A stress-management program helped heart patients reduce their risk of heart attacks or the need for surgery by 74 percent, researchers reported in the Oct. 27 issue of the American Medical Association's Archives of Internal Medicine.
"In addition to diet, quitting smoking and controlling blood pressure, you need to think about managing stress" to avert potentially fatal heart problems, said James Blumenthal, a professor of medical psychology at Duke University Medical Center and the lead researcher.
All 107 patients studied showed impaired blood flow to the heart during mental stress tests or during normal daily activities when they wore heart monitors. Such impaired blood flow, called ischemia, is known to worsen the outlook for heart patients, Blumenthal said.
Among the estimated 11 million Americans with heart disease, 50 percent to 60 percent are believed to develop ischemia under mental stress, he said, and 40 percent to 50 percent during normal daily activities.
All of the patients studied belonged to one of those categories, as documented by medical tests, and were broken into three groups. One group took a four-month stress management program, another a four-month exercise program and the third received usual heart care from their personal physicians.
In the next three years, only three of the 33 people in the stress-management group suffered "cardiac events," defined as a fatal or nonfatal heart attack or a surgical procedure such as bypass or angioplasty. In the same period, seven of the 34 people in the exercise group and 12 out of the 40 patients in usual care suffered such events.
There was a 74 percent reduction in risk in the stress-management group compared to routine medical care, Blumenthal said Friday.
The risk was calculated after controlling for differences in other traits that can affect heart risk, such as age, sex and the severity of initial heart disease.
The risk reduction in patients in the exercise program, which consisted of brisk walking or jogging for 35 minute periods three times weekly, was not statistically significant, researchers said.
The stress-management program involved weekly sessions lasting 1 1/2 hours. It included instruction on heart disease and stress; training in stress-reduction skills, such as avoiding stressful situations or responding to them differently; and group support, Blumenthal said.
An expert on stress and the heart who did not participate in the study said it was a good step toward justifying a larger test of stress management and exercise training.
"It's a very provocative finding, if replicated," said Richard Sloan, coordinator of the behavioral medical program at Columbia-Presbyterian Medical Center in New York.
Though many studies have linked emotional stress with an increased risk
of heart attacks, he said, this is one of the first to report that
stress reduction can actually reduce the risk.