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Wankhar D, Prabu Kumar A, Vijayakumar V, A V, Balakrishnan A, Ravi P, Rudra B, K M. Effect of Meditation, Mindfulness-Based Stress Reduction, and Relaxation Techniques as Mind-Body Medicine Practices to Reduce Blood Pressure in Cardiac Patients: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e58434. [PMID: 38765359 PMCID: PMC11099499 DOI: 10.7759/cureus.58434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/22/2024] Open
Abstract
Elevated blood pressure is one of the major risk factors for cardiovascular diseases. Available evidence on mind-body medicine (MBM) techniques on blood pressure is inconclusive and provides conflicting results. The objective of the current systematic review and meta-analysis is to evaluate the effect of MBM techniques on blood pressure in patients with cardiovascular disease. Randomized control trials (RCTs) done between the years 2000 and 2020 on cardiovascular disease, using MBM techniques such as meditation, mindfulness-based stress reduction and relaxation techniques were searched through electronic databases such as PubMed, Cumulative Index to Nursing & Allied Health (CINAHL), EMBASE and Cochrane Library. Three authors independently performed article selection, data extraction and validation. Meta-analysis was performed using a random effect model and standardized mean difference (SMD) with 95% confidence interval (CI) estimated for the effect size. Fifteen RCTs with 927 patients were included in the meta-analysis. Heterogeneity among the studies was very high for all analyses (I2>94%). For studies comparing systolic blood pressure, MBM interventions show a significant (p=0.01) effect when compared to conventional treatment, an overall estimated effect size of SMD - 0.78 (95% CI: -1.36, -0.20). For studies comparing the diastolic blood pressure, MBM intervention did not show any significant effect when compared to the conventional treatment, an overall effect size of SMD -0.26 (95% CI: -0.91, 0.39). The findings of the meta-analysis suggest that MBM interventions may improve systolic blood pressure alone in patients with cardiac diseases. With high heterogeneity and low quality of the included studies, more robust evidence is required before suggesting MBM as an effective treatment modality for reducing blood pressure in cardiovascular diseases.
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Affiliation(s)
- Dapkupar Wankhar
- Physiology, People's College of Medical Sciences and Research Centre, Bhanpur, IND
| | - Archana Prabu Kumar
- College of Medicine and Medical Science, Arabian Gulf University, Manama, BHR
| | | | - Velan A
- Yoga, International Institute of Yoga and Naturopathy Medical Sciences, Chengalpattu, IND
| | - Arthi Balakrishnan
- Naturopathy, International Institute of Yoga and Naturopathy Medical Sciences, Chennai, IND
| | - Poornima Ravi
- Yoga, Government Yoga and Naturopathy Medical College and Hospital, Chennai, IND
| | | | - Maheshkumar K
- Physiology and Biochemistry, Government Yoga and Naturopathy Medical College and Hospital, Chennai, IND
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Rees K, Takeda A, Court R, Kudrna L, Hartley L, Ernst E. Meditation for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2024; 2:CD013358. [PMID: 38358047 PMCID: PMC10867897 DOI: 10.1002/14651858.cd013358.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Interventions incorporating meditation to address stress, anxiety, and depression, and improve self-management, are becoming popular for many health conditions. Stress is a risk factor for cardiovascular disease (CVD) and clusters with other modifiable behavioural risk factors, such as smoking. Meditation may therefore be a useful CVD prevention strategy. OBJECTIVES To determine the effectiveness of meditation, primarily mindfulness-based interventions (MBIs) and transcendental meditation (TM), for the primary and secondary prevention of CVD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers on 14 November 2021, together with reference checking, citation searching, and contact with study authors to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) of 12 weeks or more in adults at high risk of CVD and those with established CVD. We explored four comparisons: MBIs versus active comparators (alternative interventions); MBIs versus non-active comparators (no intervention, wait list, usual care); TM versus active comparators; TM versus non-active comparators. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were CVD clinical events (e.g. cardiovascular mortality), blood pressure, measures of psychological distress and well-being, and adverse events. Secondary outcomes included other CVD risk factors (e.g. blood lipid levels), quality of life, and coping abilities. We used GRADE to assess the certainty of evidence. MAIN RESULTS We included 81 RCTs (6971 participants), with most studies at unclear risk of bias. MBIs versus active comparators (29 RCTs, 2883 participants) Systolic (SBP) and diastolic (DBP) blood pressure were reported in six trials (388 participants) where heterogeneity was considerable (SBP: MD -6.08 mmHg, 95% CI -12.79 to 0.63, I2 = 88%; DBP: MD -5.18 mmHg, 95% CI -10.65 to 0.29, I2 = 91%; both outcomes based on low-certainty evidence). There was little or no effect of MBIs on anxiety (SMD -0.06 units, 95% CI -0.25 to 0.13; I2 = 0%; 9 trials, 438 participants; moderate-certainty evidence), or depression (SMD 0.08 units, 95% CI -0.08 to 0.24; I2 = 0%; 11 trials, 595 participants; moderate-certainty evidence). Perceived stress was reduced with MBIs (SMD -0.24 units, 95% CI -0.45 to -0.03; I2 = 0%; P = 0.03; 6 trials, 357 participants; moderate-certainty evidence). There was little to no effect on well-being (SMD -0.18 units, 95% CI -0.67 to 0.32; 1 trial, 63 participants; low-certainty evidence). There was little to no effect on smoking cessation (RR 1.45, 95% CI 0.78 to 2.68; I2 = 79%; 6 trials, 1087 participants; low-certainty evidence). None of the trials reported CVD clinical events or adverse events. MBIs versus non-active comparators (38 RCTs, 2905 participants) Clinical events were reported in one trial (110 participants), providing very low-certainty evidence (RR 0.94, 95% CI 0.37 to 2.42). SBP and DBP were reduced in nine trials (379 participants) but heterogeneity was substantial (SBP: MD -6.62 mmHg, 95% CI -13.15 to -0.1, I2 = 87%; DBP: MD -3.35 mmHg, 95% CI -5.86 to -0.85, I2 = 61%; both outcomes based on low-certainty evidence). There was low-certainty evidence of reductions in anxiety (SMD -0.78 units, 95% CI -1.09 to -0.41; I2 = 61%; 9 trials, 533 participants; low-certainty evidence), depression (SMD -0.66 units, 95% CI -0.91 to -0.41; I2 = 67%; 15 trials, 912 participants; low-certainty evidence) and perceived stress (SMD -0.59 units, 95% CI -0.89 to -0.29; I2 = 70%; 11 trials, 708 participants; low-certainty evidence) but heterogeneity was substantial. Well-being increased (SMD 0.5 units, 95% CI 0.09 to 0.91; I2 = 47%; 2 trials, 198 participants; moderate-certainty evidence). There was little to no effect on smoking cessation (RR 1.36, 95% CI 0.86 to 2.13; I2 = 0%; 2 trials, 453 participants; low-certainty evidence). One small study (18 participants) reported two adverse events in the MBI group, which were not regarded as serious by the study investigators (RR 5.0, 95% CI 0.27 to 91.52; low-certainty evidence). No subgroup effects were seen for SBP, DBP, anxiety, depression, or perceived stress by primary and secondary prevention. TM versus active comparators (8 RCTs, 830 participants) Clinical events were reported in one trial (201 participants) based on low-certainty evidence (RR 0.91, 95% CI 0.56 to 1.49). SBP was reduced (MD -2.33 mmHg, 95% CI -3.99 to -0.68; I2 = 2%; 8 trials, 774 participants; moderate-certainty evidence), with an uncertain effect on DBP (MD -1.15 mmHg, 95% CI -2.85 to 0.55; I2 = 53%; low-certainty evidence). There was little or no effect on anxiety (SMD 0.06 units, 95% CI -0.22 to 0.33; I2 = 0%; 3 trials, 200 participants; low-certainty evidence), depression (SMD -0.12 units, 95% CI -0.31 to 0.07; I2 = 0%; 5 trials, 421 participants; moderate-certainty evidence), or perceived stress (SMD 0.04 units, 95% CI -0.49 to 0.57; I2 = 70%; 3 trials, 194 participants; very low-certainty evidence). None of the trials reported adverse events or smoking rates. No subgroup effects were seen for SBP or DBP by primary and secondary prevention. TM versus non-active comparators (2 RCTs, 186 participants) Two trials (139 participants) reported blood pressure, where reductions were seen in SBP (MD -6.34 mmHg, 95% CI -9.86 to -2.81; I2 = 0%; low-certainty evidence) and DBP (MD -5.13 mmHg, 95% CI -9.07 to -1.19; I2 = 18%; very low-certainty evidence). One trial (112 participants) reported anxiety and depression and found reductions in both (anxiety SMD -0.71 units, 95% CI -1.09 to -0.32; depression SMD -0.48 units, 95% CI -0.86 to -0.11; low-certainty evidence). None of the trials reported CVD clinical events, adverse events, or smoking rates. AUTHORS' CONCLUSIONS Despite the large number of studies included in the review, heterogeneity was substantial for many of the outcomes, which reduced the certainty of our findings. We attempted to address this by presenting four main comparisons of MBIs or TM versus active or inactive comparators, and by subgroup analyses according to primary or secondary prevention, where there were sufficient studies. The majority of studies were small and there was unclear risk of bias for most domains. Overall, we found very little information on the effects of meditation on CVD clinical endpoints, and limited information on blood pressure and psychological outcomes, for people at risk of or with established CVD. This is a very active area of research as shown by the large number of ongoing studies, with some having been completed at the time of writing this review. The status of all ongoing studies will be formally assessed and incorporated in further updates.
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Affiliation(s)
- Karen Rees
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Rachel Court
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Laura Kudrna
- Institute of Applied Health, University of Birmingham, Birmingham, UK
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Integrating MEditatioN inTO heaRt disease (The MENTOR study): Phase II randomised controlled feasibility study protocol. Collegian 2022. [DOI: 10.1016/j.colegn.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Susceptibility of Women to Cardiovascular Disease and the Prevention Potential of Mind-Body Intervention by Changes in Neural Circuits and Cardiovascular Physiology. Biomolecules 2021; 11:biom11050708. [PMID: 34068722 PMCID: PMC8151888 DOI: 10.3390/biom11050708] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/25/2021] [Accepted: 05/05/2021] [Indexed: 12/28/2022] Open
Abstract
Women have been reported to be more vulnerable to the development, prognosis and mortality of cardiovascular diseases, yet the understanding of the underlying mechanisms and strategies to overcome them are still relatively undeveloped. Studies show that women's brains are more sensitive to factors affecting mental health such as depression and stress than men's brains. In women, poor mental health increases the risk of cardiovascular disease, and conversely, cardiovascular disease increases the incidence of mental illness such as depression. In connection with mental health and cardiovascular health, the presence of gender differences in brain activation, cortisol secretion, autonomic nervous system, vascular health and inflammatory response has been observed. This connection suggests that strategies to manage women's mental health can contribute to preventing cardiovascular disease. Mind-body interventions, such as meditation, yoga and qigong are forms of exercise that strive to actively manage both mind and body. They can provide beneficial effects on stress reduction and mental health. They are also seen as structurally and functionally changing the brain, as well as affecting cortisol secretion, blood pressure, heart rate variability, immune reactions and reducing menopausal symptoms, thus positively affecting women's cardiovascular health. In this review, we investigate the link between mental health, brain activation, HPA axis, autonomic nervous system, blood pressure and immune system associated with cardiovascular health in women and discuss the effects of mind-body intervention in modulating these factors.
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Scott-Sheldon LAJ, Gathright EC, Donahue ML, Balletto B, Feulner MM, DeCosta J, Cruess DG, Wing RR, Carey MP, Salmoirago-Blotcher E. Mindfulness-Based Interventions for Adults with Cardiovascular Disease: A Systematic Review and Meta-Analysis. Ann Behav Med 2021; 54:67-73. [PMID: 31167026 DOI: 10.1093/abm/kaz020] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Individuals with cardiovascular disease (CVD) report psychological distress and poor physical functioning and may benefit from mindfulness training. PURPOSE To examine the effects of mindfulness-based interventions (MBIs) on psychological and physiological measures in adults with CVD using meta-analysis. METHODS Comprehensive searches identified studies that (a) evaluated MBIs in adults with CVD or who had experienced a cardiac event, (b) included a comparison condition, and (c) assessed psychological (e.g., anxiety and depression) or physiological (e.g., systolic or diastolic blood pressure [BP]) outcomes. Independent raters coded methodological (e.g., design and quality) and intervention features (e.g., intervention content) as potential moderators. Weighted mean effect sizes (d+), using full information maximum likelihood estimation, were calculated. RESULTS Of the 1,507 records reviewed, 16 studies met inclusion criteria (N = 1,476; M age = 56 years; 40% women). Compared to controls, participants who received an MBI reported greater improvements in psychological outcomes (i.e., anxiety, depression, distress, and perceived stress: d+s = 0.49 to 0.64). MBI recipients also reduced their systolic (d+ = 0.89, 95% confidence interval [CI] = 0.26, 1.51; k = 7) but not diastolic (d+ = 0.07, 95% CI = -0.47, 0.60; k = 6) BP relative to controls. CONCLUSIONS MBIs demonstrated favorable effects on psychological and physiological outcomes among adults with CVD. Future research should investigate if such benefits lead to improvements in disease outcomes in studies with longer follow-ups.
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Affiliation(s)
- Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Emily C Gathright
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Marissa L Donahue
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Providence, RI, USA
| | - Brittany Balletto
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Providence, RI, USA
| | - Melissa M Feulner
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Providence, RI, USA
| | - Julie DeCosta
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Providence, RI, USA
| | - Dean G Cruess
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Rena R Wing
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Providence, RI, USA.,Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA.,Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Zou H, Cao X, Chair SY. A systematic review and meta-analysis of mindfulness-based interventions for patients with coronary heart disease. J Adv Nurs 2021; 77:2197-2213. [PMID: 33433036 DOI: 10.1111/jan.14738] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/28/2020] [Accepted: 12/10/2020] [Indexed: 12/25/2022]
Abstract
AIMS To assess the effects of mindfulness-based interventions for patients with coronary heart disease. DESIGN A systematic review with meta-analysis. DATA SOURCES Eight mainstream databases, including Ovid MEDLINE, Embase, Ovid Emcare, PsycInfo, CINAHL complete, Web of Science, CENTRAL and PubMed, were searched from January 1979-March 2020. REVIEW METHODS Randomized controlled trials that evaluated mindfulness-based interventions on psychological outcomes, cardiovascular risk factors and quality of life in adults with coronary heart disease were considered. We conducted meta-analyses using the random-effects model. RESULTS Nine studies involving 644 participants were included. Compared with inactive controls (e.g. usual care), mindfulness-based interventions significantly reduced depression (SMD -0.72, 95% CI -1.23 to -0.21, p < .01) and stress (SMD -0.67, 95% CI -1.00 to -0.34, p < .01), but not anxiety and blood pressure. There were no significant psychological effects compared with active controls (e.g. other psychological interventions). In one of three studies that assessed generic quality of life, mindfulness-based interventions significantly improved psychological and social domains compared with active control. The intervention effects on other cardiovascular risk factors were inconclusive given that only one study assessed each outcome with non-significant findings. Subgroup analyses suggest that intervention type and participants' depression and anxiety status may influence intervention effects. CONCLUSIONS Mindfulness-based interventions may benefit patients with coronary heart disease in reducing depression and stress, but the effects on cardiovascular risk factors and quality of life are inconclusive. IMPACT This review offers preliminary evidence for the potential of mindfulness-based interventions as an effective complementary approach to addressing psychological distress among people with coronary heart disease. Given the limitations in current studies, further rigorously designed and well-reported research is necessary to give robust evidence. Studies exploring the intervention effects on cardiovascular risk factors and quality of life are warranted to remedy the research and knowledge gap.
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Affiliation(s)
- Huijing Zou
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xi Cao
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sek Ying Chair
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
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Zou H, Cao X, Geng J, Chair SY. Effects of mindfulness-based interventions on health-related outcomes for patients with heart failure: a systematic review. Eur J Cardiovasc Nurs 2019; 19:44-54. [PMID: 31635481 DOI: 10.1177/1474515119881947] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Mindfulness-based interventions may offer a promising approach for promoting psychological and physical health and wellbeing for patients with heart failure. However, the effects of mindfulness-based interventions for this population have not been systematically reviewed. AIMS This review aimed to synthesise available evidence to assess the effects of mindfulness-based interventions on psychological and physical outcomes and health-related quality of life in patients with heart failure. METHODS Seven English and two Chinese electronic databases were searched with keywords from inception to May 2019. Experimental studies that examined mindfulness-based interventions in adults with heart failure were eligible for inclusion. Two reviewers independently performed study selection, data extraction and study quality assessment. The results were then narratively synthesised. RESULTS This review identified five studies involving 467 patients with heart failure. The reviewed studies had weak to moderate quality. There were consistent findings that mindfulness-based interventions could significantly reduce depression (three studies) and anxiety (two studies) and improve health-related quality of life (two studies) after intervention. However, the effects on physical symptoms were inconsistent in three studies. The effects on physical function were only measured in one study, with non-significant changes being reported. CONCLUSIONS This review provides preliminary evidence that mindfulness-based interventions are beneficial for patients with heart failure in reducing depression and anxiety and enhancing health-related quality of life in the short term. These findings should be carefully generalised considering the methodological limitations across studies. More rigorous studies are required to examine further the effects of mindfulness-based interventions in patients with heart failure.
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Affiliation(s)
- Huijing Zou
- The Nethersole School of Nursing, The Chinese University of Hong Kong, China
| | - Xi Cao
- The Nethersole School of Nursing, The Chinese University of Hong Kong, China
| | - Jing Geng
- Cardiology Department, Renmin Hospital of Wuhan University, China
| | - Sek Ying Chair
- The Nethersole School of Nursing, The Chinese University of Hong Kong, China
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Sahoo S, Padhy SK, Padhee B, Singla N, Sarkar S. Role of personality in cardiovascular diseases: An issue that needs to be focused too! Indian Heart J 2018; 70 Suppl 3:S471-S477. [PMID: 30595309 PMCID: PMC6310178 DOI: 10.1016/j.ihj.2018.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/31/2018] [Accepted: 11/02/2018] [Indexed: 01/02/2023] Open
Abstract
This review provides a broad overview of the relationship of personality with cardiovascular diseases (CVDs). There has been a sustained interest over the last half a century on the issue of relationship between personality traits and CVDs. Type A behavior was the initial focus of inquiry as it was observed that individuals who were competitive, hostile, and excessively driven were overrepresented among patients seeking treatment for CVDs and also were prone to develop coronary artery disease/syndrome. However, the research gradually expanded to assess the relationship of cardiac morbidity with various other personality facets. Furthermore, studies found out that negative effects (including anger and hostility) were also associated with adverse cardiovascular outcomes. Subsequently, a new personality entity named as the type D ‘distressed’ personality, which combined negative affectivity and social inhibition. type D personality then became the area of research and was demonstrated to be related with poorer cardiac outcomes. Interestingly, the results of various research studies are not equivocal, and hence, there are several critiques related to the current understanding of the link between personality construct and the risk of development as well as the outcome of CVDs. Furthermore, few personality traits such as optimism, conscientiousness, openness to experience, and curiosity have been found to be protective factors against development of CVDs and therefore are called ‘cardioprotective’ personality traits. A detailed discussion on the various aspects of personality in relation to CVDs along with a critical appraisal has been presented in this review.
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Affiliation(s)
- Swapnajeet Sahoo
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar-751019, India.
| | - Susanta Kumar Padhy
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar-751019, India.
| | - Binayananda Padhee
- Department of Cardiology, Hi-Tech Medical College and Hospital, Bhubaneswar 751025, India.
| | - Neha Singla
- National Health Mission, Kavaratti 682555, India.
| | - Siddharth Sarkar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India.
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Farquhar JM, Stonerock GL, Blumenthal JA. Treatment of Anxiety in Patients With Coronary Heart Disease: A Systematic Review. PSYCHOSOMATICS 2018; 59:318-332. [PMID: 29735242 PMCID: PMC6015539 DOI: 10.1016/j.psym.2018.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/14/2018] [Accepted: 03/19/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Anxiety is common in patients with coronary heart disease (CHD) and is associated with an increased risk for adverse outcomes. There has been a relative paucity of studies concerning treatment of anxiety in patients with CHD. OBJECTIVE We conducted a systematic review to organize and assess research into the treatment of anxiety in patients with CHD. METHODS We searched CCTR/CENTRAL, MEDLINE, EMBASE, PsycINFO, and CINAHL for randomized clinical trials conducted before October 2016 that measured anxiety before and after an intervention for patients with CHD. RESULTS A total of 475 articles were subjected to full text review, yielding 112 publications that met inclusion criteria plus an additional 7 studies from reference lists and published reviews, yielding 119 studies. Sample size, country of origin, study quality, and demographics varied widely among studies. Most studies were conducted with nonanxious patients. The Hospital Anxiety and Depression Scale and State-Trait Anxiety Inventory were the most frequently used instruments to assess anxiety. Interventions included pharmacological, counseling, relaxation-based, educational, or "alternative" therapies. Forty (33% of total) studies reported that the interventions reduced anxiety; treatment efficacy varied by study and type of intervention. Elevated anxiety was an inclusion criterion in only 4 studies, with inconsistent results. CONCLUSION Although there have been a number of randomized clinical trials of patients with CHD that assessed anxiety, in most cases anxiety was a secondary outcome, and only one-third found that symptoms of anxiety were reduced with treatment. Future studies need to target anxious patients and evaluate the effects of treatment on anxiety and relevant clinical endpoints.
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Affiliation(s)
- Julia M Farquhar
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Gregory L Stonerock
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC.
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Levine GN, Lange RA, Bairey-Merz CN, Davidson RJ, Jamerson K, Mehta PK, Michos ED, Norris K, Ray IB, Saban KL, Shah T, Stein R, Smith SC. Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2017; 6:e002218. [PMID: 28963100 PMCID: PMC5721815 DOI: 10.1161/jaha.117.002218] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Despite numerous advances in the prevention and treatment of atherosclerosis, cardiovascular disease remains a leading cause of morbidity and mortality. Novel and inexpensive interventions that can contribute to the primary and secondary prevention of cardiovascular disease are of interest. Numerous studies have reported on the benefits of meditation. Meditation instruction and practice is widely accessible and inexpensive and may thus be a potential attractive cost-effective adjunct to more traditional medical therapies. Accordingly, this American Heart Association scientific statement systematically reviewed the data on the potential benefits of meditation on cardiovascular risk. Neurophysiological and neuroanatomical studies demonstrate that meditation can have long-standing effects on the brain, which provide some biological plausibility for beneficial consequences on the physiological basal state and on cardiovascular risk. Studies of the effects of meditation on cardiovascular risk have included those investigating physiological response to stress, smoking cessation, blood pressure reduction, insulin resistance and metabolic syndrome, endothelial function, inducible myocardial ischemia, and primary and secondary prevention of cardiovascular disease. Overall, studies of meditation suggest a possible benefit on cardiovascular risk, although the overall quality and, in some cases, quantity of study data are modest. Given the low costs and low risks of this intervention, meditation may be considered as an adjunct to guideline-directed cardiovascular risk reduction by those interested in this lifestyle modification, with the understanding that the benefits of such intervention remain to be better established. Further research on meditation and cardiovascular risk is warranted. Such studies, to the degree possible, should utilize randomized study design, be adequately powered to meet the primary study outcome, strive to achieve low drop-out rates, include long-term follow-up, and be performed by those without inherent bias in outcome.
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Mehrabani S, Mohammadifard N, Mehrabani S, Sadeghi M, Sajjadi F, Maghroun M, Maracy MR, Safavi SM. The Effect of Nutrition Consultation on Dietary Diversity Score of Cardiac Patients Referred to Cardiac Rehabilitation Research Center Isfahan Cardiovascular Research Institute during 2008-2013. Int J Prev Med 2016; 7:121. [PMID: 27994822 PMCID: PMC5139448 DOI: 10.4103/2008-7802.193464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 09/03/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Dietary diversity score (DDS) measurement was used to assessment of diet quality in different disease like cardiovascular disease. One way to improve the cardiovascular patient's ability is cardiac rehabilitation program that include exercise training, nutrition consultation and psychological treatment. No study was designed to compare the DDS before and after dietary consultation among cardiac rehabilitation patients, so this study was designed to examine this purpose. METHODS Subjects were participated in the 2-month cardiac rehabilitation program. All patients that completed the cardiac rehabilitation program and 2 dietary records (before and after nutritional counseling in cardiac rehabilitation program) enrolled in study. Kant et al method was used for scoring dietary diversity. Data were analyzed using the statistical package for social sciences (SPSS version 20). Wilcoxon test were used to compare DDS score for each subgroup and pair sample T test was used to compare total DDS after and before nutrition counseling. P < 0.05 was considered as statistically significant. RESULTS The differences between DDS of grain, fruit, vegetable and meat before and after nutrition counseling were not significant (P = 0.635, P = 0.423, P = 0.826, P = 0.207 respectively), but differences of DDS for dairy and total DDS before and after nutrition counseling were significant (P = 0, P = 0.001). CONCLUSIONS Dietary diversity was increased after nutrition counseling among patients with cardiac disease.
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Affiliation(s)
- Sepideh Mehrabani
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of clinical Nutrition, School of Nutrition and Food Science, Isfahan, Iran
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sanaz Mehrabani
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of clinical Nutrition, School of Nutrition and Food Science, Isfahan, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firouzeh Sajjadi
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Maghroun
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Department of Biostatistics and Epidemiology, School of public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyyed Morteza Safavi
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of clinical Nutrition, School of Nutrition and Food Science, Isfahan, Iran
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Xinxing W, Wei L, Lei W, Rui Z, Baoying J, Lingjia Q. A neuroendocrine mechanism of co-morbidity of depression-like behavior and myocardial injury in rats. PLoS One 2014; 9:e88427. [PMID: 24551098 PMCID: PMC3923793 DOI: 10.1371/journal.pone.0088427] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 01/08/2014] [Indexed: 11/19/2022] Open
Abstract
Depression is generally a recurrent psychiatric disorder. Evidence shows that depression and cardiovascular diseases are common comorbid conditions, but the specific pathological mechanisms remain unclear. The purpose of this study is to determine the effects of depression induced by chronic unpredictable mild stress (CUMS) on myocardial injury and to further elucidate the biological mechanism of depression. Rats were used as a model. The CUMS procedure lasted for a total of 8 weeks. After 4 weeks of CUMS, treated rats exhibited a reduced sucrose preference and changes in scores on an open field test, body weight and content of 5-HT in the brain as compared with the values of these variables in controls. These changes indicated depression-like changes in CUMS rats and demonstrated the feasibility of the depression model. In addition, pathological changes in the myocardium and increased cardiomyocyte apoptosis demonstrated that myocardial injury had occurred after 6 weeks of CUMS and had increased significantly by the end of 8 weeks of CUMS. Plasma serotonin (5-HT), norepinephrine (NE) and epinephrine (E), all depression-related neuroendocrine factors, were measured by HPLC-ECD techniques, and the content of plasma corticosterone (GC) was evaluated by an I(125)-cortisol radioactivity immunoassay in control and CUMS rats. The results indicated that 5-HT had decreased, whereas NE, E and GC had increased in CUMS rats, and these factors might be associated with depression-induced myocardial injury. The effects of 5-HT, NE and GC on the survival rate of cultured cardiomyocytes were determined using an orthogonal design. The results showed that 5-HT was a more important factor affecting cell survival than GC or NE. The results suggested that normal blood levels of 5-HT had a cytoprotective effect. The neuroendocrine disorders characterized by decreased 5-HT combined with increased GC and NE mediated the occurrence of depression-induced myocardial injury.
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Affiliation(s)
- Wang Xinxing
- Beijing Institute of Basic Medical Sciences, Beijing, China
- * E-mail: (WX); (JB); (QL)
| | - Liu Wei
- Institute of Health & Environmental Medicine, Tianjin, China
| | - Wu Lei
- Institute of Health & Environmental Medicine, Tianjin, China
| | - Zhan Rui
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Jin Baoying
- Tianjin Occupational Disease Prevention Hospital (Hospital Workers), Tianjin, China
- * E-mail: (WX); (JB); (QL)
| | - Qian Lingjia
- Beijing Institute of Basic Medical Sciences, Beijing, China
- * E-mail: (WX); (JB); (QL)
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13
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Ray IB, Menezes AR, Malur P, Hiltbold AE, Reilly JP, Lavie CJ. Meditation and coronary heart disease: a review of the current clinical evidence. Ochsner J 2014; 14:696-703. [PMID: 25598736 PMCID: PMC4295748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Chest pain from coronary heart disease (CHD) accounts for more than 8 million emergency department visits every year in the United States, emphasizing the need for cardiovascular (CV) interventions to help reduce this high number. Meditation--a state of contemplation, concentration, and reflection--has the potential to help decrease CV disease. METHODS This article reviews the available data regarding the effects of meditation on various aspects of CV health. RESULTS During the past few decades, multiple studies have demonstrated the beneficial effects of meditation on various CV risk factors. In addition to decreasing CV mortality, meditation has also been shown to improve conditions such as hypertension, type 2 diabetes mellitus, dyslipidemia, and high cortisol levels. Still unclear is how current medical therapies impact overall CHD in comparison to meditation techniques. CONCLUSION Prospective trials are needed to study the effects of meditation on CV risk factors, to provide guidelines for daily meditation practice, and to determine the efficacy of meditation compared to current pharmacologic therapies.
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Affiliation(s)
- Indranill Basu Ray
- Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA
| | - Arthur R. Menezes
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA
| | - Pavan Malur
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA
| | - Aimee E. Hiltbold
- Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA
| | - John P. Reilly
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA
| | - Carl J. Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA
- Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
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