The recurrent coronary prevention project. Some preliminary findings

Abstract

The Recurrent Coronary Prevention Project (RCPP) was established as a 5-year clinical trial to examine two basic questions: --1. Can the recurrence rate of post-coronary subjects be substantially reduced over a 5-year period by means of a programme of behavioural change, in comparison with treatment by cardiologists focussing on medication, diet, exercise and cardiovascular issues, and with subjects who only receive regular care from their own physician? 2. Can the Type A behaviour pattern (TABP) be changed and do such changes correspond to reduced recurrences of coronary heart disease (CHD) over a 5 year period? To answer these questions, four major treatment groups are currently being compared: --1. A small group treatment programme (Section I) led by cardiologists emphasizing adherence to medication, diet and exercise, and giving cardiovascular and cardiological information. 2. A behavioural change treatment programme (Section II) based primarily on a cognitive social learning model and attempting to alter TABP. 3. A control group of subjects assessed annually and receiving private medical care from their own physicians. 4. A dropout comparison group composed of subjects voluntarily discontinuing participation in groups led by cardiologists or in behavioural change groups. Results to date show a significantly reduced rate of recurrence for subjects in the behavioural change group, compared to those in the groups led by cardiologists as well as control and dropout groups. These significantly lower recurrence rates are accompanied by data suggesting that subjects in the behavioural change programme are also altering their TABP as measured by both behavioural questionnaires and videotaped Type A structured interviews. Clinical impressions suggest that treatment programmes to alter TABP should consider the primary importance of the personal meaning of the TABP and other behaviours to the individual concerned, particularly how basic underlying beliefs set the stage for the TABP. The central role of hostility as a pervasive orientation towards self and others is emphasized, as are issues of excessive controllability related to extreme competitiveness and hyper-arousal. The multiple roles of group leaders, especially as social models for coping, and the impact of the small groups settings, is also discussed.