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Rosenberg EL, Ekman P, Jiang W, Babyak M, Coleman RE, Hanson M, O'Connor C, Waugh R, Blumenthal JA. Linkages between facial expressions of anger and transient myocardial ischemia in men with coronary artery disease. Emotion 2001; 1:107-15. [PMID: 12899191 DOI: 10.1037/1528-3542.1.2.107] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors examined whether facial expressions of emotion would predict changes in heart function. One hundred fifteen male patients with coronary artery disease underwent the Type A Structured Interview, during which time measures of transient myocardial ischemia (wall motion abnormality and left ventricular ejection fraction) were obtained. Facial behavior exhibited during the ischemia measurement period was videotaped and later coded by using the Facial Action Coding System (P. Ekman & W. V. Friesen, 1978). Those participants who exhibited ischemia showed significantly more anger expressions and nonenjoyment smiles than nonischemics. Cook-Medley Hostility scores did not vary with ischemic status. The findings have implications for understanding how anger and hostility differentially influence coronary heart disease risk.
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Affiliation(s)
- E L Rosenberg
- Department of Psychology, College of William and Mary, USA.
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Khatri P, Babyak M, Croughwell ND, Davis R, White WD, Newman MF, Reves JG, Mark DB, Blumenthal JA. Temperature during coronary artery bypass surgery affects quality of life. Ann Thorac Surg 2001; 71:110-6. [PMID: 11216728 DOI: 10.1016/s0003-4975(00)02350-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The objective of this study was to examine the effects of temperature on a variety of indices of psychologic adjustment and quality of life. METHODS A total of 209 patients randomly received normothermic (warm) or hypothermic (cold) conditions during coronary artery bypass surgery (CABS), and a number of physical, social, and psychologic measures were assessed before as well as 6 weeks and 6 months after CABS. RESULTS Repeated measures analyses of covariance revealed significant temperature group main effects for anxiety (p = 0.008) and depression (p = 0.039), with the normothermic group obtaining lower anxiety and depression levels than the hypothermic group at both 6 weeks and 6 months after surgery. Additionally, among patients who entered the study with higher depression levels, those in the hypothermic group tended to have higher depression scores at follow-up compared with patients in the normothermic condition (p = 0.012). No temperature group differences were observed on other quality of life indices. CONCLUSIONS The results of the present study indicate that hypothermic conditions during CABS are associated with higher levels of emotional distress after CABS than normothermic conditions, particularly for patients with greater stress to begin with.
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Affiliation(s)
- P Khatri
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA
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Babyak M, Blumenthal JA, Herman S, Khatri P, Doraiswamy M, Moore K, Craighead WE, Baldewicz TT, Krishnan KR. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med 2000; 62:633-8. [PMID: 11020092 DOI: 10.1097/00006842-200009000-00006] [Citation(s) in RCA: 507] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the status of 156 adult volunteers with major depressive disorder (MDD) 6 months after completion of a study in which they were randomly assigned to a 4-month course of aerobic exercise, sertraline therapy, or a combination of exercise and sertraline. METHODS The presence and severity of depression were assessed by clinical interview using the Diagnostic Interview Schedule and the Hamilton Rating Scale for Depression (HRSD) and by self-report using the Beck Depression Inventory. Assessments were performed at baseline, after 4 months of treatment, and 6 months after treatment was concluded (ie, after 10 months). RESULTS After 4 months patients in all three groups exhibited significant improvement; the proportion of remitted participants (ie, those who no longer met diagnostic criteria for MDD and had an HRSD score <8) was comparable across the three treatment conditions. After 10 months, however, remitted subjects in the exercise group had significantly lower relapse rates (p = .01) than subjects in the medication group. Exercising on one's own during the follow-up period was associated with a reduced probability of depression diagnosis at the end of that period (odds ratio = 0.49, p = .0009). CONCLUSIONS Among individuals with MDD, exercise therapy is feasible and is associated with significant therapeutic benefit, especially if exercise is continued over time.
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Affiliation(s)
- M Babyak
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
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Blumenthal JA, Sherwood A, Gullette EC, Babyak M, Waugh R, Georgiades A, Craighead LW, Tweedy D, Feinglos M, Appelbaum M, Hayano J, Hinderliter A. Exercise and weight loss reduce blood pressure in men and women with mild hypertension: effects on cardiovascular, metabolic, and hemodynamic functioning. Arch Intern Med 2000; 160:1947-58. [PMID: 10888969 DOI: 10.1001/archinte.160.13.1947] [Citation(s) in RCA: 178] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Lifestyle modifications have been recommended as the initial treatment strategy for lowering high blood pressure (BP). However, evidence for the efficacy of exercise and weight loss in the management of high BP remains controversial. METHODS One hundred thirty-three sedentary, overweight men and women with unmedicated high normal BP or stage 1 to 2 hypertension were randomly assigned to aerobic exercise only; a behavioral weight management program, including exercise; or a waiting list control group. Before and following treatment, systolic and diastolic BPs were measured in the clinic, during daily life, and during exercise and mental stress testing. Hemodynamic measures and metabolic functioning also were assessed. RESULTS Although participants in both active treatment groups exhibited significant reductions in BP relative to controls, those in the weight management group generally had larger reductions. Weight management was associated with a 7-mm Hg systolic and a 5-mm Hg diastolic clinic BP reduction, compared with a 4-mm Hg systolic and diastolic BP reduction associated with aerobic exercise; the BP for controls did not change. Participants in both treatment groups also displayed reduced peripheral resistance and increased cardiac output compared with controls, with the greatest reductions in peripheral resistance in those in the weight management group. Weight management participants also exhibited significantly lower fasting and postprandial glucose and insulin levels than participants in the other groups. CONCLUSIONS Although exercise alone was effective in reducing BP, the addition of a behavioral weight loss program enhanced this effect. Aerobic exercise combined with weight loss is recommended for the management of elevated BP in sedentary, overweight individuals.
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Affiliation(s)
- J A Blumenthal
- Department of Psychiatry and Behavioral Sciences, PO Box 3119, Duke University Medical Center, Durham, NC 27710, USA.
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Carels RA, Sherwood A, Babyak M, Gullette EC, Coleman RE, Waugh R, Jiang W, Blumenthal JA. Emotional responsivity and transient myocardial ischemia. J Consult Clin Psychol 1999. [PMID: 10450634 DOI: 10.1037//0022-006x.67.4.605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined the relationship between "emotional responsivity" (i.e., individuals who exhibit relatively large variations of self-reported tension levels) and myocardial ischemia. One hundred thirty-six patients with coronary artery disease underwent 48 hr ambulatory electrocardiographic (ECG) monitoring and laboratory mental stress testing using radionuclide angiocardiography. Compared with individuals characterized as low emotional responders, a higher proportion of individuals characterized as high emotional responders exhibited wall motion abnormalities in response to laboratory mental stress testing and were more likely to exhibit ECG ST-segment depression (> or = 1 mm for > or = 1 min) during routine daily activities. These results suggest that emotional responsivity may represent an individual difference characteristic that is associated with an increased likelihood of exhibiting myocardial ischemia in both the laboratory and the real-world setting.
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Affiliation(s)
- R A Carels
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Khatri P, Babyak M, Clancy C, Davis R, Croughwell N, Newman M, Reves JG, Mark DB, Blumenthal JA. Perception of cognitive function in older adults following coronary artery bypass surgery. Health Psychol 1999. [PMID: 10357512 DOI: 10.1037//0278-6133.18.3.301] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined the effects of coronary artery bypass grafting (CABG) on objective and subjective measures of neurocognitive functioning. Participants were 170 older patients (127 men and 43 women; mean age = 61 years) undergoing CABG. Measures of neurocognitive function, depression, anxiety, and perceived cognitive abilities were administered immediately prior to and 6 weeks following surgery. Although objective measures of impaired cognitive performance following CABG were not related to perceived cognitive difficulties, the presence of anxiety and depression was related to the perception of cognitive functioning. Patients who reported high levels of anxiety and depression 6 weeks after surgery perceived themselves as having poorer cognitive function. Interventions designed to reduce emotional distress could improve patient's perceived cognitive abilities following CABG.
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Affiliation(s)
- P Khatri
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Carels RA, Sherwood A, Babyak M, Gullette EC, Coleman RE, Waugh R, Jiang W, Blumenthal JA. Emotional responsivity and transient myocardial ischemia. J Consult Clin Psychol 1999; 67:605-10. [PMID: 10450634 DOI: 10.1037/0022-006x.67.4.605] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined the relationship between "emotional responsivity" (i.e., individuals who exhibit relatively large variations of self-reported tension levels) and myocardial ischemia. One hundred thirty-six patients with coronary artery disease underwent 48 hr ambulatory electrocardiographic (ECG) monitoring and laboratory mental stress testing using radionuclide angiocardiography. Compared with individuals characterized as low emotional responders, a higher proportion of individuals characterized as high emotional responders exhibited wall motion abnormalities in response to laboratory mental stress testing and were more likely to exhibit ECG ST-segment depression (> or = 1 mm for > or = 1 min) during routine daily activities. These results suggest that emotional responsivity may represent an individual difference characteristic that is associated with an increased likelihood of exhibiting myocardial ischemia in both the laboratory and the real-world setting.
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Affiliation(s)
- R A Carels
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Khatri P, Babyak M, Clancy C, Davis R, Croughwell N, Newman M, Reves JG, Mark DB, Blumenthal JA. Perception of cognitive function in older adults following coronary artery bypass surgery. Health Psychol 1999; 18:301-6. [PMID: 10357512 DOI: 10.1037/0278-6133.18.3.301] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined the effects of coronary artery bypass grafting (CABG) on objective and subjective measures of neurocognitive functioning. Participants were 170 older patients (127 men and 43 women; mean age = 61 years) undergoing CABG. Measures of neurocognitive function, depression, anxiety, and perceived cognitive abilities were administered immediately prior to and 6 weeks following surgery. Although objective measures of impaired cognitive performance following CABG were not related to perceived cognitive difficulties, the presence of anxiety and depression was related to the perception of cognitive functioning. Patients who reported high levels of anxiety and depression 6 weeks after surgery perceived themselves as having poorer cognitive function. Interventions designed to reduce emotional distress could improve patient's perceived cognitive abilities following CABG.
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Affiliation(s)
- P Khatri
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Blumenthal JA, Sherwood A, Babyak M, Thurston R, Tweedy D, Georgiades A, Gullette EC, Khatri P, Steffan P, Waugh R, Light K, Hinderliter A. Mental stress and coronary disease. The Smart-Heart Study. N C Med J 1999; 60:95-9. [PMID: 10344134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- J A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University, USA
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Gullette EC, Blumenthal JA, Babyak M, Jiang W, Waugh RA, Frid DJ, O'Connor CM, Morris JJ, Krantz DS. Effects of mental stress on myocardial ischemia during daily life. JAMA 1997; 277:1521-6. [PMID: 9153365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the relative risk of myocardial ischemia triggered by specific emotions during daily life. DESIGN AND SETTING Relative risk was calculated by the recently developed case-crossover method, in which the frequency of a presumed trigger during nonischemic, or control, hours is compared with the trigger's frequency during ischemic, or case, hours. Outpatients at Duke University Medical Center, Durham, NC, underwent 48 hours of ambulatory electrocardiographic (ECG) monitoring with concurrent self-report measures of activities and emotions. Occurrences of negative emotions in the hour before the onset of myocardial ischemia were compared with their usual frequency based on all hours in which ischemia did not occur. SUBJECTS From a sample of 132 patients with coronary artery disease and recent evidence of exercise-induced ischemia who underwent 48 hours of ambulatory ECG monitoring, 58 patients exhibited ambulatory ischemia and were included in the analysis. OUTCOME MEASURES Myocardial ischemia during 48-hour ECG monitoring was defined as horizontal or downsloping ST-segment depression of 1 mm (0.1 mV) or more for 1 minute or longer compared with resting baseline. The ECG data were cross-tabulated with subjects' concurrent diary ratings of 3 negative emotions-tension, sadness, and frustration-and 2 positive emotions-happiness and feeling in contro-on a 5-point scale of intensity. RESULTS The unadjusted relative risk of occurrence of myocardial ischemia in the hour following high levels of negative emotions was 3.0 (95% confidence interval [CI], 1.5-5.9; P<.01) for tension, 2.9 (95% CI, 1.0-8.0; P<.05) for sadness, and 2.6 (95% CI, 1.3-5.1; P<.01) for frustration. The corresponding risk ratios adjusted for physical activity and time of day were 2.2 (95% CI, 1.1 -4.5; P<.05) for tension, 2.2 (95% CI, 0.7-6.4; P=.16) for sadness, and 2.2 (95% CI, 1.1-4.3; P<.05) for frustration. CONCLUSIONS Mental stress during daily life, including reported feelings of tension, frustration, and sadness, can more than double the risk of myocardial ischemia in the subsequent hour. The clinical significance of mental stress-induced ischemia during daily life needs to be further evaluated.
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Affiliation(s)
- E C Gullette
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
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Jiang W, Babyak M, Krantz DS, Waugh RA, Coleman RE, Hanson MM, Frid DJ, McNulty S, Morris JJ, O'Connor CM, Blumenthal JA. Mental stress--induced myocardial ischemia and cardiac events. JAMA 1996; 275:1651-6. [PMID: 8637138 DOI: 10.1001/jama.275.21.1651] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To assess the clinical significance of mental stress-induced myocardial ischemia in patients with coronary artery disease (CAD). DESIGN AND SETTING Cohort study in outpatients in a tertiary care teaching hospital assessed at baseline and followed up for up to 5 years. SUBJECTS A total of 126 volunteer patients (112 men, 14 women; mean age, 59 years) with documented CAD and exercise-induced myocardial ischemia. OUTCOME MEASURES Patients underwent baseline mental stress and exercise testing using radionuclide ventriculography and 48-hour Holter monitoring. Patients were subsequently contacted by mailed questionnaires or telephone to document cardiac events, including death, nonfatal myocardial infarction, and cardiac revascularization procedures. Logistic regression and Cox proportional hazards models were used to examine the prognostic value of the ischemic measures after adjusting for such potential confounding factors as age, baseline left ventricular ejection fraction (LVEF), and history of myocardial infarction. RESULTS Twenty-eight patients (22%) experienced at least 1 cardiac event. Baseline mental stress-induced ischemia was associated with significantly higher rates of subsequent cardiac events (odds ratio, 2.8; 95% confidence interval [CI], 1.0-7.7; P < .05). The LVEF change during mental stress was significantly related to event-free survival (risk ratio [RR], 2.4; 95% CI, 1.12-5.14; P = .02), controlling for age, history of prior myocardial infarction, and baseline LVEF. This relationship remained significant after controlling for electrocardiogram (ECG)-defined ischemia during exercise (RR, 2.2; 95% CI, 1.01-4.81; P < .05). The RR for ECG-defined ischemia during exercise testing was 1.9 (95% CI, 0.95-3.96; P = .07) and the RR for ambulatory ECG ischemia was 0.75 (95% CI, 0.35-1.64; P = .47). CONCLUSIONS The presence of mental stress-induced ischemia is associated with significantly higher rates of subsequent fatal and nonfatal cardiac events, independent of age, baseline LVEF, and previous myocardial infarction, and predicted events over and above exercise-induced ischemia. These data suggest that the relationship between psychological stress and adverse cardiac events may be mediated by the occurrence of myocardial ischemia.
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Affiliation(s)
- W Jiang
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
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Blumenthal JA, Jiang W, Waugh RA, Frid DJ, Morris JJ, Coleman RE, Hanson M, Babyak M, Thyrum ET, Krantz DS. Mental stress-induced ischemia in the laboratory and ambulatory ischemia during daily life. Association and hemodynamic features. Circulation 1995; 92:2102-8. [PMID: 7554188 DOI: 10.1161/01.cir.92.8.2102] [Citation(s) in RCA: 123] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The purpose of this study was to determine the correspondence of mental stress-induced ischemia in the laboratory with ambulatory ischemia and to assess the relationship between hemodynamic responses to mental stress and the occurrence of ischemia. Although exercise testing is usually used to elicit myocardial ischemia, ischemia during daily life usually occurs at relatively low heart rates and in the absence of strenuous physical exercise. Mental stress has been shown to trigger ischemic events in the laboratory at lower heart rates but at blood pressures comparable to exercise. We therefore compared the extent to which mental stress and exercise testing identify patients who develop ischemia out of hospital. METHODS AND RESULTS One hundred thirty-two patients with documented coronary disease and recent evidence of exercise-induced myocardial ischemia underwent 48-hour ambulatory monitoring and radionuclide ventriculography during exercise and mental stress testing. Patients who displayed mental stress-induced ischemia in the laboratory were more likely to exhibit ischemia during daily life (P < .021). Furthermore, patients who exhibited ischemia during ambulatory monitoring displayed larger diastolic blood pressure (P < .006), heart rate (P < .039), and rate-pressure product responses (P < .018) during mental stress. CONCLUSIONS Among patients with prior positive exercise stress tests, mental stress-induced ischemia, defined by new wall motion abnormalities, predicts daily ischemia independent of exercise-induced ischemia. Exaggerated hemodynamic responses during mental stress testing also identify individuals who are more likely to exhibit myocardial ischemia during daily life and mental stress.
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Affiliation(s)
- J A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
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