Those in program
had 41% fewer fatal and non-fatal heart events and a 28% lower death
Jan. 24, 2011 -
A cognitive behavioral therapy program focusing on stress management
appears to decrease the risk of recurrent heart attacks by 45 percent
and other cardiovascular events in patients with heart disease,
according to a report in the January 24 issue of Archives of Internal
Medicine, one of the JAMA/Archives journals.
and social factors account for an estimated 30 percent of heart attack
risk, according to background information in the article.
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," the authors write.
These issues are
believed to contribute to the risk of heart disease even after adjusting
for the effects of traditional risk factors.
controlled clinical trial of cognitive behavioral therapy (CBT) among
362 men and women discharged from the hospital after a coronary heart
disease event within the previous 12 months was conducted by Mats
Gulliksson, M.D., Ph.D., and colleagues at Uppsala University Hospital,
A group of 192
patients were randomly assigned to participate in CBT.
"The program has
five key components with specific goals - education, self-monitoring,
skills training, cognitive restructuring and spiritual development - and
is focused on stress management, coping with stress and reducing
experience of daily stress, time urgency and hostility," the authors
delivered in 20 two-hour sessions during one year, in small groups
separated by sex. The other 170 patients received traditional care.
There was a
follow-up with participants that averaged 94 months.
Results for the
CBT group were:
● 23 participants died,
● 69 (35.9 percent) had a non-fatal cardiovascular event and
● 41 (21.4 percent) had a non-fatal heart attack.
This compares to
the traditional care group results:
● 25 deaths,
● 77 (45.3 percent) non-fatal cardiovascular events and
● 51 (30 percent) non-fatal heart attacks.
Patients in the
CBT group had a 41 percent lower rate of both fatal and non-fatal heart
events, 45 percent fewer recurrent heart attacks and a non-significantly
lower rate of death (28 percent) than patients in the traditional care
group. Attending a higher proportion of the therapy sessions was
associated with a further reduction in risk.
imply that, to affect cardiovascular disease or coronary heart disease
end points, the interventions need to be long-term (possibly six to 12
months), be conducted in groups and include specific techniques for
altering behavior," the authors write.
mechanism is decreased behavioral and emotional reactivity, which would
lead to less psychophysiologic burden on the cardiovascular system."
represent not only statistical significance but also clinical
importance, the authors note.
demonstrates the potential efficacy of adding CBT to secondary
preventive programs after acute myocardial infarction (heart attack) for
better patient adherence to treatment and better outcome," they
Author Janet Bond
Brill inspired after her father dies from
second heart attack; focus is on 8 foods, includes recipes
Jan. 12, 2011 - Each year, roughly 1.5 million
Americans have a heart attack -- and most of them survive. But research
shows that just one year after their diagnosis, the vast majority of
these 13 million American heart attack survivors fail to adhere to the
dietary changes that could prevent a second heart attack.
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