The Effects of Heart Rate Variability (HRV) Biofeedback on HRV Reactivity and Recovery During and After Anger Recall Task for Patients with Coronary Artery Disease.

Patients with coronary artery disease (CAD) often experience anger events before cardiovascular events. Anger is a psychological risk factor and causes underlying psychophysiological mechanisms to lose balance of the autonomic nervous system (ANS). The heart rate variability (HRV) was the common index for ANS regulation. It has been confirmed that heart rate variability biofeedback (HRV-BF) restored ANS balance in patients with CAD during the resting state. However, the effects of HRV-BF during and after the anger event remain unknown. This study aimed to examine the effects of HRV-BF on ANS reactivity and recovery during the anger recall task in patients with CAD. This study was a randomized control trial with a wait-list control group design, with forty patients in the HRV-BF group (for six sessions) and 44 patients in the control group. All patients received five stages of an anger recall task, including baseline, neutral recall task, neutral recovery, anger recall task, and anger recovery. HRV reactivity in the HRV-BF group at the post-test was lower than that in the control group. HRV recovery at the post-test in the HRV-BF group was higher than that in the control group. The HRV-BF reduced ANS reactivity during anger events and increased ANS recovery after anger events for CAD patients. The possible mechanisms of HRV-BF may increase total HRV, ANS regulation, and baroreflex activation at anger events for patients with CAD, and may be a suitable program for cardiac rehabilitation.

Yoga-Based Cardiac Rehabilitation: Current Perspectives from Randomized Controlled Trials in Coronary Artery Disease.

Coronary artery disease carries a high morbidity and mortality worldwide, and exercise-based cardiac rehabilitation programmes play a large role in secondary prevention. Exercise-based rehabilitation programmes are expensive, and in certain subgroups uptake is poor. Yoga has been suggested to show improvements in cardiovascular health which would support its use in cardiac rehabilitation programmes. We carried out a review of current randomized controlled trials to determine if yoga-based cardiac rehabilitation leads to reduced cardiac risk factors, and improved physiological and psychological outcomes in patients with coronary artery disease compared to standard care. Six randomized controlled studies were identified after a medical database search, and meta-analysis was carried out for the different outcomes. Overall, the addition of yoga to standard care resulted in improved subjective feeling of cardiac health and quality of life. There was also a trend towards improvement in left ventricular systolic function. Improvement in cardiac risk factors, MACE and psychological health in this cohort has still to be proven, but was not inferior to standard or enhanced care, and the benefits became more pronounced at longer follow-up. Future studies with longer follow-up and larger patient numbers would aid in accurately assessing the long-term benefit of yoga-based rehabilitation.

Xinkeshu Improves Endothelial Function and Augments Reendothelialization Capacity in Coronary Artery Disease with Anxiety/Depression.

The disruption of endothelial homeostasis is the hallmark of coronary artery disease (CAD) and psychological disorders such as anxiety/depression. Xinkeshu (XKS), a traditional Chinese patent medicine, plays an essential role in CAD and psychological condition; however, the mechanisms underlying the effects of XKS on the endothelial function and endogenous endothelium-repair capacity in CAD patients with anxiety/depression remain elusive. In this study, endothelial function and endothelial progenitor cell- (EPC-) mediated reendothelialization capacity were compared among age-matched healthy subjects, CAD patients with or without anxiety/depression. Besides, CAD patients with anxiety/depression received 1-month XKS treatment. Anxiety/depression symptoms were evaluated by Generalized Anxiety Disorder 7-item (GAD-7)/Patient Health Questionnaire-9 (PHQ-9) score, endothelial function was tested by flow mediated dilation (FMD) measurement, and EPC-mediated reendothelialization capacity was evaluated by a carotid artery injury model in nude mouse (n = 6) with the injection of XKS-incubated EPCs from CAD patients with anxiety/depression. The results showed that FMD and EPC-mediated reendothelialization capacity of CAD patients with anxiety/depression were compromised compared to healthy subjects and CAD patients without anxiety/depression. After 1 month of XKS treatment, FMD increased from 4.29 ± 1.65 to 4.87 ± 1.58% (P < 0.05) in CAD patients with anxiety/depression, whereas it remained unchanged in the controls. Moreover, XKS decreased GAD-7 and PHQ-9 scores. Meanwhile, incubating XKS enhanced in vivo reendothelialization capacity and in vitro apoptosis of EPCs from CAD patients with anxiety/depression, which was associated with the upregulation of CXC-chemokine receptor 7 (CXCR7) and inhibition of phosphorylation of p38 signaling. CXCR7 knockdown abolished the beneficial effects of XKS, which was rescued by p38 inhibitor SB203580. Our data demonstrate for the first time that XKS improves endothelial function and enhances EPC-mediated reendothelialization through CXCR7/p38/cleaved casepase-3 signaling and provides novel insight into the detailed mechanism of XKS in maintaining endothelial homeostasis in CAD patients with anxiety/depression.

Immersive Virtual Reality Therapy as a Support for Cardiac Rehabilitation: A Pilot Randomized-Controlled Trial.

Depression and anxiety can significantly reduce the effectiveness of cardiac rehabilitation (CR). Several studies have assessed the effectiveness of virtual reality (VR)-based interventions for symptoms of anxiety and depression; however, they do not relate to patients with heart disease. The aim of this study was to assess the effects of VR therapy on the mental state of patients with coronary artery disease (CAD). Thirty-four CAD patients with elevated anxiety or depression symptoms were recruited. After randomization, 17 participants were assigned to the intervention group, and 17 to the control group. Both groups underwent standard CR for outpatients. In the intervention group, eight VR therapy sessions were applied. In the control group, eight sessions of Schultz' Autogenic Training were applied. To assess patient mental states, Hospital Anxiety and Depression Scale (HADS) and Perception of Stress Questionnaire (PSQ) were used, before and after 4 weeks of CR. In the intervention group, a significant decrease in HADS score was observed (19.46 pretreatment vs. 15.73 post-treatment, p = 0.003), HADS-Anxiety subscale decreased by 16.0 percent (p = 0.01) and HADS-Depression by 23.0 percent (p = 0.003). Similarly, a significant decrease in PSQ was recorded at 12.8 percent (64.73 vs. 56.47, p = 0.03). In the control group, HADS and PSQ data did not change. VR therapy significantly reduced the severity of depressive symptoms, anxiety, and stress levels in CAD patients undergoing CR. Immersive VR therapy effectively supports the CR of individuals with anxiety-depressive symptoms. ClinicalTrials.gov (NCT04045977).

Effect of voluntary breathing exercises on stable coronary artery disease in heart rate variability and rate-pressure product: a study protocol for a single-blind, prospective, randomized controlled trial.

BACKGROUND: At present, China has more than 11 million patients with stable coronary heart disease and this is becoming a major public health problem. The pathological changes of coronary heart disease can lead to dysfunction of the cardiac autonomic nervous system, which increases the risk of complications such as malignant arrhythmia (ventricular flutter, ventricular fibrillation, etc.), heart rate, systolic blood pressure, and rate-pressure product (RPP), which is highly correlated with myocardial oxygen consumption and indirectly reflects myocardial blood supply and oxygen consumption. Although the guidelines recommend that such patients take drugs to reduce heart rate and myocardial oxygen consumption, the clinical control of heart rate is still not ideal. Thus, in this trial, we will use voluntary breathing exercises as the strategy of exercise rehabilitation for patients with stable coronary artery disease (SCAD), in order to increase the vagus nerve activity and/or reduce the sympathetic nervous activity, help maintain or rebuild the balance of plant nerve system, improve the time-domain index of heart rate variability, reduce the burden on the heart, and relieve patients' anxiety and other negative emotions. METHODS: This is a 6-month single-blind, randomized controlled clinical trial that will be conducted in the First Affiliated Hospital of Soochow University. A total of 140 patients who fill out the Informed Consent Form are registered and randomized 1:1 into the Voluntary Breathing Exercises (VBE)-based clinical trial monitoring group (n = 70) or the Routine follow-up group (n = 70). The VBE-based clinical trial monitoring group is given VBE training on the basis of conventional treatment and health education, while the control group received conventional health education and follow-up. The primary outcomes will be measured heart rate variability and RPP. Secondary outcomes will include changes in Self-rating Anxiety Scale, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, weight, and body mass index. DISCUSSION: This trial will carry out scientific respiratory exercise for patients with SCAD, which belongs to the category of active secondary prevention for patients, and changes from remedial to pre-protective. VBE is easy to operate and is not limited by time and place. It is important and meaningful to carry out VBE for patients with SCAD. This study will provide considerable evidence for further large-scale trials and alternative strategies for the rehabilitation nursing of patients with SCAD. TRIAL REGISTRATION: Chinese Clinical Trials Registry, 1900024043 . Registered on 23 June 2019.

Area-Based Medicine in the Super-Ageing Society in Japan.

Japan's health insurance system has reached a critical turning point owing to a decreasing birthrate, increasing longevity, and changes in disease trends. The Japanese government is promoting the establishment of a community-based integrated care system aimed at maintaining the dignity of elderly individuals and supporting independent living. This care system will ensure medical and nursing care, preventive measures, and independent living support. This type of care system should be based on the characteristics of individual geographical areas, as there are marked regional variations in patterns of aging, lifestyle, and the adequacy of local medical care. Therefore, it is important that medical services are tailored to fit the kind of medical care needed by residents of each geographical area and to provide medical services accordingly. In this paper, we propose a need for area-based medicine, whereby medical care is provided according to the characteristics of individual geographical areas in super-ageing societies such as that of Japan. J. Med. Invest. 67 : 40-43, February, 2020.

The effect of music therapy on pain, anxiety and depression in patients after coronary artery bypass grafting.

OBJECTIVE: The purpose of this study was to explore the effects of music therapy on pain, anxiety and depression in patients after coronary artery bypass grafting. METHODS: A retrospective study of 99 patients after coronary artery bypass from January 2017 to January 2019 was conducted in a cardiac center in China. According to the different interventions, all the participants were divided into 3 groups: group A: music therapy; group B: rest without music therapy; and group C: conventional treatment. The Numerical Rating Scale (NRS), Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to measure the patient's pain, anxiety and depression before and after 30 min of the intervention. RESULTS: There were no significant differences in the NRS, SDS and SAS scores between the three groups of patients before the intervention. After 30 min of music therapy, the NRS, SDS and SAS scores of patients in group A were significantly lower than those before music therapy, and the differences were statistically significant. However, before and after the intervention in groups B and C, the NRS, SDS and SAS scores were not statistically significant. By comparison among the three groups after 30 min of intervention, the NRS, SDS and SAS scores in patients in group A were significantly lower than those in groups B and C, and the differences were statistically significant. The scores were not significantly different between groups B and C. CONCLUSION: Music therapy can effectively alleviate the pain, anxiety and depression of patients after coronary artery bypass grafting.

The Effect of an Empowerment Program on the Perceived Risk and Physical Health of Patients With Coronary Artery Disease.

This study was conducted to assess the effect of an empowerment program on the perceived risk and physical health of patients with coronary artery disease. This randomized clinical trial recruited 84 patients with coronary artery disease admitted to post-cardiac care unit (CCU) wards in Tehran Heart Center in 2017. The study subjects were selected and assessed according to inclusion criteria and assigned to intervention and control groups by block randomization. Both groups completed questionnaires for demographic details and disease history, perceived risk in cardiac patients, and physical health. The Magic Empowerment Program was performed for the intervention group as 3 workshops on 3 successive days. Intervention continued after patients' discharge from the hospital through phone calls once a week for 8 weeks. The perceived risk in cardiac patients and physical health questionnaires were completed for both groups. Postintervention results showed significant differences between the 2 groups in total score of perceived risk (P = .001) and its subscales. The Empowerment Program changed patients' attitudes toward risk-motivating behavior change and improving physical health.

The effect of Xinkeshu tablets on depression and anxiety symptoms in patients with coronary artery disease: Results from a double-blind, randomized, placebo-controlled study.

A large proportion of patients with coronary artery disease (CAD) suffer from depression or anxiety symptoms and this is associated with increased mortality [1]. This double-blinded, randomized, placebo-controlled, clinical trial (ChiCTR-IPR-17010940) aimed to explore whether Xinkeshu tablets can reduce anxiety or depressive symptoms in CAD patients and how this is related to the concentration of plasma cytokines. Sixty patients with CAD anda Hospital Anxiety and Depression Scale (HADS-a/HADS-d) score of ≥8 were treated with Xinkeshu tablets or placebo for 12 weeks following percutaneous revascularization. Depressive/anxiety symptoms and the levels of 440 peripheral blood cytokines were evaluated at baseline and after 12 weeks treatment. Results showed significantly lower (P < 0.05) HADS-a/HADS-d and PHQ-9 scores in CAD patients treated with Xinkeshu tablets than in those who received placebo. These improvements were associated with changes in certain peripheral blood cytokines; most notably trappin-2, adiponectin, interleukin 1ß (IL-1ß), thrombopoietin, activated leukocyte cell adhesion molecule (ALCAM), neurotrophin-3 (NT-3), and transferrin. A significant correlation between anxiety/depression symptoms and trappin-2, NT-3, transferrin, and ALCAM (p < 0.05) were observed in an independent cohort of patients with CAD. These findings were in-keeping with the anti-depressive effects of Xinkeshu tablets. This trial demonstrates that Xinkeshu tablets can improve anxiety and depression symtoms effectively address in patients with coronary heart disease possibly through increasing the blood ratio of anti-inflammatory:pro-inflammatory cytokines.

Stress and Inflammation in Coronary Artery Disease: A Review Psychoneuroendocrineimmunology-Based.

Recent findings have deeply changed the current view of coronary heart disease, going beyond the simplistic model of atherosclerosis as a passive process involving cholesterol build-up in the subintimal space of the arteries until their final occlusion and/or thrombosis and instead focusing on the key roles of inflammation and the immune system in plaque formation and destabilization. Chronic inflammation is a typical hallmark of cardiac disease, worsening outcomes irrespective of serum cholesterol levels. Low-grade chronic inflammation correlates with higher incidence of several non-cardiac diseases, including depression, and chronic depression is now listed among the most important cardiovascular risk factors for poor prognosis among patients with myocardial infarction. In this review, we include recent evidence describing the immune and endocrine properties of the heart and their critical roles in acute ischaemic damage and in post-infarct myocardial remodeling. The importance of the central and autonomic regulation of cardiac functions, namely, the neuro-cardiac axis, is extensively explained, highlighting the roles of acute and chronic stress, circadian rhythms, emotions and the social environment in triggering acute cardiac events and worsening heart function and metabolism in chronic cardiovascular diseases. We have also included specific sections related to stress-induced myocardial ischaemia measurements and stress cardiomyopathy. The complex network of reciprocal interconnections between the heart and the main biological systems we have presented in this paper provides a new vision of cardiovascular science based on psychoneuroendocrineimmunology.

Study on syndrome differentiation and treatment in the management of chronic stable coronary artery disease to improve quality of life.

BACKGROUND: Chronic stable coronary artery disease (SCAD) is a general term for all kinds of coronary artery disease (CAD), which includes patients with chronic stable angina, old myocardial infarctions, and also stable condition after revascularization (i.e., percutaneous coronary intervention, coronary artery bypass graft). According to 2012 AHA/ACC guidelines, the objective of the treatment for SCAD is to maintain or recover patients' exercise tolerance, quality of life, and avoid complication like heart failure, so as to decrease mortality, eliminate symptoms, and avoid adverse reactions. Traditional Chinese medicine (TCM) has 2000 years of history in managing CAD and has its advantages in improving quality of life. Using scientific method to evaluate, demonstrate, and conclude the clinical curative effect of TCM is an extremely important task for both TCM and integrative Chinese and Western medicine in the treatment of CAD. METHODS: This research is to collect real effective cases from authoritative TCM cardiologists' clinic, so as to build a TCM diagnosis and treatment information database that involve 2000 patients from 32 different top-3 hospitals of china. The primary outcome includes EuroQol-5 Dimensions and Four diagnostic method of TCM, and secondary outcome includes angina score and some laboratory indexes like electrocardiograms, dynamic electrocardiogram, ultrasonic cardiogram, and treadmill exercise testing. This research uses SPSS17.0. to do the statistical analysis application. Enumeration data use χ test and measurement data which fit normality test use t test. The analysis of drugs usage in different diseases, different syndromes and different life quality effect will use principal component analysis, factorial analysis, clustering analysis. and point mutual information method, and so on. RESULTS: This research, based on past syndromes research and real clinical effective chronic SCAD cases, aim to build a TCM diagnosis and treatment information database.

Challenges adhering to a medication regimen following first-time percutaneous coronary intervention: A patient perspective.

BACKGROUND: Percutaneous coronary intervention is the most common therapeutic intervention for patients with narrowed coronary arteries due to coronary artery disease. Although it is known that patients with coronary artery disease often do not adhere to their medication regimen, little is known about what patients undergoing percutaneous coronary interventions find challenging in adhering to their medication regimen after hospital discharge. OBJECTIVES: To explore patients' experiences in adhering to medications following early post-discharge after first-time percutaneous coronary intervention. DESIGN: An abductive qualitative approach was used to conduct in-depth interviews of patients undergoing first-time percutaneous coronary intervention. SETTINGS: Participants were recruited from a single tertiary university hospital, which services a large geographical area in western Norway. Patients fulfilling the inclusion criteria were identified through the Norwegian Registry for Invasive Cardiology. PARTICIPANTS: Participants were patients aged 18 years or older who had their first percutaneous coronary intervention six to nine months earlier, were living at home at the time of study inclusion, and were prescribed dual antiplatelet therapy. Patients who were cognitively impaired, had previously undergone cardiac surgery, and/or were prescribed anticoagulation therapy with warfarin or novel oral anticoagulants were excluded. Purposeful sampling was used to include patients of different gender, age, and geographic settings. Twenty-two patients (12 men) were interviewed between December 2016 and April 2017. METHODS: Face-to-face semi-structured interviews were conducted, guided by a set of predetermined open-ended questions to gather patient experiences on factors relating to medication adherence or non-adherence. Transcribed interviews were analysed by qualitative content analysis. FINDINGS: Patients failed to adhere to their medication regimen for several reasons; intentional and unintentional reasons, multifaceted side effects from heart medications, scepticism towards generic drugs, lack of information regarding seriousness of disease after percutaneous coronary intervention, psychological impact of living with coronary artery disease, and these interacted. There were patients who felt that the medication information they received from physicians and nurses was uninformative and inadequate. Side effects from heart medications were common, ranging from minor ones to more disabling side effects, such as severe muscle and joint pain and fatigue. Patients found well established medication taking routines and aids to be necessary, and these improved adherence. CONCLUSION: Patients undergoing first-time percutaneous coronary intervention face multiple, interacting challenges in trying to adhere to prescribed medications following discharge. This study highlights the need for a more structured follow-up care in order to improve medication adherence and to maximise their self-care abilities.

Effects of Mindfulness-Based Art Therapy on Psychological Symptoms in Patients with Coronary Artery Disease.

BACKGROUND: Mindfulness-based art therapy (MBAT) induces emotional relaxation in coronary artery disease (CAD) patients, and is a treatment known to improve psychological stability. The objective of this study was to evaluate the treatment effects of MBAT for CAD patients. METHODS: A total of 44 CAD patients were selected as participants, 21 patients belonged to a MBAT group, and 23 patients belonged to the control group. The patients in the MBAT group were given 12 sessions of treatments. To measure depression and anxiety, Beck Depression Inventory (BDI) and Trait Anxiety Inventory (TAI) were used. Anger and anger expression were evaluated using the State Trait Anger Expression Inventory (STAXI). The treatment results were analyzed using two-way repeated measures analysis of variance (ANOVA). RESULTS: The results showed that significant effects for groups, time, and interaction in the depression (interaction effect, [F(1,36) = 23.15, P < 0.001]; between groups, [F(1,36) = 5.73, P = 0.022]), trait anxiety (interaction effect, [F(1,36) = 13.23, P < 0.001]; between groups, [F(1,36) = 4.38, P = 0.043]), state anger (interaction effect, [F(1,36) = 5.60, P = 0.023]), trait anger (interaction effect, [F(1,36) = 6.93, P = 0.012]; within group, [F(1,36) = 4.73, P = 0.036]), anger control (interaction effect, [F(1,36) = 8.41, P = 0.006]; within group, [F(1,36) = 9.41, P = 0.004]), anger out (interaction effect, [F(1,36) = 6.88, P = 0.012]; within group, [F(1,36) = 13.17, P < 0.001]; between groups, [F(1,36) = 5.62, P = 0.023]), and anger in (interaction effect, [F(1,36) = 32.66, P < 0.001]; within group, [F(1,36) = 25.90, P < 0.001]; between groups, [F(1,36) = 12.44, P < 0.001]). CONCLUSION: MBAT can be seen as an effective treatment method that improves CAD patients' psychological stability. Evaluation of treatment effects using program development and large-scale research for future clinical application is needed.

Knowledge and attitudes about vitamin D, and behaviors related to vitamin D in adults with and without coronary heart disease in Saudi Arabia.

BACKGROUND: Vitamin D deficiency is prevailing in Saudi Arabia. Recent national data indicated an inverse association between vitamin D status and coronary heart disease (CHD), which increases concerns about vitamin D deficiency as a serious public health problem. Therefore, the current study aimed to investigate whether knowledge, attitudes and behaviors related to vitamin D contribute to the prevalence of vitamin D deficiency among adults with and without CHD in Saudi Arabia. METHODS: This case-control study consisted of 130 CHD cases and 195 matched controls. The study subjects were recruited from three hospitals in Saudi Arabia. Structured interviews were completed to collect data on participants' socio-demographics, knowledge about vitamin D, attitudes toward sun exposure, and behaviors related to vitamin D. Also, serum vitamin D levels were measured. RESULTS: Severe vitamin D deficiency [serum 25(OH)D < 10 ng/mL] was more prevalent in the CHD cases than in the controls (46% and 3%, respectively). The total knowledge score was higher in the controls than in the cases [2.5 (±1.8) and 1.6 (±2.2), respectively]. The cases had better attitudes toward sun exposure compared to the controls (p = 0.001); however, the controls had better attitudes toward vitamin D compared to the cases (p = 0.001). The controls had a higher consumption of multivitamin supplements than the cases (6.7% and 0.8%, respectively; p = 0.010). Similarly, the controls had a higher consumption of butter (p = 0.001), oily fish (p = 0.004), and liver (p = 0.003) than the cases; however, the cases had a significantly higher intake of milk (p = 0.001). A multivariate logistic regression showed that vitamin D deficiency [25(OH)D < 20 ng/mL] was associated with low levels of knowledge about vitamin D, with an odds ratio of 1.82 (95% CI: 1.08-3.06, P = 0.024). Vitamin D deficiency was also associated with low intake of vitamin supplements, with an odds ratio of 4.35 (95% CI: 2.12-8.92, P < 0.001). CONCLUSION: The present study revealed that low levels of knowledge about vitamin D and low consumption of vitamin supplementation, including vitamin D, calcium, multivitamin, and calcium supplements with vitamin D, may have contributed to the higher prevalence of vitamin D deficiency among the CHD cases than among the controls. Further studies using a qualitative approach are crucial to explore the underlying reasons for low knowledge about vitamin D and behaviors related to vitamin D including the intake of vitamin supplementation  that may contribute to the high burden of vitamin D deficiency in the country.

Effects of aromatherapy on sleep quality and anxiety of patients.

BACKGROUND: In intensive care units (ICUs), patients cannot sleep well. Aromatherapy is used for depression, anxiety, relaxation and disorders related with sleep and stress. AIM: This study aimed to investigate the effect of lavender essential oil on the sleep quality and anxiety level of patients in coronary ICU. PARTICIPANTS: A total of 60 patients in coronary ICU participated in this study. DESIGN: A randomized controlled study was conducted with 60 patients in a province located in the southeast of Turkey. METHODS: After informing the patients in both groups about the study, they were administered a questionnaire, Pittsburgh Sleep Quality Index (PSQI) and the Beck Anxiety Inventory (BAI) scale. The patients in the intervention group were given 2% lavender essential oil via inhalation for 15 days after which they were administered the same scales again to evaluate the sleep quality and anxiety. As for the control group, they were administered the same scales again after 15 days without the inhalation of lavender essential oil. RESULTS: Comparison of the PSQI and BAI scores of the patients in the control and intervention groups before and after the intervention showed statistically significant differences in the change in favour of the intervention group (p < 0·05). CONCLUSION: Lavender essential oil increased quality of sleep and reduced level of anxiety in patients with coronary artery disease. RELEVANCE TO CLINICAL PRACTICE: As a non-invasive, cheap, easily applicable, cost-effective, independent nursing intervention and appropriate for cardiac patients, lavender essential oil could be applied in ICUs.

Psychological Resources Are Independently Associated with Markers of Inflammation in a Middle-Aged Community Sample.

PURPOSE: To elucidate possible independent associations of psychological resources with inflammatory markers, all linked with coronary heart disease (CHD). METHOD: In a middle-aged general population (n = 944), psychological resources (coping, self-esteem, and sense of coherence (SOC)), a global measure of quality of life (Cantril's self-anchoring ladder, also called "ladder of life"), and psychological risk factors (hopelessness, vital exhaustion, and depressive symptoms) were used in linear regression models to evaluate associations with the inflammatory markers interleukin (IL)-6, C-reactive protein (CRP), and matrix metalloproteinase (MMP)-9. Adjustments were done for age, sex, medical conditions, and cardiovascular risk factors. RESULTS: After full adjustments, self-esteem was independently associated with all three biomarkers. Ladder of life was associated with IL-6 and log-CRP; coping, vital exhaustion, and depressive symptoms with IL-6; and SOC with MMP-9 (p < 0.05 for all associations). CONCLUSION: Numerous significant associations of psychological resources and risk factors with IL-6, CRP, and MMP-9 were found in a community-based sample. The associations of psychological resources were mostly independent, while the psychological risk factors seemed preferentially dependent on lifestyle factors as smoking, physical activity, and body mass index (BMI). This suggests that the psychological resources' (in particular self-esteem) protective effects on CHD are linked to inflammatory markers.

The Cultural Meaning of Cardiac Illness and Self-Care Among Lebanese Patients With Coronary Artery Disease.

BACKGROUND: Cardiac disease is the leading cause of death in Lebanon, accounting for 22% to 26% of total deaths in the country. A thorough understanding of perceptions of cardiac illness and related self-care management is critical to the development of secondary prevention programs that are specific to the Lebanese culture. PURPOSE: To explore the cultural perceptions of cardiac illness and the associated meaning of self-care among Lebanese patients. DESIGN: Using a qualitative descriptive method, semistructured interviews were conducted with a purposive sample of 15 Lebanese cardiac patients recruited from a medical center in Beirut, Lebanon. FINDINGS: The qualitative descriptive analysis yielded one overarching and two other themes describing perceptions of cardiac illness and self-care within the Lebanese cultural context. The overarching cultural theme was, "Lebanese cardiac patients were unfamiliar with the term concept and meaning of self-care." Lebanese cardiac patients thanked God and accepted their fate (Theme I). The participants considered their cardiac incident a life or death warning (Theme II). IMPLICATIONS FOR PRACTICE: Health care providers need to consider patients' cultural perception of illness while planning and evaluating cardiac self-care programs.

Omega-3/omega-6 fatty acid ratios in different phospholipid classes and depressive symptoms in coronary artery disease patients.

Depressive symptoms are highly incident among coronary artery disease (CAD) patients and increase mortality. Reduced ratios of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (omega-3 fatty acids) to arachidonic acid (AA, omega-6 fatty acid) concentrations have been linked with depressive symptoms in CAD. It remains unclear whether depressive symptoms are differentially associated with that ratio in different phospholipid classes, and this may have mechanistic implications. This study investigated associations between depressive symptoms in CAD patients and the EPA+DHA to AA ratio in the major phospholipid classes. This was a cross-sectional study of stable CAD patients. Sociodemographic, medical, medication, and cardiopulmonary fitness data were collected from each patient. Each patient was assessed for depressive symptoms using the 17-item Hamilton Depression Rating Scale (HAM-D). The percentage of EPA, DHA, and AA in each erythrocyte phospholipid class was determined using gas chromatography from fasting blood. Relationships between EPA+DHA to AA ratios and depressive symptoms were assessed using linear regression and were corrected for multiple comparisons. Seventy-six CAD patients were included (age=61.9 ± 8.5, 74% male, HAM-D=7.2 ± 5.9). In a backward elimination linear regression model, lower EPA+DHA to AA in erythrocyte phosphatidylinositol (B=-12.71, ß=-0.33, p<.01) and sphingomyelin (B=-2.52, ß=-0.37, p<.01) was associated with greater depressive symptom severity, independently of other known predictors. Other phospholipid classes were not associated with depressive symptoms. In conclusion, the relationship between EPA+DHA to AA ratios and depressive symptoms in CAD may not be consistent across phospholipid classes. Continued investigation of these potentially differential relationships may clarify underlying disease mechanisms.

Randomized controlled trial of heart rate variability biofeedback in cardiac autonomic and hostility among patients with coronary artery disease.

Hostility is a psychosocial risk factor that may decrease heart rate variability (HRV) in coronary artery disease (CAD) through cardiac autonomic imbalance. Heart rate variability biofeedback (HRV-BF) increases HRV indices and baroreflex gain. This study examines the effectiveness of HRV-BF in restoring cardiac autonomic balance and decreasing hostility among patients with CAD. One hundred and fifty-four patients with CAD were assigned randomly to receive 6 weeks of HRV-BF, in addition to the standard medical care received by the wait-list control (WLC) group. A 5-min electrocardiogram, blood pressure, and hostility were assessed pre-intervention, post-intervention, and at 1-month follow-up. The standard deviation of normal-to-normal intervals (SDNN), low frequency (LF), and log LF at post-intervention was significantly higher than that at pre-intervention in the HRV-BF group. Baseline log LF was significantly higher post-intervention and at follow-up after HRV-BF training than at pre-intervention. The treatment curve of log LF pre-session increased significantly after session 2, which was maintained to post-intervention. Expressive hostility, suppressive hostility, and hostility total score at post-intervention and one-month follow-up after HRV-BF were significantly lower than at pre-intervention. This study showed increased HRV and decreased expressive and suppressive hostility behavior in patients with CAD following HRV-BF.

Biofeedback on heart rate variability in cardiac rehabilitation: practical feasibility and psycho-physiological effects.

OBJECTIVE: Biofeedback is a self-regulation therapy by which the patient learns how to optimize the functioning of his autonomic nervous system. It has been applied to patients with various cardiovascular disorders. The purpose of this study was to investigate the practical feasibility and the psychophysiological effects of biofeedback applied to heart rate variability (HRV biofeedback) in order to increase cardiac coherence in coronary artery disease (CAD) patients participating in a cardiac rehabilitation programme. METHODS AND RESULTS: In this randomised and controlled study, 31 CAD patients were randomly assigned to an experimental or to a control group. The experimental group participated in a programme of 10 sessions of cardiac coherence biofeedback training, in addition to the rehabilitation programme. The control group participated in the usual cardiac rehabilitation programme only. Physiological variables (systolic and diastolic blood pressure, SDNN) and psychosocial variables (anxiety, depression, type D personality) were measured at the start and at the end of the programme in both groups. Statistical comparisons assessed the inter and intra group differences. The small sample size precludes any firm conclusions concerning the effect of cardiac coherence biofeedback on physiological or psychological variables. However, we observed a significant increase of the percentage of cardiac coherence, in relation with an increased SDNN index. CONCLUSIONS: Our study demonstrated the practical feasibility of cardiac coherence biofeedback training in CAD patients. Further research is desirable to investigate the potential benefit of cardiac coherence biofeedback as an adjunct to stress management in cardiac rehabilitation.