Published online before print January 6, 2009, doi: 10.1161/CIRCOUTCOMES.108.812859
Original Articles |
Stress Reduction Prolongs Life in Women With Coronary Disease
The Stockholm Women’s Intervention Trial for Coronary Heart Disease (SWITCHD)
From the Department of Public Health Sciences (K.O.-G.), Karolinska Institute, Stockholm, Sweden; Behavioral Medicine Program (N.S.), Department of Psychology, Department of Neurobiology (H.-X.W.), Care Sciences and Society, Aging Research Center, University of Miami, Fla; the Department of Cardiology (C.W., M.B., T.J.), Karolinska University Clinics, Stockholm, Sweden; and the Department of Psychosomatics (K.O.-G.), Campus Benjamin Franklin, Charité Universitätsmedizin, Berlin, Germany.
Correspondence to Kristina Orth-Gomér, MD, PhD, Department of Psychosomatic Medicine, Charité Universitätsmedizin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, Germany. E-mail k.orth-gomer{at}ki.se
Received August 6, 2008; accepted November 14, 2008.
Background— Psychosocial stress may increase risk and worsen prognosis of coronary heart disease in women. Interventions that counteract women’s psychosocial stress have not previously been presented. This study implemented a stress reduction program for women and investigated its ability to improve survival in women coronary patients.
Methods and Results— Two hundred thirty-seven consecutive women patients, aged 75 years or younger, hospitalized for acute myocardial infarction, coronary artery bypass grafting, or percutaneous coronary intervention were randomized to a group-based psychosocial intervention program or usual care. Initiated 4 months after hospitalization, intervention groups of 4 to 8 women met for a total of 20 sessions that were spread over a year. We provided education about risk factors, relaxation training techniques, methods for self-monitoring and cognitive restructuring, with an emphasis on coping with stress exposure from family and work, and self-care and compliance with clinical advice. From randomization until end of follow-up (mean duration, 7.1 years), 25 women (20%) in the usual care and 8 women (7%) in the stress reduction died, yielding an almost 3-fold protective effect of the intervention (odds ratio, 0.33; 95% CI, 0.15 to 0.74; P=0.007). Introducing baseline measures of clinical prognostic factors, including use of aspirin, β-blockers, angiotensin-converting enzyme inhibitors, calcium-channel blockers, and statins into multivariate models confirmed the unadjusted results (P=0.009).
Conclusions— Although mechanisms remain unclear, a group-based psychosocial intervention program for women with coronary heart disease may prolong lives independent of other prognostic factors.
Key Words: coronary heart disease • women • psychosocial factors • intervention • mortality
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- Letter regarding Orth-Gomér et al.
- Edward P. Havranek
- Circ Cardiovasc Qual Outcomes Online, 2 Feb 2009 [Full text]