Abstract 1177: Effects of Stress Reduction on Clinical Events in African Americans With Coronary Heart Disease: A Randomized Controlled Trial
Introduction: Atherosclerotic cardiovascular disease (CVD) is the leading cause of death in the US. African Americans suffer from disproportionately high rates of mortality and morbidity from CVD. Substantial epidemiological and mechanistic research has demonstrated that psychosocial stress contributes to CVD pathophysiology and clinical events. However, there is paucity of clinical trial data on the effects of stress reduction on cardiovascular clinical events. Previous controlled clinical studies have reported that a selected stress reduction technique, the Transcendental Meditation program is associated with reductions in CVD risk factors–hypertension, insulin resistance, and psychosocial stress and surrogate markers of disease–carotid intima-media thickness, left ventricular mass and stress-induced myocardial ischemia.
Objective: To evaluate the effects of stress reduction with the Transcendental Meditation program on cardiovascular clinical events in a high-risk group of African Americans.
Methods: The subjects were 201 African American participants (46% female, mean age 58) with angiographically documented coronary artery disease. Subjects were randomly allocated to either the Transcendental Meditation program or health education control. The intervention arms were matched for nonspecific factors. Usual care was continued in all subjects. The primary outcome was a composite of death from any cause, myocardial infarction or stroke. Secondary outcomes included blood pressure, body mass index and a psychosocial stress index including depression, anger and hostility.
Results: After 5 years of follow-up, the risk (hazard) ratio for the primary outcome of clinical events was 0.57 (p=.048). Systolic BP decreased by mean of 5.1 mm Hg (p=.012). Subgroup analyses showed reduction in psychosocial stress in the high stress subgroup (p=.047). There were no significant changes in diastolic BP or BMI.
Conclusion: Stress reduction with the Transcendental Meditation program was associated with 43% reduction in risk for all cause mortality, myocardial infarction and stroke in a high-risk sample of African Americans. A selected stress reduction approach may be useful in the secondary prevention of atherosclerotic CVD.