Research on Heart Disease
Below are brief summaries of relevant research on Heart Disease. To find more information about an article, click on the title of the article.
- Overviews of the Integrative Approach
- Causes and Risk Factors
- Related Health Conditions
- Preventing Future Coronary Events
- Psychological Factors
- Social Factors
- Treatments:
- Acupuncture and East Asian Medicine
- Exercise/Movement
- Healing Arts/Creativity
- Manual Therapies: massage, chiropractic, Craniosacral therapy
- Mind-Body Practices: guided imagery, biofeedback, meditation/relaxation
- Nutrition/Herbs/Supplements
- Therapies for Psychological Health
- Age-specific: children, young adults, older adults
- Gender specific: cardiovascular disease in men and women
- Environmental influences
Overviews of the Integrative Approach
Comprehensive Lifestyle Changes. National Heart, Lung and Blood Institute, NIH, 2006
People with high blood pressure who sustain healthy lifestyle changes for up to 1 ½ years can reduce their rates of high blood pressure without the use of medications. This includes behavioral counseling, physical activity and a healthy eating plan called DASH.
Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998; 280(23): 2001-7.
This landmark study showed that intensive lifestyle changes can lead to reversal of coronary atherosclerosis after one year, which can continue over 5 years. Lifestyle changes consisted of a 10% fat whole foods vegetarian diet, aerobic exercise, stress management, smoking cessation, and group support. In the usual care group, atherosclerosis progressed and more than twice as many cardiac events occurred.
Gavagan T. Cardiovascular Disease. Primary Care: Clinics in Office Practice. 2002;29(2): 323-38.
Lifestyle factors that have a positive effect on cardiovascular disease are reviewed including omega-3 fatty acids, vegetable-based diets, red yeast supplements, garlic, Coenzyme-Q10, hawthorn, exercise and stress reduction.
American College of Cardiology Foundation Task Force. Integrating Complementary Medicine into Cardiovascular Medicine. Journal of the American College of Cardiology. 2005; 46(10):184-221.
This consensus statement reviews the most recent advances and the use of integrative therapies in cardiovascular practice that address the needs of patients on a physical, mental and spiritual level.
Arthur HM, Patterson C, Stone JA. The role of complementary and alternative therapies in cardiac rehabilitation: a systematic evaluation. European Journal of Cardiovascular Prevention & Rehabilitation. 2006;13(10):3-9.
This systematic review showed that some complementary therapies can be useful on their own or with traditional cardiac rehabilitation. In particular, tai chi can be used for low and intermediate risk heart patients and transcendental meditation was effective for stress reduction.
Nies L, Cymbala AA, Kasten SL. et al. Complementary and alternative therapies for the management of dyslipidemia. The Annals of Pharmacotherapy. 2006;40:1984-92.
To lower blood lipids, evidence was found for increasing the intake of fiber, fruits, vegetables, nuts, seeds, cereals, legumes and vegetable oils, replacing animal protein with soy protein, reducing foods high in saturated fat, and increasing foods high in monounsaturated fats. Omega-3 fatty acids were found to be effective for reducing triglycerides.
Causes and Risk Factors
Heart Valve Disease
Caira FC, Stock SR, Gleason TG, et al. Human degenerative valve disease is associated with up-regulation of low-density lipoprotein receptor-related protein 5 receptor-mediated bone formation. Journal of the American College of Cardiology. 2006;47(8):1707-12. This study found that heart valve disease is not caused by "wear and tear" but by an inflammatory process possibly triggered by high cholesterol. Because of this, heart valve disease may be able to be treated with statin medications and other cholesterol-lowering strategies, similar to coronary artery disease.
Cholesterol Levels
Hayward RA, Hofer TP, Vijan S. Narrative review: lack of evidence for recommended low-density lipoprotein treatment targets: a solvable problem. Annals of Internal Medicine. 2006;145(7):520-30.
After performing a thorough review of the research on LDL cholesterol and heart health, the authors conclude there is no scientifically valid evidence to support the ultra-low LDL target of 70 milligrams for very high-risk patients advocated by some members of the National Cholesterol Education Program. Clear, compelling evidence supports near-universal statin therapy in patients at high cardiovascular risk (regardless of their natural LDL cholesterol values).
Koro CE, Bowlin SJ, Stump TE, et al. The independent correlation between high-density lipoprotein cholesterol and subsequent major adverse coronary events. American Heart Journal. 2006;151(3):755.e1-755.e6.
A 10-mg higher initial HDL was associated with an 11% lower risk of coronary events. A 10-mg increase in HDL over two years was associated with a 7% lower risk of events. Having a high HDL may be more important than having a low LDL in protecting people from heart attack and stroke.
Galassi A, Reynolds K, He J. Metabolic syndrome and risk of cardiovascular disease: a meta-analysis. American Journal of Medicine. 2006;119(10):812-9.
Data from 21 studies show that people with the metabolic syndrome have more cardiovascular disease and stroke. The metabolic syndrome is a combination of factors including obesity, insulin resistance, high blood pressure, high cholesterol and pro-inflammatory states.
Inflammation and the Immune System
Conraads V. Pro-inflammatory cytokines and their receptors in chronic heart failure: do they really matter? Acta Cardiologica. 2006;61(2):161-8.
One new approach to congestive heart failure (CHF) involves the presence of low-grade inflammation. Strategies which help reduce inflammation may be a useful tool in the treatment of CHF.
Hansson GK, Libby P. The immune response in atherosclerosis: a double-edged sword. Nature Reviews Immunology. 2006; 6(7):508-19.
The development of atherosclerosis is at least partly due to inflammatory responses from the immune system. This review looks at the role of immune mechanisms in forming and activating atherosclerotic plaques and the use of inflammatory markers to predict cardiovascular events.
Toth MJ, Ades PA, Tischler MD, et al. Immune activation is associated with reduced skeletal muscle mass and physical function in chronic heart failure. International Journal of Cardiology. 2006;109(2):179-87.
Overactivity of certain parts of the immune system can lead to reduced muscle strength and decreased muscle mass and function in patients with chronic heart failure.
McDade TW, Hawkley LC, Cacioppo JT. Psychosocial and behavioral predictors of inflammation in middle-aged and older adults: the Chicago health, aging, and social relations study. Psychosomatic Medicine. 2006;68(3):376-81.
Stress may affect disease risk through chronic inflammation. Waist circumference, length of time it takes to get to sleep, smoking, and stress were associated with increased inflammation. Psychosocial stress is an important predictor of chronic inflammation.
Elkind MS, Tai W, Coates, Paik MC. High-sensitivity C-reactive protein, lipoprotein-associated phospholipase A2, and outcome after ischemic stroke. Archives of Internal Medicine. 2006;166(19):2073-80.
Patients who have evidence on blood tests of increased inflammation after an ischemic stroke may be at increased risk for a second stroke. Anti-inflammatory strategies may help decrease this risk.
Lack of Sleep
Cappuccio FP, Stranges S, Kandala NB, et al. Gender-specific associations of short sleep duration with prevalent and incident hypertension: the Whitehall II Study. Hypertension. 2007; 50(4):693-700.
Five hours or less sleep per night was associated with a higher risk of hypertension in middle-aged but not older adults. In particular, sleep deprivation may produce detrimental cardiovascular effects in women.
Related Health Conditions
Diabetes
Lee TT, Feinberg L, Baim DS, et al. Effect of diabetes mellitus on five-year clinical outcomes after single-vessel coronary stenting (a pooled analysis of coronary stent clinical trials). American Journal of Cardiology. 2006; 98(6):718-21.
Reblockage of a stented lesion was more common in patients with diabetes, requiring a repeat stenting procedure more frequently during the first year (16% vs. 10.9%). Myocardial infarction was also more frequent in patients with diabetes (5-year rates: 25.4% vs 17.9%).
Depression/Anxiety/Panic Disorder
de Jonge P, van den Brink RHS, Spijkerman TA, et al. Only incident depressive episodes after myocardial infarction are associated with new cardiovascular events. Journal of the American College of Cardiology. 2006; 48:2204-2208.
People who have a first bout of depression after a heart attack are at greater risk for future heart problems than patients who don't become clinically depressed or who were depressed even before the heart attack. Treatment with anti-depressants, counseling, stress management, physical exercise, and improving social support are recommended.
Gomez-Caminero A, Blumentals WA, Russo LJ, et al. Does panic disorder increase the risk of coronary heart disease? A cohort study of a national managed care database. Psychosomatic Medicine. 2005;67(5):688-91.
Patients with panic disorder had a nearly a 2-fold increased risk for coronary heart disease. Patients also diagnosed with depression were almost 3 times more likely to develop coronary heart disease.
Glassman A, Shapiro PA, Ford DE, et al. Cardiovascular health and depression. Journal of Psychiatric Practice. 2003; 9(6): 409-421.
Depression increases the likelihood of developing ischemic heart disease (IHD) and worsens the outcomes of patients who have IHD. Antidepressants and the use of non-drug options such as psychosocial interventions are discussed.
Hypertension and other factors
Dahlstrom U. Frequent non-cardiac comorbidities in patients with chronic heart failure. European Journal of Heart Failure. 2005;7(3):309-16.
Hypertension is the most common risk factor for heart failure, occurring in about 50% of patients with untreated hypertension. Diabetes, chronic obstructive pulmonary disease and anemia occur in about 20-30% of patients with heart failure.
Sleep Apnea
Gami AS, Rader S, Svatikova A, et al. Familial Premature Coronary Artery Disease Mortality and Obstructive Sleep Apnea. Chest 2007;131(1): 118-121.
Obstructive sleep apnea (OSA) is linked to both coronary artery disease and sudden death, but whether it causes it is unclear. Patients with obstructive sleep apnea are more likely to have a family history of coronary artery disease.
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Preventing Future Coronary Events
Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. Circulation. 2006;113(19):2363-72.
Important evidence supports the value of reducing risk factors in patients with coronary disease, peripheral arterial disease, atherosclerosis, and carotid artery disease. Recommendations include complete cessation of smoking and exposure to secondhand smoke; blood pressure control; lowering cholesterol and triglycerides; physical activity 30 minutes a day, 5-7 times a week; and weight management.
Jacobson TA. Secondary prevention of coronary artery disease with omega-3 fatty acids. American Journal of Cardiology. 2006; 98(4A):61i-70i.
Omega-3 fatty acids promote the stability of atherosclerotic plaques and decrease cardiac arrhythmias caused by ischemia. Significant reductions in mortality --20% to 50%--have been found in studies using doses of 0.85 to 4.0 grams a day, with treatment lasting from 12 to 42 months.
Hulten E, Jackson JL, Douglas K, et al. The effect of early, intensive statin therapy on acute coronary syndrome: a meta-analysis of randomized controlled trials. Archives of Internal Medicine. 2006;166(17):1814-21.
Thirteen studies were reviewed. Early, intensive statin therapy for acute coronary syndrome decreased the rate of death and cardiovascular events over 2 years of follow-up. This benefit begins between 4 and 12 months.
Psychological Factors: Mood, Depression, Anxiety, Happiness, Stress
Anxiety
Shibeshi WA, Young-Xu Y, Blatt CM. Anxiety worsens prognosis in patients with coronary artery disease. Journal of the American College of Cardiology. 2007; 49:2021-2027.
In people who went from low levels of anxiety to high levels, those with the highest level of anxiety had twice the risk of myocardial infarction as patients whose anxiety score was in the lowest third. People who started out fearful but were able to calm down over the 3 year follow-up period did much better.
Stress
Netterstrom B, Kristensen TS, Sjol A. Psychological job demands increase the risk of ischaemic heart disease: a 14-year cohort study of employed Danish men. European Journal of Cardiovascular Prevention & Rehabilitation. 2006;13(3):414-20.
Job strain is defined as high psychological demands and a low degree of control in the work situation. Job strain was significantly associated with ischemic heart disease, but only high demands contributed significantly to this result. Ischemic heart disease was highest among employers and managers.
Strike PC, Magid K, Whitehead DL, et al. Pathophysiological processes underlying emotional triggering of acute cardiac events. Proceedings of the National Academy of Sciences. 2006; 103(11):4322-7.
Acute negative emotional states may trigger acute coronary syndrome in some people by causing a greater platelet response to stress and a slower recovery of systolic blood pressure and cardiac output after stress.
Happiness
Steptoe A, Wardle J. Positive affect and biological function in everyday life. Neurobiology of Aging. 2005; S1:108-12.
Growing evidence shows that positive emotions may protect against poor health and disease. Greater happiness is associated with lower salivary cortisol, reduced fibrinogen stress responses, and lower heart rate in men.
Depression
Lett HS, Davidson J, Blumenthal JA. Nonpharmacologic treatments for depression in patients with coronary heart disease. Psychosomatic Medicine. 2005; 67 (Suppl 1): S58-62.
The most evidence for psychological treatments in heart patients is for cognitive behavioral therapy and interpersonal therapy. Aerobic exercise also shows promise for improving mental and physical health.
KE, Whellan DJ, O'Connor CM. Depression and cardiovascular disease: mechanisms of interaction. Biological Psychiatry. 2003;54(3): 248-61.
Depression is associated with health changes that may influence cardiovascular disease. These include not following medical recommendations, smoking, hypertension,
inflammation, and the tendency for excessive blood clotting.
Whooley M. Depression and cardiovascular disease. JAMA. 2006; 295: 2874-2881.
Major depressive disorder is a risk factor for heart disease events in healthy patients and for poor outcomes in patients with heart disease. Depression is present in 1 of 5 patients with coronary heart disease and in 1 of 3 patients with congestive heart failure. Antidepressant treatment with selective serotonin reuptake inhibitors is generally safe and effective.
Ferketich AK, Ferguson JP, Binkley PF. Depressive symptoms and inflammation among heart failure patients. American Heart Journal. 2005;150(1): 132-6.
Depression has been linked to heart failure. Elevated levels of pro-inflammatory cytokines may be the link between the two conditions. Inflammation may promote disease progression in patients with heart failure.
Sher L. Type D personality: the heart, stress, and cortisol. QJM. 2005; 98(5): 323-9.
A new personality type, the 'distressed' personality or Type D personality, is characterized by unexpressed negative emotions and avoidance of social contacts. Cardiac patients with type D personality may be at increased risk for severe heart events due to a greater cortisol reaction to stress.
Social Factors
Everson-Rose SA, Lewis TT. Psychosocial factors and cardiovascular diseases. Annual Review of Public Health. 2005; 26:469-500.
Psychosocial factors impact cardiovascular disease. These include emotional states such as depression, anger, hostility, and anxiety and social ties, social support, and social conflict.
Friedmann E, Thomas SA. Pet ownership, social support, and one-year survival after acute myocardial infarction in the cardiac arrhythmia suppression trial (CAST). American Journal of Cardiology. 1995; 76: 1213-1217.
Social support and pet ownership have been associated with increased coronary artery disease survival. In this study, one year survival data showed that pet ownership and social support were significant predictors of survival.
TREATMENTS
VanWormer AM, Lindquist R, Sendelbach SE. The effects of acupuncture on cardiac arrhythmias: a literature review. Heart & Lung. 37(6):425-31, 2008.
In a review of studies that examined the effectiveness of acupuncture on cardiac arrhythmias, eight studies reported that 87% to 100% of participants converted to normal sinus rhythm after acupuncture. Acupuncture seems to be effective in treating several cardiac arrhythmias, but more high quality studies are needed.
Ballegaard S, Borg E, Karpatschof B, et al. Long-term effects of integrated rehabilitation in patients with advanced angina pectoris: a nonrandomized comparative study. Journal of Alternative and Complementary Medicine. 2004;10(5):777-83.
In this three year study, integrated rehabilitation consisted of acupuncture, a self-care program including acupressure, Chinese health philosophy, stress management, and lifestyle changes. This approach added years to the lives of patients with severe angina pectoris.
Middlekauff HR. Acupuncture in the treatment of heart failure. Cardiology in Review. 2004; 12(3):171-173.
Several clinical studies on the use of acupuncture in heart failure have been done. Recent animal studies support the concept that acupuncture might act to reduce over-stimulation of the heart by the nervous system.
Richter A, Herlitz J, Hjalmarson A. Effect of acupuncture in patients with angina pectoris. European Heart Journal. 1991; 12: 175-178.
Twenty-one patients with stable angina pectoris received either 4 weeks of traditional Chinese acupuncture or placebo treatment. During the acupuncture period, the number of angina attacks per week dropped from 10.6 to 6.1. Pain intensity decreased from 1.4 to 0.8. Feelings of well-being improved. Acupuncture showed an added benefit in patients with severe, intensively treated angina pectoris.
Lan C, Chen SY, Wong MK, Lai JS. Tai Chi training for patients with coronary heart disease. Medicine & Sport Science. 52:182-94, 2008.
Studies have found that lower intensity exercise such as Tai Chi also benefit patients with coronary heart disease. Tai chi improves aerobic capacity, muscle strength, blood vessel function and well-being and helps reduce some cardiovascular risk factors, such as hypertension. Studies show that it is safe and effective for patients with myocardial infarction, coronary bypass surgery and heart failure.
Pullen PR, Nagamia SH, Mehta PK, et al. Effects of yoga on inflammation and exercise capacity in patients with chronic heart failure. Journal of Cardiac Failure. 14(5):407-13, 2008.
This study compared 8-weeks of yoga with standard medical therapy to standard medical therapy alone in 19 patients with Class I-III heart failure. Yoga improved exercise tolerance and had a positive effect on levels of inflammatory markers in patients with chronic heart failure.
Tully MA, Cupples ME, Hart ND, et al. Randomised controlled trial of home-based walking programmes at and below current recommended levels of exercise in sedentary adults. Journal of Epidemiology and Community Health. 2007 Sep;61(9):778-83.
Participants in this walking program did 30 minutes of brisk walking three days a week or five days a week. Systolic blood pressure and waist and hip circumferences fell significantly and overall fitness increased in both groups. Diastolic blood pressure fell in the five day a week group.
Carnethon MR, Gidding SS, Nehgme R, et al. Cardiorespiratory fitness in young adulthood and the development of cardiovascular disease risk factors. JAMA. 2003;290(23):3092-100.
Participants in the CARDIA study with low fitness were 3- to 6-times more likely to develop diabetes, hypertension, and the metabolic syndrome, all cardiovascular disease risk factors involving obesity. At least 30 minutes of a moderate-intensity physical activity such as brisk walking on most days of the week is recommended.
Passino C, Severino S, Poletti R, et al. Aerobic training decreases B-type natriuretic peptide expression and adrenergic activation in patients with heart failure. Journal of the American College of Cardiology. 2006;47(9):1835-9.
Aerobic training is associated with a reversal of abnormal hormonal patterns that underlie many of the symptoms of heart failure and may help patients function more normally and feel better.
Jayasinghe SR. Yoga in cardiac health (a review). European Journal of Cardiovascular Prevention and Rehabilation. 2004;11: 369-75. Yoga was found to be effective in modifying cardiovascular risk factors, preventing ischemic heart disease and in cardiac rehabilitation. Significant positive findings were reported for blood pressure, stress hormone levels, body mass index, lipid profiles, cardiovascular endurance, breath volume, oxygen consumption, heart rate, blood sugar control, ischemic symptoms, exercise tolerance and psychological status.
Bijlani RL, Vempati RP, Yadav RK, et al. A brief but comprehensive lifestyle education program based on yoga reduces risk factors for cardiovascular disease and diabetes mellitus. Journal of Alternative and Complementary Medicine. 2005; 11(2):267-74.
The short-term impact of a brief yoga lifestyle intervention on some of the risk factors for cardiovascular disease and diabetes was studied. Total triglycerides were significantly lower and HDL cholesterol significantly higher on the last day of the course compared to the first day.
Taylor-Piliae RE. Tai Chi as an adjunct to cardiac rehabilitation exercise training. Journal of Cardiopulmonary Rehabilitation. 2004;23(2):90-6.
Tai chi leads to improvement in cardiorespiratory function, balance, fall prevention and stress reduction and may add benefit to cardiac rehabilitation training.
Cheung BM, Lo JL, Fong DY, et al. Randomised controlled trial of qigong in the treatment of mild essential hypertension. Journal of Human Hypertension. 2005; 19(9); 697-704.
In this study patients with mild hypertension practiced qigong (a traditional Chinese exercise consisting of breathing and gentle movements) or conventional exercise for 16 weeks. Both types of exercise significantly decreased blood pressure, heart rate, weight, BMI, waist circumference, and total cholesterol.
Yeh GY, Wood MJ, Lorell Bh, et al. Effects of tai chi mind-body movement therapy on functional status and exercise capacity in patients with chronic heart failure: a randomized controlled trial. American Journal of Medicine. 2004; 117(3):541-8. At 12 weeks, patients with heart failure in the tai chi group showed improved quality-of-life scores and increased distance walked in 6 minutes.
Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease; systematic review and meta-analysis of randomized controlled trials. American Journal of Medicine. 2004;116(10):782-92.
A systematic review of 48 studies compared usual care and cardiac rehabilitation. Cardiac rehabilitation was associated with reduced rate of mortality, greater reductions in total cholesterol, triglyceride levels, and systolic blood pressure, and lower rates of smoking.
Haykowsky MJ, Liang Y, Pechter D, et al. A meta-analysis of the effect of exercise training on left ventricular remodeling in heart failure patients: the benefit depends on the type of training performed. Journal of the American College of Cardiology. 2007; 49(24):2329-36.
This review of 14 studies showed that when patients with heart failure did aerobic exercise several times a week, the oversized heart became significantly smaller and better able to pump blood. It is recommended that patients be evaluated by a physician before beginning exercise training.
Miller M, Mangano C, Park Y, et al. Impact of cinematic viewing on endothelial function. Heart. 2006;92(2):261-2.
Watching comedy films boosts blood flow to the heart. In this study, brachial artery blood flow (a good indicator of blood flow throughout the body) was reduced after movie clips that caused distress and was increased after movie clips that caused laughter.
Wichrowski M, Whiteson J, Haas F, et al. Effects of horticultural therapy on mood and heart rate in patients participating in an inpatient cardiopulmonary rehabilitation program. Journal of Cardiopulmonary Rehabilitation. 2005;25(5):270-4.
The effects of gardening on mood and heart rate in a cardiac rehabilitation program were studied. Immediately following the gardening therapy session, total mood disturbance was significantly reduced and the heart rate fell between 4 and 9.6 beats per minute.
Nilsson, U. Unosson, M. Rawal, N. Stress reduction and analgesia in patients exposed to calming music postoperatively: a randomized controlled trial. European Journal of Anaesthesiology. 2005; 22(2):96-102.
Music given during surgery may decrease postoperative pain while music provided after surgery may reduce anxiety, pain and morphine use.
Cadigan ME, Caruso NA, Haldeman SM, et al. The effects of music on cardiac patients on bed rest. Progress in Cardiovascular Nursing. 2001; 16(1):5-13.
The effect of a 30-minute music intervention on heart rate, blood pressure, respiratory rate, pain, and mood was measured in 140 subjects. Music helped reduce blood pressure, respiratory rate, and psychological distress.
Anderson PG, Cutshall SM. Massage therapy: a comfort intervention for cardiac surgery patients. Clinical Nurse Specialist. 2007. 21(3):161-5.
Cardiac surgical patients often experience back, shoulder, and neck pain and general stress and tension. The benefits of massage after cardiac surgery include reduction of pain, anxiety, and tension.
Bakris G, Dickholtz M, Meyer PM, et al. Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. Journal of Human Hypertension. 2007;21(5):347-52.
This pilot study tests whether correcting misalignment of the atlas vertebra at the base of the skull reduces and maintains a lower blood pressure. Fifty patients with Stage 1 hypertension received either a specific chiropractic procedure (NUCCA) or a sham procedure. They took no antihypertensive medications during the 8-week study. At week 8, there were significant differences in systolic and diastolic blood pressure, showing that restoring Atlas alignment is associated with marked and sustained reductions in blood pressure.
Field T, Hernandez-Reif M, Diego M, et al. Cortisol decreases and serotonin and dopamine increase following massage therapy. International Journal of Neuroscience. 2005; 115(10): 1397-413. Studies showed significant decrease in cortisol levels (averaging 31%) and an increase of 28% for serotonin and 31% for dopamine after massage. This suggests the stress-alleviating effects (decreased cortisol) and the activating effects (increased serotonin and dopamine) of massage therapy on a variety of medical conditions.
back to topSwanson KS, Gevirtz RN, Brown M, et al. The effect of biofeedback on function in patients with heart failure. Applied Psychophysiology & Biofeedback. 34(2):71-91, 2009.
This study looked at the effect of 6-weeks of heart rate variability (HRV) biofeedback and breath retraining in patients with heart failure. HRV biofeedback significantly increased exercise tolerance in people who were in the high left ventricular ejection fraction (LVEF) category.
Astin JA, Shapiro SL, Eisenberg DV, et al. Mind-body medicine: state of the science, implications for practice. Journal of the American Board of Family Practice. 2003; 16:131-47.
Considerable evidence exists on the effectiveness of relaxation, behavioral therapies, meditation, imagery, biofeedback and hypnosis in the treatment of coronary artery disease, insomnia, chronic low back pain, and other health conditions.
Luskin F, Reitz M, Newell K, et al. A controlled pilot study of stress management in elderly patients with congestive heart failure. Cardiology. 2002; 5(4): 168-71.
The effect of the Freeze-Frame stress management program developed by the Institute of HearthMath was tested in elderly patients with congestive heart failure. Significant improvements were noted in perceived stress, emotional distress, 6-minute walk, and depression.
Van Dixhoorn J, White A. Relaxation therapy for rehabilitation and prevention in ischaemic heart disease: a systematic review and meta-analysis. European Journal of Cardiovascular Prevention and Rehabilitation. 2005;12(3):193-202.
Relaxation therapy leads to reduced resting heart rate, increased heart rate variability, improved exercise tolerance, increased HDL, reduced anxiety and depression, reduced frequency of angina pectoris, arrhythmia and exercise-induced ischemia, fewer cardiac events and increased ability to return to work.
Halpin LS, Speir AM, CapoBianco P, et al. Guided Imagery in cardiac surgery. Outcome Management. 2002; 6(3): 132-137.
Research shows that guided imagery, a simple form of relaxation, can reduce pre-operative anxiety and post-operative pain in patients undergoing surgery, decrease the average length of stay and lead to less pain medication use.
Kranitz L, Lehrer P. Biofeedback applications in the treatment of cardiovascular diseases. Cardiology in Review. 2004; 12(3): 177-81.
Biofeedback has shown promise in the management of hypertension, cardiac arrhythmias, angina pectoris, cardiac ischemia, myocardial infarction.
Jacobs GC. Clinical applications of the relaxation response and mind-body interventions. Journal of Alternative and Complementary Medicine. 2001;7 Suppl 1:S93-101.
The relaxation response and mind-body interventions are effective in treating many stress-related health problems. Recent studies show they may improve coronary heart disease outcomes and enhance immune function.
Joseph CN, Porta C, Casucci G, et al. Slow breathing improves arterial baroreflex sensitivity and decreases blood pressure in essential hypertension. Hypertension. 2005; 46(4): 714-8.
Hypertension is partially related to an imbalance between stimulating and relaxing signals from the nervous system to the circulatory system. Slow breathing (6 breaths per minute) decreased systolic and diastolic pressures in patients with hypertension. Controlled breathing (15 per minute) decreased only systolic pressure.
Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits. A meta-analysis. Journal of Psychosomatic Research. 2004; 57(1): 35-43.
Mindfulness-based stress reduction improves coping and quality of life in patients with pain, cancer, heart disease, depression, anxiety and stress.
Paul-Labrador M, Polk D, Dwyer JH, et al. Effects of a randomized controlled trial of transcendental meditation on components of the metabolic syndrome in subjects with coronary heart disease. Archives of Internal Medicine. 2006; 166(11):1218-24.
In this 16-week study, the transcendental meditation group had improved blood pressure, insulin resistance, and autonomic nervous system tone, showing that TM may have a positive effect on the body's response to stress and improve risk factors for coronary heart disease including the metabolic syndrome.
Schneider RH, Alexander CN, Staggers F, et al. A randomized controlled trial of stress reduction in African Americans treated for hypertension for over one year. American Journal of Hypertension. 2005; 18(1):88-98.
The effects Transcendental Meditation or progressive muscle relaxation and a health education class on hypertension in African-American men and women were compared. The meditation group showed decreases in both systolic and diastolic blood pressure and less use of antihypertensive medication.
Sebregts EH, Falger PR, Bar FW, et al. Cholesterol changes in coronary patients after a short behavior modification program. International Journal of Behavioral Medicine. 2003; 19(4):315-30.
After an 8-week behavior modification program, patients with coronary artery disease showed a 20% decline of total cholesterol and a 29% decline of LDL cholesterol levels.
Pittler MH, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database of Systematic Reviews. (1):CD005312, 2008.
Ten studies comparing hawthorn extract and placebo in patients with chronic heart failure showed that it improved exercise tolerance, maximal workload, shortness of breath and fatigue. Side events were uncommon, mild, and brief. These results suggest a significant benefit in symptom control and physiologic outcomes from hawthorn extract as an additional treatment for chronic heart failure.
Borek C. Garlic reduces dementia and heart-disease risk. Journal of Nutrition. 2006;136 (3 Suppl):810S-812S.
Antioxidant-rich aged garlic extract (AGE or Kyolic) reduces cholesterol and adds to the action of statins. It inhibits arterial plaque formation, decreases homocysteine, lowers blood pressure, and increases microcirculation, which is important in diabetes.
Breslow JL. n-3 fatty acids and cardiovascular disease. American Journal of Clinical Nutrition. 2006; 83(6 Suppl): 1477S-1482S.
Studies show that eating fish or taking fish oil containing about 1 gram per day of omega-3 fatty acids helps to reduce cardiovascular death. This appears to be due to suppression of fatal arrhythmias rather than stabilization of atherosclerotic plaques. The American Heart Association recommends that everyone eat oily fish twice per week and people with coronary heart disease have 1 gram a day of omega-3 fatty acids from oily fish or supplements.
De Lorgeril M, Salen P. The Mediterranean-style diet for the prevention of cardiovascular diseases. Public Health Nutrition. 2006;9(1A):118-23.
A striking protective effect of a Mediterranean diet was reported in the Lyon Diet Heart Study with a 50% to 70% reduction of the risk of recurrence after 4 years in coronary heart disease patients. Supplementation with omega-3 fatty acids (about 1 g per day) in patients following a Mediterranean diet decreased the risk of cardiac death by 30% and of sudden cardiac death by 45%. Along with a Mediterranean type diet, even small doses of omega-3 fatty acids (about 1 gram of fish oil capsules or 2 grams alpha-linolenic acid in canola oil and margarine) might be very protective.
Estruch R, Martinez-Gonzalez MA, Corella D, et al. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Annals of Internal Medicine. 2006;145(1):1-11.
Compared with a low-fat diet, two Mediterranean diets (one supplemented with olive oil and the other with nuts) produced beneficial effects on cardiovascular risk factors including glucose levels, systolic blood pressure, cholesterol-HDL ratio, and C-reactive protein levels in the olive oil group.
Giugliano D, Ceriello A, Esposito K. The effects of diet on inflammation: emphasis on the metabolic syndrome. Journal of the American College of Cardiology. 2006;48(4):677-85.
The main dietary strategies to reduce coronary heart disease include adequate omega-3 fatty acids, less saturated and trans-fats, and a diet high in fruits, vegetables, nuts, and whole grains and low in refined grains, all of which lower inflammation. The whole diet approach is a promising way to reduce the inflammation associated with the metabolic syndrome.
Halton T, Willet WC, Liu S, et al. Low-carbohydrate-diet score and the risk of coronary heart disease in women. New England Journal of Medicine. 2006; 355(19):1991-2002.
During 20 years of follow-up in the Nurses' Health Study, diets moderately lower in carbohydrate and higher in protein and fat were not associated with increased risk of coronary heart disease in women. Using vegetable sources of fat and protein (such as nuts, avocados and tofu products), these diets can cut the risk of heart disease by as much as 30% compared to just a low-fat dietary approach.
He FJ, Nowson CA, MacGregor GA. Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet. 2006; 367(9507):320-6.
In a meta-analysis of 8 studies, both men and women who ate more than five servings of fruit and vegetables per day had a significantly lower risk of stroke. One serving of fruit or vegetables is about 3 ounces.
Jenkins DJ, Kendall CW, Faulkner DA, et al. Assessment of the longer-term effects of a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia. American Journal of Clinical Nutrition. 2006; 83(3):582-91.
More than 30% of participants who ate cholesterol-lowering foods were able to lower LDL-cholesterol concentrations more than 20%, which was a similar response to a first-generation statin drug.
Martinez-Gonzalez MA. The SUN cohort study. Public Health Nutrition. 2006;9(1A):127-31.
Increased use of olive oil or a Mediterranean diet was associated with a decrease in myocardial infarction and a reduced risk of hypertension in men.
Nambi V, Ballantyne CM. Combination therapy with statins and omega-3 fatty acids. American Journal of Cardiology. 2006;98(4A):34i-38i.
The combination of statins and omega-3 fatty acids has consistently been shown to be effective, safe, and well-tolerated. Patients with recent myocardial infarction may also benefit from this combination. Omega-3 fatty acids provide additional improvements in cholesterol and trigylcerides.
Pokan R, Hofmann P, von Duvillard SP, et al. University of Vienna, Vienna, Austria. Oral magnesium therapy, exercise heart rate, exercise tolerance, and myocardial function in coronary artery disease patients. British Journal of Sports Medicine. 2006; 40(9):773-8.
Magnesium supplementation improves endothelial function, exercise tolerance, and exercise-induced chest pain in patients with coronary artery disease.
Rahman K, Lowe GM. Garlic and cardiovascular disease: a critical review. Journal of Nutrition. 2006; 136(3 Suppl): 736S-740S.
Studies point to the fact that garlic reduces cholesterol, inhibits the clumping together of platelets, reduces blood pressure, and increases antioxidant status. Since 1993, 44% of clinical trials have indicated a reduction in total cholesterol.
Reiffel JA, McDonald A. Antiarrhythmic effects of omega-3 fatty acids. American Journal of Cardiology. 2006; 98(4A):50i-60i.
Fish oil, especially omega-3 fatty acids, has been found to reduce triglycerides, increase HDL, the good cholesterol, and have a positive effect on heart arrhythmias. One of the most significant findings was decrease in sudden death in survivors of myocardial infarction and the recommendation of fish oil as part of the post-myocardial infarction regimen in Europe.
Robinson JG, Stone NJ. Antiatherosclerotic and antithrombotic effects of omega-3 fatty acids. American Journal of Cardiology. 2006; 98(4A):39i-49i.
Omega-3 fatty acids from both sea and plant sources reduce the risk of death from coronary artery disease. They may help prevent the development of arterial plaques and blood clots. Studies show that omega-3 fatty acids from fish consistently lower triglycerides and blood pressure, improve blood vessel function, and increase levels of HDL.
Ros E, Nunez I, Perez-Heras A. A walnut diet improves endothelial function in hypercholesterolemic subjects: a randomized crossover trial. Circulation. 2004; 109(13):1609-14.
Patients were randomized to a cholesterol-lowering Mediterranean diet and a similar diet in which walnuts replaced approximately 32% of the energy from monounsaturated fat. The walnut diet improved blood vessel function and significantly reduced total cholesterol and LDL cholesterol.
Lesperance F, Frasure-smith N, Koszycki D, et al. Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: The Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. JAMA: 2007;297(4): 367-379.
This study looked at the short-term effects of an antidepressant medication (citalopram) and interpersonal psychotherapy (IPT) in reducing depression in patients with coronary artery disease. Citalopram plus weekly clinical management for major depression was found to be effective and no added benefit of IPT was found.
Lett HS, Davidson J, Blumenthal JA. Nonpharmacologic treatments for depression in patients with coronary heart disease. Psychosomatic Medicine. 2005; 67(Suppl1):S58-S62.
Non-drug treatments for depression in patients with coronary heart disease include psychological therapies such as cognitive behavior therapy (CBT) and interpersonal therapy (IPT), aerobic exercise, St. John's wort, essential fatty acids, SAMe, acupuncture, and chromium picolinate. The best evidence exists for psychological treatments, particularly CBT and IPT. Aerobic exercise offers promise due to its effect on cardiovascular risk factors.
Naqvi TZ, Naqvi SS, Merz CN. Gender differences in the link between depression and cardiovascular disease. Psychosomatic Medicine. 2005;67(Suppl1):S15-S18.
Major depression in patients with recent acute myocardial infarction (AMI) or angina more than doubles the risk of cardiac death in both men and women. Treatment of depression with serotonin reuptake inhibitors (antidepressants) is safe after an AMI and is particularly effective in patients with recurrent depression.
Tiller WA, McCraty R, Atkinson M. Cardiac coherence: a new, noninvasive measure of autonomic nervous system order. Alternative Therapies in Health and Medicine. 1996; 2(1): 52-65.
The results of this study of the Freeze-Frame self-management technique suggest that positive emotions lead to changes in heart rate variability that may benefit hypertension and may reduce the likelihood of sudden death in patients with congestive heart failure and coronary artery disease.
Lewin RJ, Furze G, Robinson J, et al. A randomized controlled trial of a self-management plan for patients with newly diagnosed angina. British Journal of General Practice. 2002; 52(476): 194-6.
The effect of a cognitive behavioral disease management program, the Angina Plan, on adjustment in patients with newly diagnosed angina showed a greater reduction in the frequency of angina, the use of angina medication, anxiety and depression, and physical limitations. They were more likely to report having changed their diet and increased their daily walking.
Age-Specific
Moalla W, Maingourd Y, Gauthier R, et al. Effect of exercise training on respiratory muscle oxygenation in children with congenital heart disease. European Journal of Cardiovascular Prevention & Rehabilitation. 2006;13(4):604-11.
The effects of a home-based training program on muscular and respiratory weakness in children with congenital heart disease were studied. A significant improvement in exercise performance was found in the exercise training group vs. the control group.
Rhodes J, Curran TJ, Camil L, et al. Sustained effects of cardiac rehabilitation in children with serious congenital heart disease. Pediatrics. 2006;118(3):e586-93.
Past studies show the short term benefits of cardiac rehabilitation in children with congenital heart disease. The results of this study indicate that cardiac rehabilitation also produces significant, sustained improvements in exercise function, behavior, self-esteem, and emotional state.
Wray J. Intellectual development of infants, children and adolescents with congenital heart disease. Developmental Science. 2006; 9(4):368-78.
This article provides an overview of the effects of oxygen deficiency on the intellectual development of infants, children and adolescents with congenital heart disease.
Moons P, Barrea C, Suys B, et al. Improved perceived health status persists three months after a special sports camp for children with congenital heart disease. European Journal of Pediatrics. 2006;165(11):767-72.
This study investigated changes in the health status and physical activities of children with congenital heart disease who attended a special sports camp. Significant improvements in their sense of physical functioning, general health, emotional functioning, self-esteem, and mental health were seen.
Rhodes J, Curran TJ, Camil L, et al. Impact of cardiac rehabilitation on the exercise function of children with serious congenital heart disease. Pediatrics. 2005; 116(6): 1339-45.
This study looked at the effect of a cardiac rehabilitation program on their exercise capacity of children with congenital heart disease. Improvements were found in 15 of 16 patients with no complications.
Dong M, Giles WH, Felitti VJ, et al. Insights into causal pathways for ischemic heart disease: adverse childhood experiences study. Circulation. 2004; 110(13): 1761-6.
This study looked at the relationship between difficult childhood experiences including abuse and neglect and the risk of ischemic heart disease in adulthood. Nine out of ten categories of adverse childhood experiences significantly increased the risk of ischemic heart disease.
Haji SA, Ulusoy RE, Patel DA, et al. Predictors of left ventricular dilatation in young adults (from the Bogalusa Heart Study). American Journal of Cardiology. 2006; 98(9):1234-7.
An early sign of worsening heart function is enlargement of the left ventricle of the heart. Obesity beginning in childhood and obesity and hypertension in young adulthood are predictors of this type of enlargement early in life.
Juonala M, Viikari JS, Rasanen L, et al. Young adults with family history of coronary heart disease have increased arterial vulnerability to metabolic risk factors: the Cardiovascular Risk in Young Finns Study. Arteriosclerosis, Thrombosis & Vascular Biology. 2006; 26(6):1376-82.
The occurrence of early atherosclerosis was investigated in young adults with a family history of coronary heart disease. They were found to have increased carotid artery wall thickening partly explained by their increased vulnerability to metabolic risk factors.
El Menyar AA. Drug-induced myocardial infarction secondary to coronary artery spasm in teenagers and young adults. Journal of Postgraduate Medicine. 2006; 52(1):51-6.
In this review, 50 articles reported the role of illicit drugs and certain medications in acute myocardial infarction due to coronary artery spasm. Coronary artery spasm was associated with 12 illicit substances in teenagers including cocaine, marijuana, alcohol, butane and amphetamines. Myocardial infarction caused by cocaine is the most frequent finding. Coronary artery spasm was reported with 19 types of medications including over-the-counter medications, chemotherapy, anti-migraine and antibiotics.
Lavie CJ, Milani RV. Adverse psychological and coronary risk profiles in young patients with coronary artery disease and benefits of formal cardiac rehabilitation. Archives of Internal Medicine. 2006;166(17):1878-83.
The substantial benefit of cardiac rehabilitation and exercise training programs in younger adults was seen in this study. They showed improvements in body mass index, percentage of body fat, HDL, C-reactive protein, peak oxygen consumption, resting heart rate, and resting systolic pressure. They also had greater than 50% to 80% reductions in anxiety, hostility and depression.
Aronow WS. Heart failure update: treatment of heart failure with a normal left ventricular ejection fraction in the elderly. Geriatrics. 2006; 61(8):16-20.
Heart failure increases with age and is higher in older women than men. Hypertension should be treated with diuretics, ACE inhibitors, and beta blockers. Myocardial ischemia should be treated with nitrates and beta blockers. Anemia, hyperthyroidism, hypothyroidism, and obstructive sleep apnea should be treated. Use of nonsteroidal anti-inflammatory drugs should be avoided. Coronary revascularization should be performed in selected individuals.
Giallauria F, Lucci R, Pietrosante M, et al. Exercise-based cardiac rehabilitation improves heart rate recovery in elderly patients after acute myocardial infarction. Journals of Gerontology Series A-Biological Sciences & Medical Sciences. 2006; 61(7):713-7.
Exercise training in elderly patients with acute myocardial infarction resulted in improvement in heart rate recovery which was correlated with improvement in heart and lung function.
Luskin FM, Newell KA, Griffith M, et al. A review of mind-body therapies in the treatment of cardiovascular disease. Part 1:implications for the elderly. Alternative Therapies in Health and Medicine. 1998; 4(30):46-61.
Mind-body practices for cardiovascular disorders in the elderly include social support, cognitive-behavioral treatment, meditation, faith, imagery, music therapy, hypnosis, yoga, t'ai chi, and qigong among others. Mind-body techniques were found to be effective for cardiovascular disease-related conditions.
Luskin F, Reitz M, Newell K, et al. A controlled pilot study of stress management in elderly patients with congestive heart failure. Cardiology. 2002; 5(4): 168-71.
The effect of stress management in elderly patients with congestive heart failure was studied. Significant improvements were noted in perceived stress, emotional distress, 6-minute walk, and depression after 8 training sessions a stress management program developed by the Institute of HeartMath.
Gender Specific
Everson-Rose SA, Lewis TT, Karavolos K, et al. Cynical hostility and carotid atherosclerosis in African American and white women: the Study of Women's Health Across the Nation (SWAN) Heart Study. American Heart Journal. 2006; 152(5):982e7-13.
The association between hostility, thickening of the arterial wall and plaque in the carotid arteries in middle-aged women was studied. Each 1-point increase in hostility score predicted a significantly higher arterial wall thickness.
Arthur JM, Wright DM, Smith KM. Women and heart disease: the treatment may end but the suffering continues. Canadian Journal of Nursing Research. 2001;33:17-19.
Women's main rehabilitative need may be support, particularly from women with similar experiences. In this study, group support helped women cope with their emotional reactions and manage their health problem.
Claesson M, Birgander LS, Lindahl B, et al. Women's hearts--stress management for women with ischemic heart disease: explanatory analyses of a randomized controlled trial. Journal of Cardiopulmonary Rehabilitation. 2005;25(2):93-102.
The effects of a 1-year group cognitive-behavioral stress management program for women with ischemic heart disease was studied. Results showed improved psychological well-being relative to stress and exhaustion.
Thorne SA. Pregnancy in Heart Disease. Heart. 2004;90(4):450-6.
This review describes pregnancy-related issues in women with congenital heart disease, ischemic heart disease, cardiomyopathy, rheumatic heart disease, mitral stenosis, aortic stenosis and other health conditions. The article is available in full text online.
Sermer M, Colman J, Sui S. Pregnancy complicated by heart disease: a review of Canadian experience. Journal of Obstetrics & Gynaecology. 2003; 23(5):540-4.
A review of 276 pregnancies in patients with pre-existing heart disease showed 18% of births were complicated by congestive heart failure, arrhythmia and stroke. Medical problems for mother and infant are increased significantly in women with pre-existing heart disease, but mortality is low. Factors that place the mother and the neonate at risk can be identified before pregnancy.
Berger JS, Roncaglioni Maria C, Avanzini F, et al. Aspirin for the Primary Prevention of Cardiovascular Events in Women and Men: A Sex-Specific Meta-analysis of Randomized Controlled Trials. JAMA. 2006;295:306-313.
In women, aspirin therapy was associated with a 12% reduction in cardiovascular events and a 17% reduction in ischemic stroke. In men, it was associated with a 14% reduction in cardiovascular events and a 32% reduction in myocardial infarctions. Aspirin treatment increased the risk of bleeding in both women and in men.
Buring JE. Aspirin prevents stroke but not MI in women; vitamin E has no effect on CV disease or cancer. Clevevand Clinic Journal of Medicine. 2006; 73(9):863-70.
Low-dose aspirin taken every other day helps prevent stroke in women 45 years and older, but does not prevent a first myocardial infarction or cardiovascular death among healthy women. No benefit from alternate-day vitamin E was seen.
Larosa JH, Larosa JC. Coronary heart disease prevention in women: focus on lipids. Minerva Cardioangiolica. 2006; 54(3):311-22.
Clinical trials show a clear cut benefit of LDL lowering in both women and men with coronary disease. It is felt that patients at high risk of coronary heart disease will in the long run benefit from lowering LDL.
Ren J. Cardiac health and diabetes mellitus in women: problems and prospects. Minerva Cardioangiolica. 2006;54(3):289-309.
Women develop cardiovascular disease at a later age than men and have a higher prevalence of other diseases as well. Women with diabetes have a 5-fold increase of heart disease.
Rosen RC, Jackson G, Kostis JB. Erectile dysfunction and cardiac disease: recommendations of the Second Princeton Conference. Current Urology Reports. 2006; 7(6):490-6. Erectile dysfunction (ED) has been linked to cardiovascular risk factors. Sexual activity is safe for most patients, but all patients with ED should be assessed for obesity, hypertension, and high cholesterol. Exercise and weight loss is strongly encouraged.
Hjelstuen A, Anderssen SA, Holme I, et al. Markers of inflammation are inversely related to physical activity and fitness in sedentary men with treated hypertension. American Journal of Hypertension. 2006;19(7):669-75.
The relationship between physical activity and atherosclerosis in men with hypertension was studied. Results showed the benefit of good fitness and low intensity physical activity on vessel wall inflammation.
Hjerkinn EM, Abdelnoor M, Breivik L, et al. Effect of diet or very long chain omega-3 fatty acids on progression of atherosclerosis, evaluated by carotid plaques, intima-media thickness and by pulse wave propagation in elderly men with hyper-cholesterolaemia. European Journal of Cardiovascular Prevention & Rehabilitation. 2006;13(3):325-33.
The effect of dietary counseling and omega-3 fatty acid supplements (2.4 grams a day) on atherosclerosis in carotid arteries was studied in over 500 elderly men. Reduced progression in carotid artery wall thickening was seen after dietary counseling, while omega-3 supplements had a positive effect on the elasticity of the carotid arteries.
Chiuve SE, McCullough ML, Sacks FM, Rimm EB. Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid-lowering and antihypertensive medications. Circulation. 2006;114(2):160-7.
In men taking medication for hypertension or high cholesterol, 57% of all coronary events may have been prevented with a low-risk lifestyle. Those who adopted two or more additional low-risk lifestyle factors had a 27% lower risk of coronary heart disease.
Malkin CJ, Pugh PJ, West JN, et al. Testosterone therapy in men with moderate severity heart failure: a double-blind randomized placebo controlled trial. European Heart Journal. 2006;27(1):57-64.
Testosterone replacement therapy (5 mg Androderm) improved the exercise capacity, ability to perform daily activities and symptoms in 76 men with heart failure in a one-year study.
Nicholson A, Fuhrer R, Marmot M. Psychological distress as a predictor of CHD events in men: the effect of persistence and components of risk. Psychosomatic Medicine. 2005;67(4):522-30.
In 5,449 men studied, psychological distress increased the risk of coronary events. This was related to anxiety and sleep disturbance rather than depressive symptoms.
Kubzansky LD, Loenen KC, Spiro A, et al. Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the normative aging study. Archives of General Psychiatry. 2007; 64:109-116.
Researchers correlated the results of questionnaires from 1,996 men with post- traumatic stress disorder and their incidence of coronary heart disease. The
more severe the stress symptoms, the greater risk of coronary heart disease later in life.
Environmental Influences
Bhatnagar A. Environmental cardiology: studying mechanistic links between pollution and heart disease. Circulation Research. 2006; 99(7):692-705.
There is growing evidence that exposure to pollutants and chemicals increase the risk of ischemic heart disease, arrhythmias, and heart failure. Animal studies show that exposure to ambient air particles increases blood clots and the build up of plaque in the arteries. Exposures to arsenic, lead, cadmium, pollutant gases, solvents, and pesticides have also been linked to increased incidence of cardiovascular disease.
Gong KW, Zhao W, Li N, et al. Air pollutant chemicals and oxidized lipids exhibit genome wide synergistic effects on endothelial cells. Genone Biology. 2007;8:R149.
This study is the first to reveal a direct genetic link between vehicle exhaust and hardening of the arteries. Microscopic pollution particles in diesel exhaust can combine with blood cholesterol to switch on genes that inflame the blood vessels and lead to arteriosclerosis.
Hagele TJ, Mazerik JN, Gregory A, et al. Mercury activates vascular endothelial cell phospholipase D through thiols and oxidative stress. International Journal of Toxicology. 2007;26(1):57-69.
Mercury is a risk factor of cardiovascular disease, possibly by triggering a process leading to plaque buildup in blood vessel walls. In this study mercury caused changes in the behavior of cells that line the blood vessel walls.
Peel JL, Metzger KB, Klein M, et al. Ambient air pollution and cardiovascular emergency department visits in potentially sensitive groups. American Journal of Epidemiology. 2007;15;165(6):625-33.
Data was collected on visits to the emergency room for cardiovascular disease in relation to levels of pollutants in the air. People with hypertension, diabetes and chronic obstructive pulmonary disease were more susceptible to cardiovascular events at a time of increased air pollution.