Behavioral Cardiology - Where the Heart and Head Meet

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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. 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. 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.

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. As of yet, interventional studies are scarce that have explored interventions to increase optimism, sense of humor and other positive emotions, but, on the other hand, physical activity interventions have demonstrated improvements in mood and sense of wellbeing. In addition, effective and feasible methods to help patients increase their adherence to preventive therapies have been identified and validated. If such interventions can help improve therapies of known effectiveness, such as lipid lowering therapy and anti-hypertensive therapyÔÇötwo areas of treatment that are vastly under-prescribed by healthcare providers and under-utilized by patientsÔÇöthen they could substantially help reduce rates of CAD events in the future.

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