Document Detail

Psychological risk factors may moderate pharmacological treatment effects among ischemic heart disease patients. Canadian Amlodipine/Atenolol in Silent Ischemia Study (CASIS) Investigators.
MedLine Citation:
PMID:  10593636     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Numerous research findings support the proposed connection between such psychological characteristics as stress and hostility and the manifestation of disease. However, less evidence is available concerning the role(s) psychological factors might play in the process of disease recovery. METHODS: Eighty patients with known coronary disease and exercise-induced ischemia underwent treadmill exercise testing and 48-hour ambulatory electrocardiographic monitoring and completed a battery of standardized psychological tests assessing hostility, depression, and daily stress on four occasions during a 12-week pharmacological treatment study. After withdrawal of antiischemic drugs at baseline, patients returned for subsequent tests at 3-week intervals. During the second and third intervals, patients were prescribed one of two antiischemic medications, atenolol or amlodipine, or given a placebo. All patients were then placed on a combination treatment protocol for the 3 weeks before the final testing date. RESULTS: The combination treatment produced highly significant benefits across all measured cardiac variables (20.3% improvement in exercise performance, 13% reduction in reported angina, 64.0% reduction in the frequency of ischemic episodes; for all, p < .01). However, results showed that high baseline levels of daily stress were associated with reliably smaller treatment effects on measures of ischemia frequency and treadmill exercise time and with a significantly greater likelihood of reporting angina after treatment (r = -0.24, -0.25, and -0.33, respectively; p <.05). In addition, high baseline hostility predicted significantly smaller diastolic blood pressure improvements (r = -0.29, p < .05). CONCLUSIONS: These results indicate that psychological risk factors may have globally negative effects on the course of treatment and suggest particular factors that may warrant attention in trials targeting cardiac symptom reduction.
T Rutledge; W Linden; R F Davies
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Psychosomatic medicine     Volume:  61     ISSN:  0033-3174     ISO Abbreviation:  Psychosom Med     Publication Date:    1999 Nov-Dec
Date Detail:
Created Date:  2000-01-06     Completed Date:  2000-01-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376505     Medline TA:  Psychosom Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  834-41     Citation Subset:  IM    
Department of Psychology, University of British Columbia, Vancouver, Canada.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use*
Amlodipine / therapeutic use*
Angina Pectoris / drug therapy,  psychology
Atenolol / therapeutic use*
Calcium Channel Blockers / therapeutic use*
Depression / complications
Double-Blind Method
Drug Therapy, Combination
Electrocardiography, Ambulatory
Exercise Test
Middle Aged
Myocardial Ischemia / drug therapy*,  psychology*
Prospective Studies
Psychiatric Status Rating Scales
Regression Analysis
Stress, Psychological / complications*
Type A Personality*
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Calcium Channel Blockers; 29122-68-7/Atenolol; 88150-42-9/Amlodipine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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