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Women's hearts: ischaemic heart disease and stress management in women
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Acute myocardial infarction (AMI), caused by ischaemic heart disease (IHD), is a leading cause of death in both men and women in the western society. Hypertension, diabetes, and smoking are examples of well-known risk factors of IHD, but also there are psychosocial factors, such as stress, vital exhaustion (unusual fatigue, irritability, and demoralization) and depression that have been associated with an increased risk in both genders. After an AMI, however, women are more likely than men to be psychosocially impaired resulting in suffering and a presumed increase in the risk of recurrent cardiac events.

Psychosocial factors may be targeted in secondary prevention, complementary to drug treatment and conventional lifestyle advice. There is some evidence of beneficial effects on both psychosocial well-being and cardiac outcomes by psychosocial interventions in men. Far fewer women have been studied and the results have been inconsistent. It is not clear how psychosocial factors convey the increased risk of cardiac events, but many possible psychopathological mechanisms, including biochemical and physiological links, have been suggested.

In the Women’s Hearts study we have, in a randomised controlled trial, evaluated a one-year cognitive-behavioural stress management programme designed specifically for women with IHD. We included 198 women with IHD, with a mean age of 61 years and from the county of Västerbotten in Northern Sweden, who were randomised to either conventional treatment and follow-up, or to stress management in addition to conventional care. Extensive questionnaires, blood samplings, and biomedical and physiologic data were obtained before randomisation, as well as at follow-ups approximately one and two years after randomisation. Two groups of healthy controls were included for comparisons with women with IHD.

Compared to women without IHD, women with IHD reported more stress behaviour and vital exhaustion. Women with IHD also had a lower heart rate variability (HRV) than the healthy controls, possibly reflecting a dysfunctional autonomic nervous regulation of the heart. Reduced HRV has been shown to increase the risk of cardiac arrhythmias and sudden death.

At the first follow-up, performed at the end of the one-year stress management programme, women who had participated in the programme had reduced the stress behaviour and vital exhaustion, compared to the women in the conventional care group. We could not find any evidence of a direct cause-effect relationship between stress management and biological cardiovascular risk indicators, or HRV; the intervention and control groups did not differ in insulin resistance, inflammatory, haemostatic and fibrinolytic factors, or HRV.

At second follow-up one year later, several additional psychosocial domains were studied. The stress management programme had accelerated psychosocial recovery at the first follow-up over and above that observed in the control group. At the second follow-up, there was further marked improvement in the control group, so the differences in psychosocial variables between the intervention and control groups were no longer significant.

In conclusion, a cognitive-behavioural stress management programme could accelerate psychosocial improvement in women with IHD, and thus reduce the amount of psychological and psychosocial suffering. We could not find any evidence that the stress management programme was associated with a concomitant improvement in biological cardiovascular risk indicators, or HRV. Our results suggest that the women with the greatest psychosocial burden should be identified and targeted in new clinical trials of cognitive-behavioural interventions in women with IHD. Future studies within the Women’s Hearts project will evaluate the psychosocial effects at a five-year follow-up, as well as investigations of other possible pathways by which psychosocial interventions might mediate beneficial effects on cardiac events.

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin , 2006. , 82 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1011
Keyword [en]
Medicine, ischaemic heart disease, women, cognitive-behavioural therapy, psychosocial risk factors, inflammation, leptin, haemostasis, fibrinolysis, insulin resistance, HRV, ischemic heart disease, cognitive behavioral therapy, heart rate variability, chd, cvd, cad
Keyword [sv]
Medicin
National Category
Dermatology and Venereal Diseases
Research subject
Medicine
Identifiers
URN: urn:nbn:se:umu:diva-725ISBN: 91-7264-037-5 (print)OAI: oai:DiVA.org:umu-725DiVA: diva2:144325
Public defence
2006-03-31, E04, 6E, Norrlands Universitetssjukhus, 901 85, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2006-03-14 Created: 2006-03-14 Last updated: 2009-10-01Bibliographically approved
List of papers
1. Psychosocial distress and impaired quality of life - targets neglected in the secondary prevention in women with ischaemic heart disease
Open this publication in new window or tab >>Psychosocial distress and impaired quality of life - targets neglected in the secondary prevention in women with ischaemic heart disease
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2003 (English)In: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, Vol. 10, no 4, 258-266 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-4987 (URN)10.1097/01.hjr.0000085255.65733.68 (DOI)14555880 (PubMedID)
Available from: 2006-03-14 Created: 2006-03-14Bibliographically approved
2. Women's hearts - stress management for women with ischemic heart disease: explanatory analyses of a randomized controlled trial.
Open this publication in new window or tab >>Women's hearts - stress management for women with ischemic heart disease: explanatory analyses of a randomized controlled trial.
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2005 (English)In: Journal of Cardiopulmonary Rehabilitation (JCR), ISSN 0883-9212, E-ISSN 1539-0691, Vol. 25, no 2, 93-102 p.Article in journal (Refereed) Published
Keyword
Adult, Aged, Cognitive Therapy, Depression/prevention & control/psychology, Fatigue/prevention & control/psychology, Female, Humans, Middle Aged, Myocardial Ischemia/*psychology, Patient Compliance, Prospective Studies, Quality of Life, Questionnaires, Self Assessment (Psychology), Stress; Psychological/*prevention & control
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-13395 (URN)15818198 (PubMedID)
Available from: 2007-12-06 Created: 2007-12-06 Last updated: 2013-04-02Bibliographically approved
3. Women's Hearts - Follow-up of Cognitive-Behavioural Stress Management in Women with Ischaemic Heart Disease: A randomised controlled trial
Open this publication in new window or tab >>Women's Hearts - Follow-up of Cognitive-Behavioural Stress Management in Women with Ischaemic Heart Disease: A randomised controlled trial
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Manuscript (Other academic)
Identifiers
urn:nbn:se:umu:diva-4989 (URN)
Available from: 2006-03-14 Created: 2006-03-14 Last updated: 2010-01-13Bibliographically approved
4. Cognitive-behavioural stress management does not improve biological cardiovascular risk indicators in women with ischaemic heart disease: a randomized-controlled trial.
Open this publication in new window or tab >>Cognitive-behavioural stress management does not improve biological cardiovascular risk indicators in women with ischaemic heart disease: a randomized-controlled trial.
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2006 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 260, no 4, 320-331 p.Article in journal (Refereed) Published
Keyword
Biological Markers/analysis, C-Reactive Protein/analysis, Cognitive Therapy/*methods, Female, Fibrinogen/analysis, Humans, Insulin Resistance/physiology, Leptin/blood, Middle Aged, Myocardial Ischemia/*psychology, Plasminogen Activator Inhibitor 1/blood, Prospective Studies, Risk Factors, Stress; Psychological/*therapy, Tissue Plasminogen Activator/metabolism, von Willebrand Factor/analysis
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-5744 (URN)10.1111/j.1365-2796.2006.01691.x (DOI)16961669 (PubMedID)
Available from: 2008-01-22 Created: 2008-01-22 Last updated: 2013-04-02Bibliographically approved
5. Heart Rate Variability and Stress Management in Women with Ischaemic Heart Disease
Open this publication in new window or tab >>Heart Rate Variability and Stress Management in Women with Ischaemic Heart Disease
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Manuscript (Other academic)
Identifiers
urn:nbn:se:umu:diva-4991 (URN)
Available from: 2006-03-14 Created: 2006-03-14 Last updated: 2010-01-13Bibliographically approved

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Citation style
  • apa
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