NEW YORK (Reuters Health) - Adding stress management to routine heart disease treatment might lessen some patients' long-term risk of complications, study results suggest.

A 5-year study of men with heart disease showed that those who went through 4 months of stress management training were less likely to need a heart procedure such as bypass surgery over the study period.

Overall, few of the 94 men in the study had a heart attack, and only one died. But in the study's first year, two men who received only standard care had a heart attack, while none in the stress reduction group did, according to a report in the January 15th issue of the American Journal of Cardiology.

The men in the stress management group also had somewhat fewer heart procedures than those who were assigned to an exercise group, note Dr. James A. Blumenthal of Duke University in Durham, North Carolina, and his colleagues.

And despite the added cost of stress management training, patients in this group had lower hospitalization and physicians' costs over 5 years than men in the standard care group did. Costs in the exercise group were similar to the stress reduction group's.

``These findings confirm the added value of stress management training to usual medical care, and indicate that such training is associated with fewer adverse cardiac events and less medical expenditures,'' Blumenthal's team writes.

But the results do not mean that any community-based stress reduction course would be helpful, Blumenthal noted in an interview with Reuters Health.

He explained that the study's stress management was geared specifically to heart patients, providing information on heart disease and its risk factors as well as techniques for lowering stress.

``I think the expertise is important,'' Blumenthal said--although, he pointed out, such refined courses are not yet widely available to heart disease patients.

Men in the stress management group went through 16 small-group sessions that provided them with ways to control negative emotions and thoughts, techniques for muscle relaxation and other stress-calming tactics.

Those in the exercise group had 16 weeks of supervised physical activity, while the standard care group continued with their normal treatment only.

All of the men in the study had shown evidence of exercise-induced ischemia during exercise testing. This means that exercise triggered a reduction in the blood and oxygen supply to their hearts. Seventy of the 94 also showed ischemia in response to mental stress.

This response appears relatively common among heart disease patients with exercise-induced ischemia, according to Blumenthal. But, he noted, stress-induced ischemia also appears largely ``silent''--that is, it occurs without symptoms like chest pain.

He pointed out that patients did not enter this study ''complaining of stress''--which suggests heart disease patients need not feel stress is a problem to benefit from stress management.

Blumenthal and his colleagues are currently studying a larger group of patients, and hope to figure out how stress might trigger ischemia and how stress management might prevent it.

SOURCE: American Journal of Cardiology 2002;89.

Reference Source 89

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