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, β-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.
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Some previous successful psychological interventions (with high adherence) for cardiac patients have been group-based CBT with a process-oriented focus.
“Furthermore, some previous successful psychological interventions (with high adherence) for cardiac patients [40-42] have been group-based CBT with a process-oriented focus.”
Psychological interventions have additional impact on prevention of clinical CHD, especially in patients who achieved behavioural goals.
“Two recent meta-analyses and two recent RCTs 86,199,343,348 have also shown their additional impact on the prevention of clinical CHD, especially in patients who achieved their behavioural goals.349”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [348]
A group-based stress-reduction programme for women prolongs lives independent of other prognostic factors.
“Recently, a group-based stressreduction programme for women was shown to prolong lives independent of other prognostic factors.348,358”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [348]
For women, specific behavioural group treatments may reduce distress.
“For women, specific behavioural group treatments may be useful for reducing distress.348,350,361”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [348]
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Bedeutung von psychosozialen Faktoren in der Kardiologie – Update 2024
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The Role of the Clinical Psychologist in the Care of Adults With Cardiovascular Disease
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- Authors
- Orth-Gomér, K., Schneiderman, N., Wang, H.-X., Walldin, C., Blom, M., & Jernberg, T.
- Affiliations
- From the Department of Public Health Sciences (K.O.-G.), Karolinska Institute, Stockholm, Sweden; Behavioral Medicine Program (N.S.), Department of Psychology, Department of Neurobiology (H.-X.W.), Care Sciences and Society, Aging Research Center, University of Miami, Fla; the Department of Cardiology (C.W., M.B., T.J.), Karolinska University Clinics, Stockholm, Sweden; and the Department of Psychosomatics (K.O.-G.), Campus Benjamin Franklin, Charité Universitätsmedizin, Berlin, Germany.
- University of Miami (US)
- Venue
- Circulation: Cardiovascular Quality and Outcomes
- Published
- 2009-01
- Volume
- 2
- Issue
- 1
- Pages
- 25-32
- ISSN
- 1941-7705 (ISSN-L)
- 1941-7713
- OpenAlex
- W2088381623
- Cited by
- 266
- References
- 32
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 10 · 2023: 14 · 2022: 19 · 2021: 20 · 2020: 11 · 2019: 9 · 2018: 12 · 2017: 20 · 2016: 19 · 2015: 12 · 2014: 20 · 2013: 21 · 2012: 28
- FWCI
- 13.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Cardiovascular Quality and Outcomes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (HL-45785, P01HL036588, HL36588, R01HL045785)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- psychosocial stress, stress reduction, coronary artery disease, women, survival, group intervention, relaxation training, cognitive restructuring, self-care, coping, myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention
- MeSH terms
- Adaptation, Psychological, Aged, Coronary Artery Disease, Female, Humans, Health Knowledge, Attitudes, Practice, Middle Aged, Patient Compliance, Patient Education as Topic, Psychotherapy, Group, Relaxation Therapy, Risk Factors, Self Care, Stress, Psychological, Sweden, Time Factors, Proportional Hazards Models, Odds Ratio, Women's Health, Treatment Outcome, Risk Assessment, Kaplan-Meier Estimate
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