Acute and chronic psychological stress has been shown to be a risk factor for cardiac events. More recently, with the advent of new technology allowing cardiac imaging, acute psychological stressors have been shown to produce myocardial ischemia in certain subsets of patients with coronary artery disease. Several studies have shown that the production of myocardial ischemia in response to acute psychological stress in the laboratory is a marker for adverse events in patients with coronary artery disease. Several pathways by which psychologically induced stress may trigger ischemic events have been proposed and a number of studies have provided evidence that stress effects ischemic events via these pathways. Stress interventions have been shown to have a positive impact on CAD outcomes, with only one thus far testing their effects on psychological stress induced ischemic events. Further, some studies have reported positive results with coronary risk factors using meditation and yoga. Current clinical meditation literature suggests that a mindfulness meditation based stress reduction program (i.e., multicomponent, psychoeducational program based in mindfulness meditation which cultivates an ability to pay attention to one's moment-to- moment experiences in a nonjudgemental, nonreactive fashion) will be able to reduce stress reactivity in CAD patients. It is predicted that such reduction in stress reactivity will result in reduced radionuclide imaged perfusion defects during a laboratory mental stress task. Although it has not been used with heart patients, it has demonstrated good results with both stress and symptomology in the general and other medical populations. We believe that similar results will be seen in CAD patients with effects acting through the following pathways; 1) decreased sympathetic tone, and 2) increased parasympathetic tone. The overall goal of the proposed study is to evaluate the efficacy of a meditation based stress reduction program for the reduction of mental stress induced ischemia.
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