Behavioral Cardiology - Where the Heart and Head Meet

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The Sertraline Anti-Depressant Heart Attack Randomized Trial (SADHART) study, another similar randomized, controlled clinical trial, likewise found that treatment of depression did not translate into an improvement in CAD events in people with a previous history of MI and depression.37 It should be noted that the SADHART investigators designed the study as a safety study and did not plan it to have sufficient power for assessing the impact on CAD events.

Results from ENRICHD, SADHART, and other studies highlight the aforementioned dilemma in current behavioral cardiologyÔÇösome psychosocial factors associated with an increased risk of CAD are treatable, yet their treatment may not reduce CAD risk. Results of an observational sub-study from the ENRICHD study have increased the hope of finding a solution to this dilemma. In this observational study arm of the ENRICHD clinical trial, persons who were treated with selective serotonin reuptake inhibitor (SSRI) anti-depressant medications were found to have a lower risk of CAD events in the follow-up period than those who were treated with other anti-depressant therapies.38 Other studies have also suggested that the identification and treatment of persons with psychosocial distress can reduce subsequent CAD events, either through treatment of psychosocial factors or the aggressive treatment of other more traditional CAD risk factors.7,13,39,40 It is theorized that psychosocial treatments, such as SSRI agents, may lead to improvements in the physiologic steps that link CAD and psychosocial risk (autonomic nervous system function, for instance). In the future, randomized studies are anticipated that will explore the potential impact of SSRI therapy on psychosocial and CAD outcomes.

Ironically, another treatment that may prove to be very effective in behavioral cardiology of the future is one that has been used for CAD prevention and treatment for many yearsÔÇöphysical activity. Physical activity interventions have been reported to help improve psychosocial distress and CAD outcomes. This may help explain why cardiac rehabilitation programs are associated with improvements in psychosocial and CAD health outcomes.35

Positive psychosocial factors represent an area of large potential impact for intervention studies in the future. Interventions that may increase positive psychosocial factors, such as optimism and sense of humor, may improve psychosocial health and improve CAD risk. Perhaps most importantly of all, such interventions may help improve CAD outcomes by increasing a patientÔÇÖs adherence to important prescribed therapies.

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