The presence of transient myocardial ischemia is an important functional expression of coronary heart disease (CHD). Two hundred ten CHD patients will be recruited via local media and from surrounding area hospitals. All participants will have clinical evidence of CHD and evidence of transient myocardial ischemia on mental stress testing or ambulatory monitoring. After a comprehensive evaluation and baseline assessments, subjects will be randomly assigned to a Stress Management group, to an Exercise training group, or to a Usual Care control group. All intervention groups will last 16 weeks. The baseline and 16-week assessments include a physical examination; blood lipid and c-reactive protein assay (30 cc of blood); the completion of questionnaires; measures of hemodynamic response during mental and exercise stress testing via radionuclide ventriculography (RNV) testing; ambulatory ECG and blood pressure monitoring of myocardial ischemia; a non-invasive test of endothelial function; and a baroreflex assessment. The long-term clinical outcomes of these ischemic changes will be evaluated by obtaining patient medical records documenting cardiac events and by contacting patients annually after the second comprehensive assessment. We hypothesize that exercise and stress management training will be associated with a reduction in ischemic activity, associated with reductions in blood pressure and systemic vascular resistance, and improved endothelial function. Data from this study will provide new insights into the mechanisms of stress-induced myocardial ischemia, as well as important knowledge regarding the clinical benefits of exercise and stress management training in the treatment of CHD patients with myocardial ischemia.
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