Stress Reduction Prolongs Life in Women With Coronary Disease

Abstract

Background-Psychosocial stress may increase risk and worsen prognosis of coronary heart disease in women.Interventions that counteract women's psychosocial stress have not previously been presented. This study implemented a stress reduction program for women and investigated its ability to improve survival in women coronary patients. Methods and Results-Two hundred thirty-seven consecutive women patients, aged 75 years or younger, hospitalized for acute myocardial infarction, coronary artery bypass grafting, or percutaneous coronary intervention were randomized to a group-based psychosocial intervention program or usual care. Initiated 4 months after hospitalization, intervention groups of 4 to 8 women met for a total of 20 sessions that were spread over a year. We provided education about risk factors, relaxation training techniques, methods for self-monitoring and cognitive restructuring, with an emphasis on coping with stress exposure from family and work, and self-care and compliance with clinical advice. From randomization until end of follow-up (mean duration, 7.1 years), 25 women (20%) in the usual care and 8 women (7%) in the stress reduction died, yielding an almost 3-fold protective effect of the intervention (odds ratio, 0.33; 95% CI, 0.15 to 0.74; Pϭ0.007). Introducing baseline measures of clinical prognostic factors, including use of aspirin, ␤-blockers, angiotensin-converting enzyme inhibitors, calcium-channel blockers, and statins into multivariate models confirmed the unadjusted results (Pϭ0.009). Conclusions-Although

Sex Differences in Clinical Characteristics, Psychosocial Factors, and Outcomes Among Patients With Stable Coronary Heart Disease: Insights from the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) Trial

“…Patients with a harmonious relationship with a partner may have more social support, healthier habits, better medical adherence, and less psychological stress. Meanwhile, a group‐based stress‐reduction intervention program for women with previous MI or revascularization procedures was associated with improved survival compared with usual care 24. In the general population, the impact of stress on cardiovascular risk factors, specifically high blood pressure, might be mediated by the type of occupation; namely, higher stress levels are associated with high blood pressure in people with low occupational status but with lower blood pressure in those with a higher occupational status 25.…”

2016 European Guidelines on cardiovascular disease prevention in clinical practice

“…251 In addition to the treatment of mood symptoms, there are several other approaches to psychosocial intervention that have proved useful. Two RCTs 252,253 have shown the favourable impact of stress management and social support groups on the prognosis of clinical CAD. Nurse-led interventions reveal beneficial effects on anxiety, depression and general well-being in CAD patients.…”

Psychological Aspects of Cardiac Care and Rehabilitation: Time to Wake Up to Sleep?

“…Some observers have suggested that TABP may have suffered a premature demise given recent evidence showing that interventions targeting TABP have led to improved depression [27], and even improved cardiac endpoints for female CHD patients in particular [28,29]. Aspects of TAPB are also implicitly addressed in interventions such as transcendental meditation (TM) and mindfulness based stress reduction (MBSR) which are sometimes available to patients attending CR [30].…”