Lower Stress to Promote Heart Health

It is estimated that psychosocial factors account for an estimated 30% of heart attack risk.  Such factors that may promote atherosclerosis and cardiovascular disease belong to two general categories: chronic stressors, including low socioeconomic status, low social support, marital distress and work distress; and emotional factors, including major depression, hostility, anger and anxiety. It is thought that psychosocial factors exert a role in the risk of heart disease, even after adjusting for the effects of traditional risk factors. Mats Gulliksson, from Uppsala University Hospital (Sweden), and colleagues studied the effects of a cognitive behavioral therapy program, involving 362 men and women discharged from the hospital after a coronary heart disease event within the previous 12 months. A group of 192 patients were randomly assigned to participate in cognitive behavioral therapy, involving the specific components of education, self-monitoring, skills training, cognitive restructuring and spiritual development; and focusing on stress management.  Therapy was delivered in 20 two-hour sessions during one year, in small groups separated by sex. The other 170 patients enrolled in the study received traditional care.  During an average 94 months of follow-up, 23 participants in the cognitive behavioral therapy group died, 69 (35.9%) had a non-fatal cardiovascular event and 41 (21.4%) had a non-fatal heart attack. This compares to 25 deaths, 77 non-fatal cardiovascular events (45.3%) and 51 non-fatal heart attacks (30%) in the traditional care group.  Importantly, patients in the cognitive behavioral therapy group had a 41% lower rate of both fatal and non-fatal heart events, 45% fewer recurrent heart attacks and a lower rate of death (28%), as compared to those in the traditional care group.  Writing that: “A [cognitive behavioral therapy] intervention program decreases the risk of recurrent [cardiovascular disease] and recurrent acute myocardial infarction,” the researchers submit that: “This may have implications for secondary preventive programs in patients with coronary heart disease.”