Psychological risk factors may moderate pharmacological treatment effects among ischemic heart disease patients

Background: Numerous research findings support the proposed connection betw een such psychological characteristics as stress and hostility and the mani festation of disease. However, less evidence is available concerning the ro le(s) psychological factors might play in the process of disease recovery. Methods: Eighty patients with known coronary disease and exercise-induced i schemia underwent treadmill exercise testing and 48-hour ambulatory electro cardiographic monitoring and completed a battery of standardized psychologi cal tests assessing hostility, depression, and daily stress on four occasio ns during a 12-week pharmacological treatment study. After withdrawal of an tiischemic drugs at baseline, patients returned for subsequent tests at 3-w eek intervals. During the second and third intervals, patients were prescri bed one of two antiischemic medications. atenolol or amlodipine, or given a placebo. All patients were then placed on a combination treatment protocol for the 3 weeks before the final testing date. Results: The combination tr eatment produced highly significant benefits across all measured cardiac va riables (20.3% improvement in exercise performance, 13% reduction in report ed angina, 64.0% reduction in the frequency of: ischemic episodes; for all, p < .01). However, results showed that high baseline levels of daily stres s were associated with reliably smaller treatment effects;ls on measures of ischemia frequency and treadmill exorcise time and with a significantly gr eater likelihood of reporting angina after treatment (r = -0.24, -0.25, and -0.33, respectively; p < .05). In addition, high baseline hostility predic ted significantly smaller diastolic blood pressure improvements (r = -0.29, p < .05). Conclusions: These results indicate that psychological risk fact ors may have globally negative effects on the course of treatment and sugge st particular factors that may warrant attention in trials targeting cardia c symptom reduction.