The presence of transient myocardial ischemia is an important functional expression of coronary artery disease (CAD). Clinical studies have shown that he presence and severity of ischemic episodes mediate risk for coronary events, and affect prognosis in patients with CAD. It has been shown that the majority of ischemic episodes are not associated with symptoms (hence, are """"""""silent""""""""). Moreover, these episodes often occur during low levels of physical activity and at lower heart rates than those at which exercise-induce ischemia occurs in these same individuals. the present study is designed to examine the extent to which behavioral and psychological factors are associated with episodes of transient myocardial ischemia, and to assess the efficacy of behavioral interventions in reducing the """"""""total ischemic burden"""""""" among patients with CAD. One hundred and fifty patients with documented CAD and evidence of transient myocardial ischemia will serve as subjects for this study. The first phase of the study will involve comprehensive evaluating both in- hospital and out-of-hospital. In-hospital assessments will include provocative mental stress testing to elicit transient ischemia, and psychometric testing to assess underlying personality traits and behavioral dispositions. the out-of-hospital assessment will consist of 48-hour ECG monitoring with concurrent behavioral diary recording. In the second phase, following completion of the assessment, subjects will be randomly assigned to one of three groups: Aerobic exercise, Stress Management or Lecture Series Control. All subjects will then be re- evaluated after four months of treatment. We hypothesize that negative emotional states and certain psychological traits such as high levels of hostility will be associated with greater total ischemic burden. In addition, we hypothesize that the two behavioral intervention groups will experience a reduction n the frequency and duration of ischemic episodes measured in the laboratory and in the natural environment. This project has important scientific significance by further elucidating the role of stress in the pathogenesis and expression of CAD, and has important practical significance by determining the potential benefits of behavioral interventions in the management of patients with CAD.
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