A stress-management program can help heart patients reduce their risk of heart attacks or the need for surgery.
In a study of 107 patients, all suffered from impaired blood flow to the heart in 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.
Among the estimated 11 million Americans with heart disease, 50% to 60% are believed to develop ischemia under mental stress and 40% to 50% during normal daily activities, said the lead researcher, James A. Blumenthal, a professor of medical psychology at Duke University Medical Center.
All 107 patients belonged to one of those categories, documented by medical tests. They were divided into three groups. One group took a four-month stress management program, another underwent 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 a "cardiac event," 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% reduction in risk [in the stress-management group] relative to routine medical care," Blumenthal said.
The risk was calculated after taking into account differences in other traits that can affect heart risk, such as age, sex and the severity of initial heart disease, the researchers reported in the American Medical Assn.'s Archives of Internal Medicine.
The risk reduction in patients who had undergone the exercise program, which consisted of brisk walking or jogging for 35 minutes three times weekly, was not statistically significant, the researchers said.
The stress-management program involved weekly sessions lasting 1 1/2 hours. They included classroom teaching about heart disease and stress, training in stress-reduction skills such as avoiding stressful situations or responding to them differently with biofeedback, and group support, Blumenthal said.
An expert on stress and the heart who did not participate in the work called it "a wonderful initial study to justify a larger randomized clinical trial of stress management and exercise training."
"It's a very provocative finding, if replicated," said the expert, Richard P. Sloan, coordinator of the behavioral medical program at Columbia-Presbyterian Medical Center in New York.
Although many studies have linked emotional stress with an increased risk of heart attacks, this is one of the first to report that stress reduction can actually reduce the risk, he said.