified their diets and used vitamins & minerals as their use of therapy, which, in turn, produced results. However, further education through primary care providers, family, and friends who have taken CAM therapy is necessary.

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