Abstract
Background: The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) is a prospective randomized controlled trial of a group-based cognitive behavioral therapy (CBT) stress management program for coronary heart disease (CHD) patients. The intervention reduced the risk of fatal or non-fatal first recurrent cardiovascular (CV) events. The aim of the present study was to analyze if the positive effects of the CBT program on clinical outcomes could have been mediated by changes in biomarkers for inflammation.Methods: Altogether 362 patients with CHD were randomly assigned to intervention or usual care. The inflammatory biomarkers (VCAM-1, TNF-R1, TNF-R2, PTX3, and hs-CRP) were serially assessed at five time points every six months from study start until 24 months later, and analyzed with linear mixed models.Results: Baseline levels of the inflammatory markers were near normal, indicating a stable phase. The group-based CBT stress management program did not significantly affect the levels of inflammatory biomarkers in patients with CHD. Three out of five (VCAM-1, TNF-R2, and PTX3) inflammatory biomarkers showed a slight increase over time in both study groups, and all were positively associated with age.Conclusion: Group-based CBT stress management did not affect biomarkers for inflammation in patients with CHD. It is therefore unlikely that inflammatory processes including these biomarkers were mediating the effect the CBT program had on the reduction in CV events. The close to normal baseline levels of the biomarkers and the lack of elevated psychological distress symptoms indicate a possible floor effect which may have influenced the results.
Highlights
Several psychological and stress-related risk factors for coronary heart disease (CHD) have been identified during the last decades [1]
In the present study we have focused on five selected inflammatory biomarkers previously used in CVD research, namely vascular cell adhesion molecule 1 (VCAM-1), tumor necrosis factor (TNF) receptor 1 (TNF-R1), TNF receptor 2 (TNF-R2), pentraxin 3 (PTX3), and high-sensitivity C-reactive protein [19,20,21,22,23]
The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) study has shown a positive treatment effect in terms of reducing recurrent CV events and myocardial infarction (MI), the present results showed no effect of the cognitive behavioral therapy (CBT) program on any of the five inflammatory biomarkers tested
Summary
Several psychological and stress-related risk factors for coronary heart disease (CHD) have been identified during the last decades [1]. The array of psychological risk factors reflects both environmental triggers, the individual’s reaction to stressful burdens, and behavioral response patterns. Such factors are potentially behaviorally modifiable in preventive programs, for example through development of coping strategies, healthy behaviors, and problem-solving skills, and these programs are suggested to reduce the risk of recurrent cardiac events [3]. The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) is a prospective randomized controlled trial of a group-based cognitive behavioral therapy (CBT) stress management program for coronary heart disease (CHD) patients. The group-based CBT stress management program did not significantly affect the levels of inflammatory biomarkers in patients with CHD. The close to normal baseline levels of the biomarkers and the lack of elevated psychological distress symptoms indicate a possible floor effect which may have influenced the results
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