Published Online
on January 6, 2009

A more recent version of this article appeared on January 1, 2009

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Original Article

Stress Reduction Prolongs Life in Women With Coronary Disease

Kristina Orth-Gomér, MD, PhD;; Neil Schneiderman, PhD; Hui-Xin Wang, PhD; Christina Walldin, RN; May Blom, RN, PhD and Tomas Jernberg, MD, PhD, FACC

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

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.

This article has been cited by other articles:

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				H. M. Krumholz Outcomes Research: Myths and Realities Circ Cardiovasc Qual Outcomes, January 1, 2009; 2(1): 1 - 3. [Full Text] [PDF]

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Letter regarding Orth-Gomér et al.

Edward P. Havranek

Circ Cardiovasc Qual Outcomes Online, 2 Feb 2009 [Full text]