Effects of stress reduction on carotid atherosclerosis in hypertensive African Americans

Background and Purpose-African Americans suffer disproportionately higher c ardiovascular disease mortality rates than do whites. Psychosocial stress i nfluences the development and progression of atherosclerosis, Carotid intim a-media thickness (IMT) is a valid surrogate measure for coronary atheroscl erosis, is a predictor of coronary outcomes and stroke, and is associated w ith psychosocial stress factors. Stress reduction with the Transcendental M editation (TM) program decreases coronary heart disease risk factors and ca rdiovascular mortality in African Americans. B-mode ultrasound is useful fo r the noninvasive evaluation of carotid atherosclerosis, Methods-This randomized controlled clinical trial evaluated the effects of the TM program on carotid IMT in hypertensive African American men and wome n, aged >20 years, over a 6- to 9-month period. From the initially enrolled 138 volunteers, 60 subjects completed pretest and posttest carotid IMT dat a. The assigned interventions were either the TM program or a health educat ion group. By use of B-mode ultrasound, mean maximum IMT from 6 carotid seg ments was used to determine pretest and posttest IMT values. Regression ana lysis and ANCOVA were performed. Results-Age and pretest IMT were found to be predictors of posttest IMT val ues and were used as covariates. The TM group showed a significant decrease of -0.098 mm (95% CI -0.198 to 0.003 mm) compared with an increase of 0.05 4 mm (95% CI -0.05 to 0.158 mm) in the control group (P=0.038, 2-tailed). Conclusions-Stress reduction with the TM program is associated with reduced carotid atherosclerosis compared with health education in hypertensive Afr ican Americans, Further research with this stress-reduction technique is wa rranted to confirm these preliminary findings.