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Stress management important for heart, reducing cardiac events

Kathleen Blanchard's picture
Stress and heart disease

Managing stress is especially important for patients with heart disease, now found to reduce cardiac related events.

Researchers say stress accounts for approximately 30 percent of heart attacks. For those with existing heart disease, stress management from cognitive behavioral therapy (CBT) reduced the incidence of fatal and non-fatal heart related events by 41 percent, shown in a study.

The research, conducted by Mats Gulliksson, M.D., Ph.D., and colleagues at Uppsala University Hospital, Uppsala, Sweden, conducted a randomized, controlled trial that included 392 adults who had had a heart disease related event within the previous twelve months. Of those, 192 were randomly assigned to behavioral therapy that included targeted goals for managing stress and delivered in 20 two-hour sessions during one year. The other group of 170 participants received usual care.

The authors write, "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 groups were separated by gender.

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Average follow up of 94 months revealed the stress management group had a 41 percent lower rate of fatal and non-fatal heart events, and 45 percent fewer recurrent heart attacks. Death rates were 28 percent lower, compared to those who did not receive behavioral therapy. They also noted the risk reduction is even lower with more frequent behavioral therapy sessions.

According to the authors, stress is believed to worsen heart disease and promotes atherosclerosis. Examples of daily stressors include "low socioeconomic status, low social support, marital distress and work distress; and emotional factors, including major depression, hostility, anger and anxiety." The lower incidence of cardiac related events found in the study from CBT shows the importance of curbing stress to reduce risk factors for heart disease.

The study authors concluded, "This 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."

The researchers say the findings are significant and show stress management through cognitive behavioral therapy is important for patients with heart disease. They speculate the reduced incidence of heart related events found in the study is the result of reduced burden on the cardiovascular system that increases with emotional reactivity.

Arch Intern Med. 2011;171(2):134-140. doi:10.1001/archinternmed.2010.510