Stress reduction prolongs life in women with coronary disease: the Stockholm Women's Intervention Trial for Coronary Heart Disease (SWITCHD)

Abstract

Background: Psychosocial stress may increase risk and worsen prognosis of coronary heart disease in women. Interventions that counteract women's psychosocial stress have not previously been presented. This study implemented a stress reduction program for women and investigated its ability to improve survival in women coronary patients.

Methods and results: Two hundred thirty-seven consecutive women patients, aged 75 years or younger, hospitalized for acute myocardial infarction, coronary artery bypass grafting, or percutaneous coronary intervention were randomized to a group-based psychosocial intervention program or usual care. Initiated 4 months after hospitalization, intervention groups of 4 to 8 women met for a total of 20 sessions that were spread over a year. We provided education about risk factors, relaxation training techniques, methods for self-monitoring and cognitive restructuring, with an emphasis on coping with stress exposure from family and work, and self-care and compliance with clinical advice. From randomization until end of follow-up (mean duration, 7.1 years), 25 women (20%) in the usual care and 8 women (7%) in the stress reduction died, yielding an almost 3-fold protective effect of the intervention (odds ratio, 0.33; 95% CI, 0.15 to 0.74; P=0.007). Introducing baseline measures of clinical prognostic factors, including use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, calcium-channel blockers, and statins into multivariate models confirmed the unadjusted results (P=0.009).

Conclusions: Although mechanisms remain unclear, a group-based psychosocial intervention program for women with coronary heart disease may prolong lives independent of other prognostic factors.