This proposed research will determine whether a behavioral intervention involving stress management, dietary supervision and self-directed exercise, when superimposed upon standard pharmacological treatment, can further reduce coronary heart disease (CHD) risk in post-myocardial infarction (MI) patients. The major mechanistic hypothesis to be investigated is that behavioral procedures can decrease sympathetic nervous system (SNS) activation and insulin resistance (IR), thereby impacting favorably on CHD risk factors such as obesity, glucose intolerance, high blood pressure and dyslipidemia. The Project will use a randomized study design to compare in recent post-M.I. patients, who are not scheduled for nor have had coronary artery bypass graft (CABG) surgery: (1) a standard pharmacological treatment (standard care) condition; and (2) an enhanced care condition in which subjects will receive both standard pharmacotherapy plus behavioral treatment. The 102 subjects ina the standard care condition will generally receive thrombolytic therapy (aspirin), an angiotensin converting enzyme (ACE) inhibitor (if tolerated), a beta blocker (if tolerated) and a lipid lowering agent (if needed). The 102 subjects in the enhanced care condition will also receive pharmacological treatment as well as behavioral self-management skills training to decrease stress, improve diet and increase walking activity. Subjects ina the enhanced care condition will meet in small groups weekly during the first 12 weeks and monthly for the next 9 months. All subjects will be tested (echocardiography, brachial artery ultrasound, euglycemic-hyperinsulinemic clamp, oral glucose tolerance test, 12 lead electrocardiogram, blood pressure, urinary catecholaminns, serum lipids, adiposity, medical history, psychosocial assessments, quality of life assessment) before and after one year. All measures except echocardiographic, euglycemic-hyperinsulinemic clamp, and brachial artery ultrasound measurements will also be assessed 12 weeks after athe first assessment session.
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