EurAsian Journal of BioSciences

Eurasia J Biosci 14, 123-127 (2020)

Response of cholesterol to cupping therapy in post-

menopausal women with hypercholesterolemia
Heba Ali Abd EL-Ghaffaar 1*, Jehad Khaled Mandour 2, Fatma Abed ElKadir Atia 3
1
Department of Physical Therapy for Cardiovascular/Respirator Disorders and Geriatrics, Faculty of Physical
Therapy, Cairo university, EGYPT
2
Physical Therapist at sixth district Family Medical Center Health Ministry, EGYPT
3
Department of Internal Medicine, Faculty of Medicine (Girls), AlAzhar university, EGYPT
*Corresponding author: Hebaelshweety@gmail.com

Abstract
Hypercholesterolemia is common in post-menopausal women, increasing their risk for
cardiovascular, thyroid, kidney and liver diseases, as well as diabetes mellitus. The current study
aimed to investigate the response of cholesterol to cupping therapy in post-menopausal women with
hypercholesterolemia. Forty post-menopausal women, having hypercholesterolemia, were
randomized into 2 equal groups. Group (A) received cupping therapy, once/month for 3 months, while
group (B) didn’t receive any therapy. All women were evaluated pre- and post-treatment by
measuring the serum levels of total cholesterol, low density lipoprotein cholesterol (LDL-C) and high
density lipoprotein cholesterol (HDL-C). Comparing both groups post-treatment showed that there
was a statistically significant reduction in serum levels of total cholesterol and LDL-C (P < 0.05), while
there was a statistically significant increase in serum levels of HDL-C (P < 0.05) in favour of group
(A). Cupping therapy is an effective method for improving serum cholesterol levels in
hypercholesterolemic post-menopausal women through decreasing total cholesterol and LDL-C and
increasing HDL-C.

Keywords: cupping therapy, hypercholesterolemia, post-menopausal women

Abd EL-Ghaffaar HA, Khaled Mandour J, Abed ElKadir Atia F (2020) Response of cholesterol to
cupping therapy in post-menopausal women with hypercholesterolemia. Eurasia J Biosci 14: 123-
127.

© 2020 Abd EL-Ghaffaar et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution License.

INTRODUCTION a simple, cost effective and time saving method that has
three main steps, including suction, scarification and
Hypercholesterolemia refers to excessively high suction again (Al-Bedah et al. 2018, El Sayed et al.
levels of plasma cholesterol, which predisposes to many 2014). It has a positive effect on reducing total
diseases mainly cardiovascular illness (Stapleton et al. cholesterol blood levels in hypercholesterolemic patients
2010). Post-menopausal women have higher (Fikri et al. 2010, Makiabadi and Zakarianezhad 2020).
prevalence of hypercholesterolemia than pre- Although previous studies had examined the response
menopausal women, suggesting an etiological role for of cholesterol levels to cupping therapy in
estrogen deficiency (Davidson et al. 2002, Reddy Kilim hypercholesterolemic and dyslipidemic patients (El
and Chandala 2013). Following menopause, women Sayed et al. 2014, Fikri et al. 2010, Hairon et al. 2017,
have increased levels of total cholesterol and LDL-C in Refaat et al. 2014), few of them have addressed this
addition to decreased levels of HDL-C, increasing their question in post-menopausal women with
risk to develop cardiovascular diseases (Fonseca et al. hypercholesterolemia. Therefore, the present study
2017). Cholesterol levels in blood should be controlled aimed to investigate the response of cholesterol to
to prevent negative consequences of cupping therapy in post-menopausal women with
hypercholesterolemia. Dietary modifications, physical hypercholesterolemia.
activity and alternative therapies like cupping therapy
are recommended for hypercholesterolemic patients
(Fikri et al. 2010, Mahmood 2015). Cupping therapy
represents one of the oldest therapies used for treating
a broad range of diseases through increasing production
of endogenous opioids in the brain, excreting Received: February 2019
pathological substances from the blood, boosting Accepted: October 2019
immunity and potentiating pharmacological therapy. It is Printed: February 2020

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MATERIALS AND METHODS Table 1. Baseline characteristics of postmenopausal

women in both groups
Study Design Group A Group B Comparison
Items S
The study was designed as a prospective, Mean ± SD Mean ± SD t-value P-value
Age (years) 50.73±2.93 50.86±3.37 -0.115 0.909 NS
randomized, controlled trial. It was conducted between BMI (kg/m2) 32.13±1.72 32.53±1.68 -0.642 0.526 NS
October, 2018 and September, 2019. *SD: standard deviation, P: probability, S: significance, NS: non-significant.
Participants
Forty post-menopausal women, diagnosed with Outcome Measures
hypercholesterolemia, were recruited from the Measurement of serum cholesterol levels
outpatient internal clinic in Family Medical Center sixth The serum levels of total cholesterol, LDL-C and
district Nasr City, Cairo, Egypt. The inclusion criteria HDL-C were measured, using Cobas 6000 analyzer
were total cholesterol levels of more than 200 mg/dL. (Roche Diagnostics, IN, USA), for all women in both
The participants’ age ranged from 45 to 55 years while groups (A & B) before the beginning of the first session
the body mass index (BMI) ranged from 30 to 34.9 and 48 hours following the last session of cupping. All
kg/m2. They were excluded if they had hypertension, blood samples were taken after 12 hours of fasting
cardiovascular diseases, metabolic disorders, body (Refaat et al. 2014).
temperature of more than 37.5 Cº and hemoglobin levels
of less than 10 g/dl. Additionally, all of them didn’t
Statistical Analysis
receive cholesterol lowering drugs or follow a specific The Statistical Package for the Social Sciences
diet therapy. (SPSS) computer program (version 23) was used for
data analysis. Prior to final analysis, data were screened
Randomization for normality assumption, homogeneity of variance, and
Each participant was informed about the study presence of extreme scores. Such exploration was done
nature, purpose and benefits, the right to refuse or as a pre-requisite for parametric calculations of the
withdraw at any time, as well as the obtained data analysis of difference and of relationship measures.
confidentiality. The hypercholesterolemic post- Normality test of data using Shapiro-Wilk test revealed
menopausal women were randomly assigned into 2 that the data was normally distributed for total
equal groups (group A and group B) using a computer- cholesterol, HDL and LDL. There was homogeneity of
based randomization program. No subjects were variances, as assessed by Levene’s (p > .05) for all
dropped out from the study following randomization. dependent variables. Accordingly, 2x2 Mixed MANOVA
Interventions test was used to compare total cholesterol, HDL and
Group (A) included 20 post-menopausal women who LDL at different measuring periods at the two groups.
received cupping therapy, once/month for 3 months, The p-value of less than 0.05 was considered significant,
while group (B) included 20 post-menopausal women while the p-value of less than 0.01 was considered highly
who didn’t receive any therapy. significant (Salleh et al. 2019).
Cupping therapy
All post-menopausal women in group (A) received RESULTS
wet cupping therapy, for 20 minutes, once per month, for Both groups were similar at baseline (p>0.05)
3 months. First, the skin was cleaned by alcohol and regarding age and BMI, and all outcome measures
suitable sized cups were placed on the vertex, both (Tables 1-2).
scapula and paravertebral to the lumbar region on both Statistical analysis using 2x2 mixed design MANOVA
sides. Then, the physical therapist sucked the air inside indicated that there were no significant effects of the
each cup via manual suction and left it for 3-5 minutes. tested group (the first independent variable) on the all
Second, the therapist removed the cups and made tested dependent variables (F=2.797, P=0.063). As well
superficial incisions on the skin by surgical blades after as, there were significant effects of the measuring
their sterilization. Third, the removed cups were periods (the second independent variable) on the tested
replaced again on the previous sites, suction was dependent variables (F=77.746, P=0.0001*).
applied again and cups were left for 3-5 minutes’ till filling Additionally, the interaction between the two
with blood. Fourth, the cups were removed. Finally, the independent variables was significant, which indicates
cupping areas were cleaned, sterilized by betadine and that the effect of the tested group (first independent
dressed (Abagale et al. 2019, Hairon et al. 2017, variable) on the dependant variables was influenced by
Mohammadi and Sabourmoghaddam 2019). All women the measuring periods (second independent variable)
were asked to fast for 12 hours before the session and (F=77.746, P=0.0001*). The total cholesterol and LDL
125 ml of fruit juice was given for each woman at the end showed a statistically highly significant reduction and
of the session. highly significant increase at HDL (P=0.0001) at group A
only. The post-treatment comparison of both groups
revealed a statistically highly significant reduction at total

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EurAsian Journal of BioSciences 14: 123-127 (2020) Abd EL-Ghaffaar et al.

Table 2. Descriptive statistics and Multiple pairwise non-significant difference within group (B). Additionally,
comparison tests (Post hoc tests) for the all dependent group (A) had significantly lower levels of LDL-C when
variables for both groups at different measuring periods compared to group (B) post-treatment. These findings
Group A Group B
Post Pre Post agreed with Niasari et al. (2007) who investigated the
Variables Pre treatment
treatment treatment treatment effectiveness of wet cupping in reducing the serum LDL-
304.71
Cholesterol 30.3.23±35.36 279.84 ±33.30
±29.01
304.71±29.01 C levels of healthy men, protecting them from
HDL 58.5±18.52 65.61 ±18.03
49.82
49.82±16.88
developing atherosclerosis. Additionally, Mustafa et al.
±16.88 (2012) found a significant decrease in LDL-C levels at
166.21 166.21
LDL 155.92±32.27 137.46 ±28.75 the next two weeks after wet cupping in hyperlipidemic
±28.06 ±28.06
Within groups (Pre Vs. post) patients. Moreover, Refaat et al. (2014) reported a
Total
p-value
cholesterol
HDL LDL significant reduction in LDL-C after 2 months of wet
Group A .0001* .0001* 0.0001* cupping. Furthermore, Hairon et al. (2017) found a
Group B 1.00 1.00 1.00
significant reduction in LDL-C levels in the cupping
Between groups (group A Vs. group B)
Total cholesterol HDL LDL group from pre-treatment to the third and fourth months.
Pre treatment 0.906 0.214 0.384 In contrast, Alajwad et al. (2018) reported that wet
Post
treatment
0.04* 0.027* 0.014* cupping has no effect on LDL-C levels in hyperlipidemic
*Significant at the alpha level (p < 0.05) males and females.
Concerning HDL-C, it showed a statistically
cholesterol and LDL and highly significant increase at significant increase within group (A), while it showed a
HDL in favour of group (A) (Table 2). non-significant difference within group (B). Additionally,
group (A) had significantly higher HDL-C levels when
DISCUSSION compared to group (B) post-treatment. These results
could be supported by Refaat et al. (2014) who found
Hypercholesterolemia has high prevalence in the
that 2 months of wet cupping significantly improved
elderly people due to its connection to comorbidity as
HDL-C levels in healthy men. Also, Hairon et al. (2017)
well as genetic and environmental factors, with a higher
reported the efficacy of cupping therapy in increasing
incidence in post-menopausal women than men. The
HDL-C levels from baseline to the third and fourth
high cholesterol levels increase the risk of elderly people
months. Conversely, Niasari et al. (2007) showed that
to develop coronary heart diseases (Davidson et al.
cupping therapy has no impact on HDL-C levels of
2002, Félix-Redondo et al., 2013). Thus, the present
healthy men. Additionally, Mustafa et al. (2012) and
study was conducted to investigate the response of
Alajwad et al. (2018) showed non-significant changes in
cholesterol to cupping therapy in post-menopausal
HDL-C levels in hyperlipidemic patients received
women with hypercholesterolemia.
cupping therapy.
Concerning total cholesterol, it showed a statistically
The contrast among studies regarding different
significant decrease within group (A), while it showed a
cholesterol levels (total cholesterol, LDL-C and HDL-C)
non-significant difference within group (B). Additionally,
could be related to the variation in the design and
group (A) had significantly lower levels of total
duration of the study, the age and sex of the treated
cholesterol as compared to group (B) post-treatment.
sample, as well as the technique and site of cupping
These results were consistent with Fikri et al. (2010) who
application.
found a significant reduction in total cholesterol of
The results of the current study showed that cupping
hypercholesterolemic patients by 12% in the group of
therapy for 3 months had a positive effect on serum
cupping when compared to the control group. Also,
levels of cholesterol through decreasing total cholesterol
Mustafa et al. (2012) reported a significant reduction in
and LDL-C levels and increasing HDL-C levels in
total cholesterol levels following cupping therapy by one
hypercholesterolemic post-menopausal women. These
week and two weeks. In addition, Hairon et al. (2017)
findings could be attributed to the detoxifying effect of
found a significant decrease in total cholesterol levels
cupping as it clears blood from pathological substances,
from baseline to the third and fourth months in the
like total cholesterol and LDL-C, through skin scarifying
cupping group. Moreover, Alajwad et al. (2018)
and blood suctioning by the cups. In the cupped area,
concluded that cupping is an effective modality in
certain vasodilators like histamine, adenosine and
decreasing the serum levels of total cholesterol after one
noradrenaline enhance vasodilatation of blood vessels,
week of application in hyperlipidemic patients. On the
resulting in circulatory improvement and toxins
other hand, Niasari et al. (2007) and Refaat et al. (2014)
elimination from the body (El Sayed et al. 2014, Al-
reported non-significant differences with regard to total
Bedah et al. 2018). The blood detoxification effect of
cholesterol levels in healthy men subjected to cupping
cupping could be confirmed by previous studies that
therapy.
compared the cholesterol levels between the cupping
Concerning LDL-C, it showed a statistically
blood and the venous blood. They found higher levels of
significant reduction within group (A), while it showed a
cholesterol in the cupping blood than in the venous

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blood. Accordingly, they assumed that there might be an CONCLUSION

unrecognized substance in the cupping blood that is Cupping therapy has favorable effects on reducing
drawn and removed from the body by cupping and its total cholesterol and LDL-C serum levels as well as
removal might create a proper balance between different increasing HDL-C serum levels in post-menopausal
vital parameters (Bilal et al. 2011, Mahdavi et al. 2012). women with hypercholesterolemia. Thus, it may have a
prophylactic effect against cardiovascular diseases.

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