Depression and inadequate social support are risk factors for medical morbidity and morality after acute myocardial infarction (AMI). The Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial is a multicenter, randomized, controlled clinical study of cognitive-behavioral treatment (CBT) for depression and inadequate social support in post-AMI patients. Because the ENRICHD trial did not focus on biological risk factors (e.g., lipoproteins, lipids, glucose tolerance, adiposity, insulin, inflammatory markers, coagulation factors), possible subclinical markers of disease (e.g., coronary calcification, elevated intima-media thickness [IMT] of carotid artery, decreased brachial artery vasodilation, increased left ventricular mass) or putative mediators (e.g., cortisol, catecholamines) of increased coronary heart disease (CHD) risk or putative subclinical markers of disease, we propose to study further some 200 Miami patients previously enrolled in ENRICHD as well as 210 (180 completors) newly-recruited post-acute MI patients. Thus, approximately 100 previously studied ENRICHD patients, who received CBT, and 100 ENRICHD patients who received usual care, would be compared in terms of post-treatment cardiovascular risk factors, possible subclinical markers of disease and other biological and psychosocial variables to determine the effects of CBT. These patients would then be compared with 210 (180 completors) newly recruited post-acute MI patients. Half of these newly recruited subjects would be randomized into the CBT condition and half into usual care. These newly recruited post-MI patients would be assessed both before and after treatment (i.e., CBT or usual care) in terms of psychosocial variables (e.g., depression and social support), putative biological mediators (e.g., elevated cortisol), risk factors (e.g., elevated triglycerides) and possible subclinical markers of disease (e.g., coronary calcification) as well as demographic and medical characteristics. The project would use all of the core units.
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