The President's Racial and Ethnic Health Disparities Initiative of 1998 emphasizes that African Americans suffer from disproportionately high rates of cardiovascular disease (CVD) morbidity and mortality compared to white Americans. Numerous controlled studies suggest that this disparity is associated with chronic psychosocial and environmental stress. For these reasons, the NHLBI Working Group on Research in Coronary Heart Disease in Blacks has mandated behavior and prevention in this minority population as a national research priority. Our research team has previously demonstrated in NHLBI-supported randomized controlled trials that hypertension can be effectively treated in high risk African Americans with stress reduction using the Transcendental Meditation (TM) program compared to control procedures. These and other studies have also reported clinically significant improvements in other CVD risk factors, psychosocial stress, myocardial ischemia, left ventricular mass and mortality rates from CVD and all-causes in high risk subjects randomized to active stress reduction. Preliminary findings from our recently completed, NHLBI-supported clinical trial of stress reduction in the prevention of hypertensive heart disease in inner city African Americans has indicated that atherosclerotic CVD, assessed by carotid artery intima-media thickness (IMT), significantly regresses after eight months of active stress reduction intervention compared to control education. These results were comparable to effects of lipid lowering therapies or extensive lifestyle modification. This proposed continuation project will extend these findings by investigating the effectiveness of active stress reduction in the secondary prevention of atherosclerotic CVD in African Americans. This five year study will be a randomized, single-blind, controlled, community-based trial involving 184 African American subjects with known coronary heart disease. Male and female subjects will be enrolled at our on-going field site, Martin Luther King-Drew Medical Center in inner city Los Angeles. After baseline testing, subjects will be randomized to either active stress reduction with TM or health education control-both in addition to usual medical care-and posttested after 12 months. The primary outcome will be carotid artery atherosclerosis (IMT) measured non-invasively by quantitative B-mode ultrasonography. Secondary measures will include traditional CVD risk factors (blood pressure, lipids, smoking, exercise), psychosocial stress, quality of life and cost effectiveness. The results of this clinical trial will yield valuable new knowledge for the prevention of CVD through behavioral means in high risk African Americans.
