Posted on Feb 09, 2011, 6 a.m.
Swedish team finds that cognitive behavioral therapy focusing on stress management helps to decrease the risk of recurrent heart attacks and other cardiovascular events in patients with heart disease.
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.”
Mats Gulliksson; Gunilla Burell; Bengt Vessby; Lennart Lundin; Henrik Toss; Kurt Svardsudd. “Randomized Controlled Trial of Cognitive Behavioral Therapy vs Standard Treatment to Prevent Recurrent Cardiovascular Events in Patients With Coronary Heart Disease: Secondary Prevention in Uppsala Primary Health Care Project (SUPRIM).” Arch Intern Med, Jan 2011; 171: 134 – 140.