Cognitive behavioral therapy to prevent recurrent cardiovascular events

January 01, 0001

Cognitive behavioral therapy to prevent recurrent cardiovascular events

Psychosocial factors are independently associated with increased risk of cardiovascular disease (CVD) morbidity and mortality. These Swedish investigators performed a randomized controlled clinical trial of cognitive behavioral therapy (CBT) to measure its effects on CVD recurrence. The study included 362 women and men 75 years or younger who were discharged from the hospital after a coronary heart disease event within the past 12 months. Patients were randomized to receive traditional care (reference group, 170 patients) or traditional care plus a CBT program (intervention group, 192 patients), focused on stress management, with 20 two-hour sessions during 1 year. Median attendance at each CBT session was 85%.

They found: "During a mean 94 months of follow-up, the intervention group had a 41% lower rate of fatal and nonfatal first recurrent CVD events, 45% fewer recurrent acute myocardial, and a nonsignificant 28% lower all-cause mortality than the reference group after adjustment for other outcome- affecting variables. In the CBT group there was a strong dose-response effect between intervention group attendance and outcome. During the first 2 years of follow-up, there were no significant group differences in traditional risk factors."

The authors concluded: "A CBT intervention program decreases the risk of recurrent CVD and recurrent acute myocardial infarction. This may have implications for secondary preventive programs in patients with coronary heart disease."

This study warrants replication in other settings and if successful cognitive behavioral therapy could become a routine part of chronic care for CVD.

For the full abstract, click here.

Arch Intern Med 171(2):134-140, 24 January 2011
© 2011 to the American Medical Association
. Mats Gulliksson, Gunilla Burell, Bengt Vessby, Lennart Lundin, Henrik Toss, Kurt Svärdsudd. Correspondence to Dr. Gulliksson: [email protected]

Category: K. Circulatory, P. Psychological. Keywords: cardiovascular disease, CVD, coronary heart disease, cognitive behavioral therapy, myocardial infarction, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 8 February 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.