African Americans suffer from disproportionately high rates of cardiovascular disease morbidity and mortality compared to white Americans. Substantial evidence indicates that high levels of psychosocial and socioenvironmental stress contribute to the excessive morbidity and mortality in this population. In earlier controlled trials with African Americans and other populations at high risk for CVD, the current collaborative team demonstrated that a selected stress reduction approach, the Transcendental Meditation (TM) program, was associated with significant reductions in CVD risk factors and surrogate markers for clinical CVD. These include clinically significant decreases in hypertension, myocardial ischemia and carotid atherosclerosis, as well as improvements in psychosocial stress and quality of life. In the previous NHLBI-sponsored clinical trial, 201 African American men and women with documented coronary heart disease (mean age 59 years) were randomized to either stress reduction with the TM program or a health education control. The results showed 50 percent lower risk of combined mortality and CVD morbidity in the stress reduction group compared to control (RR = .50, p <.05) after a median three year follow-up period. Preliminary analysis, in preparation for the proposed study, suggests lower risk of """"""""hard"""""""" events alone--mortality, MI and stroke (RR= .42; p = .15). The proposed study will conduct long-term follow-up of intervention and testing of the previous trial of 201 African American participants for an additional five funded years. This study will definitively evaluate long-term effects of behavioral stress reduction compared to control on """"""""hard"""""""" CVD endpoints and sustainability of disease-free survival on combined """"""""hard"""""""" and """"""""soft"""""""" CVD endpoints (all-cause mortality, MI, stroke, coronary revascularizations, and hospitalizations for heart failure and ischemic heart disease, non-MI). Secondary outcomes will include traditional CVD risk factors (BP, lipids, diet, exercise, weight), psychosocial risk factors (depression, hostility, anger), quality of life, medication use, compliance, and cost effectiveness. To our knowledge, this is the only randomized controlled trial of behavioral stress reduction for the secondary prevention of CVD in African American men and women. The results of this unique long-term study will contribute critical new knowledge for the elimination of racial and ethnic diparities in health.
