Stress Relief

Jul 3, 2011
Stress Reduction Approach May Help Reduce Risk of Cardiovascular Events in African-American Patients With Cardiovascular Disease

A stress reduction approach using meditation techniques in African-American patients who have coronary heart disease (CHD) appears to reduce the risk of death, myocardial infarction (heart attack) and stroke, and also is associated with reduced blood pressure and stress levels, according to a report published Online First today in Archives of Internal Medicine, one of the JAMA/Archives journals.1

According to background information in the article, cardiovascular disease (CVD) is the leading cause of death in the United States and worldwide. The authors note that African Americans have higher rates of CVD-related illness and death, and that psychosocial stress might be a contributing factor. “The disparity in CVD in African Americans may be related, at least in part, to high levels of psychosocial and environmental stress,” they write.

Robert H. Schneider, M.D., from the Maharishi University of Management, Maharishi Vedic City, Iowa, and colleagues investigated the effect of stress reduction with the Transcendental Meditation (TM) program, in 201 African American patients with CHD. The clinical portion of the study was conducted at the Medical College of Wisconsin, Milwaukee.

The researchers theorized that the effects of a stress reduction intervention would help reduce CVD risk factors and perhaps prevent CVD-related morbidity and mortality. Between 1998 and 2007, study participants either engaged in meditation techniques for 20 minutes twice per day, or spent the same amount of time practicing other heart-healthy lifestyle behaviors that they were taught in a cardiovascular health education program.

The researchers found that the group practicing meditation had a lower risk, compared with the control group, of experiencing the combined endpoint of cardiovascular events that included myocardial infarction or stroke, or death. This group also experienced a reduction in systolic blood pressure of, on average, 4.9 mm Hg (millimeters of mercury) more than the control group. Participants who entered the study with high blood pressure or high stress levels were more likely to have a lower risk of CVD-related illness and death if they were in the meditation group, versus the health education group.

The authors point out that in addition to a reduction in clinical endpoints, participants who practiced meditation techniques were more likely to experience less stress and anger. Those who adhered most closely to the protocol for meditation frequency and length had greater risk reduction. “The results of this trial placed in the context of other studies in the field suggest that the TM program is feasible and efficacious to clinically implement in patients with CHD for prevention of CVD clinical events and associated risk factors,” the researchers conclude. “These clinical data along with cost-effectiveness data have implications for the role of behavioral intervention in prevention-oriented cardiovascular practice and policy.”

An accompanying commentary discusses the role that psychosocial stress may play in CVD, and the relevance of the findings from the study by Schneider and colleagues.2 Besides aggravating the effects of other pathophysiologic risk factors, the article states, psychosocial stress may contribute to injury of the lining of the blood vessel wall and to early atherosclerosis. “Accordingly, interventions that address psychosocial stress offer new therapeutic opportunities to ameliorate CHD morbidity and mortality,” write Puja K. Mehta, M.D. and C. Noel Bairey Merz, M.D., both from Cedars-Sinai Medical Center in Los Angeles.

Although the study by Schneider and colleagues improved some measures of stress and anger in the intervention group, they point out, it did not seem to affect other measures. For example, the level of depression was not significantly different between the treatment and control groups.

This, apparently, is in concordance with other research which has not shown that stress reduction can reduce major adverse events by mitigating depression, isolation and lack of social support.
Still, Mehta and Bairey Merz note, the meditation practice studied by Schneider and colleagues appeared to benefit patients with CHD, offering “new hope for the beleaguered area of psychosocial stress intervention for improving health outcomes in our over 13 million women and men with established CHD in the United States.”

They urge further research into how these methods can best help patients. “Secondary prevention guidelines should include psychosocial stress interventions demonstrated to reduce morbidity and mortality,” they add. “Cardiac rehabilitation programs should reinvigorate their psychosocial screening and treatment options.”

1. Arch Intern Med. Published online June 27, 2011. doi:10.1001/archinternmed.2011.310.
2. Arch Intern Med. Published online June 27, 2011. 2011;doi:10.1001/archinternmed.2011.300.