Cognitive Behavioral Therapy Decreases Risk for Recurrent Cardiac Events

Emma Hitt, PhD

January 24, 2011

January 24, 2011 — In patients with coronary heart disease, cognitive behavioral therapy (CBT) appears to be associated with lower rates of recurrent acute myocardial infarctions (AMIs) and coronary heart disease events, according to new research.

Mats Gulliksson, MD, PhD, and colleagues from the Uppsala University Hospital in Sweden conducted the randomized controlled trial, called the Secondary Prevention in Uppsala Primary Health Care Project, to determine whether use of CBT was associated with a reduced incidence for heart disease recurrence. They reported the findings in the January 24 issue of the Archives of Internal Medicine.

According to the authors, results from previous studies on psychological treatment programs for patients with coronary heart disease have been inconclusive. "Psychosocial factors have been shown to account for approximately 30% of the attributable risk of acute myocardial infarction," the authors note. They add that emotional factors include anxiety, depression, anger, and hostility, whereas chronic stressors include social support, work or marital stressors, and socioeconomic status.

The study focused on emotional factors and the management of stress with the use of CBT. A total of 362 men and women aged 75 years or younger who had been hospitalized with a cardiac event were included. Of the patients, the reference group (170 patients) received traditional care, whereas the intervention group (192 patients) received traditional care and CBT.

CBT consisted of 20 two-hour sessions during a year's time where participants learned different methods to manage and reduce stress. Mean follow-up time was 94 months. Eight patients attended fewer than 50% of the sessions. All patients attended at least 1 session.

Use of CBT was associated with lower rates of recurrent AMI (P = .007) and nonfatal and fatal recurrent coronary heart disease events (P = .002). All-cause mortality was not significantly different between groups (P = .28).

"A strong dose-response relationship between attendance rate at the intervention program sessions and risk of recurrent CVD [cardiovascular disease] or recurrent AMI was observed: the higher the attendance rates, the lower the risk," Dr. Gulliksson and colleagues point out.

The authors suggest that a possible explanation for the findings is "decreased behavioral and emotional reactivity, which would lead to less psychophysiologic burden on the cardiovascular system."

The study was not commercially supported. The authors have disclosed no relevant financial relationships.

Arch Intern Med. 2011;171:134-140. Abstract


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