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Psychological Factors
A central theme of our research over several decades has been the impact of the brain and nervous system on the health of the heart. The focus of research in recent years has been on the management of patients with coronary artery disease (CAD) and has been incorporated in an examination of the role of psychological factors in the outcome of patients with CAD. The long term Coronary Artery Disease Project (initiated in 1992) continues to be an important resource in our research on the management of patients with CAD and has helped confirm our earlier observations that most patients will do very well without being subjected to cardiac catheterization and bypass surgery.
In addition to studying the physical attributes of patients with CAD, we have analyzed certain psychological factors such as depression, anxiety and hostility. The CAD Project stemmed from the first report of the long-term effect of statins on the psychological state of patients with CAD (presented at the American College of Cardiology and published in the Journal of the American College of Cardiology). International interest in this research was evident with numerous requests for print and radio interviews and subsequent excerpting of the research report in medical news publications.
The CAD database was also the source of the novel observation of the impact of statins on the incidence of atrial fibrillation in patients with CAD. The potential for an intriguing relationship was therefore brought forth linking the psychological state (depression) with a cardiac arrhythmia (atrial fibrillation), and inflammation, a key target of the statins search on the mechanisms responsible for this interaction is ongoing and a recent article from Columbia University cited the Lown Foundation's research and explored the novel paradigm first put forth in our research presentation at the American Heart Association.
Over the past year we have embarked on a project aimed at assessing the impact of our clinical practice style on the outcome of patients with CAD. We hypothesized that a comparison of the level of anxiety of a patient with coronary disease at the outset of the clinical relationship with one of our cardiologists and the level of anxiety several years later might predict how well the patient will do. We examined three patterns of behavior:
1. High anxiety that remained high over time.
2. High anxiety at outset that declined over time.
3. Low anxiety at outset that increased over time.
We have found that a significant difference in mortality and incidence of myocardial infarction (heart attack) exists among these groups. Work continues on this project with further analysis of levels of anxiety and depression with respect to the outcome of these patients over time.
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