STRESS MANAGEMENT AND EXERCISE TRAINING IN CARDIAC PATIENTS WITH MYOCARDIAL-ISCHEMIA - EFFECTS ON PROGNOSIS AND EVALUATION OF MECHANISMS

Background: Previous studies have demonstrated that myocardial ischemi a can be elicited by mental stress in the laboratory and during daily life and that ischemia induced by mental stress is associated with an increased risk for future cardiac events in patients with coronary art ery disease. Objectives: To examine the extent to which ischemia induc ed by mental stress can be modified by exercise or stress management, and to evaluate the impact of these interventions on clinical outcomes . Methods: One hundred seven patients with coronary artery disease and ischemia documented during mental stress testing or ambulatory electr ocardiographic monitoring were randomly assigned to a 4-month program of exercise or stress management training. Patients living at a distan ce from the facility formed a nonrandom, usual care comparison group. Myocardial ischemia was reassessed following treatment, and patients w ere contacted annually for as long as 5 years to document cardiac even ts, including death, nonfatal myocardial infarction, and cardiac revas cularization procedures. Results: Twenty-two patients (21%) experience d at least 1 cardiac event during a mean (+/-SD) follow-up period of 3 8+/-17 months. Stress management was associated with a relative risk o f 0.26 compared with controls. The relative risk for the exercise grou p also was lower than that of controls, but the effect did not reach s tatistical significance. Stress management also was associated with re duced ischemia induced by mental stress and ambulatory ischemia. Concl usion: These data suggest that behavioral interventions offer addition al benefit over and above usual medical care in cardiac patients with evidence of myocardial ischemia.