Coronary heart disease (CHD) is the number one cause of death in African-Americans. The frequency and severity of CHD and related risk factors is greater in the African-American population. These risk factors include hypertension, left ventricular hypertrophy, obesity, smoking and psychosocial stress factors such as anger, anxiety, and depression, which are exacerbated by low socioeconomic status in this minority population. Psychosocial stress factors contribute to both physiological and behavioral risk factors for CHD and correlate directly with the incidence of CHD events in blacks and in general populations. The major functional manifestation of CHD is myocardial ischemia, and psychological stress is reported to increase the risk for myocardial ischemia events in the general population. Studies by Blumenthal at Duke University indicate that CHD events in daily life are predicted by psychosocial stress-induced myocardial ischemia events in laboratory settings. Previous research by the project team has demonstrated that the Transcendental Meditation (TM) program reduces psycho-physiological stress. Meta-analyses show that the stress- reduction effects of TM are significantly greater and more consistently replicated than those of any other researched technique. Previous NHLBI-funded research by the project team indicated that stress reduction through the TM program significantly reduced both physiological and behavioral risk factors for CHD in inner city African-American populations. A follow-up of African-American subjects with mild hypertension who learned TM showed a greater than 50 percent reduction in cardiovascular and all-cause mortality over 5 years a compared to controls. The present pilot study will be an ancillary study to a larger randomized, controlled trial of stress reduction in the treatment and prevention of CHD in high risk African-Americans (Robert Schneider #2RO1HL48107-05). The pilot study will evaluate effects of stress reduction with TM on myocardial ischemia on a subset of 40 African-Americans with CHD and correlate this outcome with changes in CHD risk factors. In a preliminary investigation of patients in the general population with CHD, the TM program reduced stress-induced myocardial ischemia in a laboratory setting. The proposed study, although still pilot research, will attempt to replicate this finding with a larger study population, including a health education control, and using a more direct measure of myocardial ischemia, SPECT-sestamibi testing. The study will elucidate a potentially major mechanism for prevention of CHD morbidity and mortality with a stress-reduction behavioral intervention.
