Abstract P341: Reduction of Insulin Resistance and Carotid Intima-Media Thickness in Older African American Women: A Randomized Comparison of Transcendental Meditation and Health Education

Abstract

Background: High stress level is thought to be a factor in the disproportionate rates of mortality from CHD and stroke in African Americans. Stress-related CVD risk factors such as hyperglycemia, dyslipidemia, obesity, and high blood pressure tend to occur together, and their co-occurrence has been labeled the “insulin-resistance” or “metabolic” syndrome. The Transcendental Meditation (TM) program is reported to prevent or reverse effects of stress and may provide benefits complementary to lifestyle changes based on diet and exercise. Methods: A total of 200 older African American women (mean age 65.5, range 55-85 y) in Washington DC and Atlanta, GA were randomly allocated to two behavioral treatment groups—the TM program and a diet-exercise health education (HE) program. The following outcomes were tested before and after one-year: carotid intima-media thickness (CIMT), insulin resistance indicated by homeostatic model assessment (HOMA-IR), serum lipids, blood pressure, and overnight urinary cortisol excretion. Between group and within group changes were analyzed. CIMT change was compared with normative data using t-test for single means. Results: CIMT declined significantly in both the TM group [ T (1, 71) = - 2.25, p < .03] and the HE group [ T (1, 63) = - 2.656, p = .03] compared to the yearly progression rate from a large normative database. In the TM group, insulin resistance indicated by HOMA-IR decreased compared to the HE group [ F (1, 138) = 4.72, p < .03]. Urinary cortisol excretion (a measure of chronic stress) decreased (statistical trend, p < 0.1) in each group. Conclusions: In this randomized trial, we found prevention of CIMT progression in both TM and HE groups compared to national norms. In the TM group, this may relate to the reduction in insulin resistance presented here and to the improved dyslipidemia presented previously. Both TM and HE groups tended to lower cortisol secretion, suggesting that the effects of both approaches may be due to lowered chronic stress, a probable contributor to CIMT and CVD.