Complementary Alternative Cardiovascular Medicine

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128 Alternative Cardiovascular Medicine circulation that used dye-dilution and radioactive clearance methods yielded results that demonstrated a small but significant increase in cardiac output (15%) during TM. In perhaps the only controlled study investigating the impact of meditation on TPR, subjects in the TM group exhibited significantly decreased TPR and systolic blood pressure, compared with increases in the eyes-closed relaxation control group (43). ELECTROENCEPHALOGRAM DURING MEDITATION Studies of electroencephalogram (EEG) during meditation demonstrate an increase in intensity of slow alpha waves and occasional theta wave activity. Beta and delta waves either decrease or remain constant during meditation (26,27). This pattern has been very well replicated in numerous studies and has been distinguished as different from relaxation (31,45,46). In fact, one study investigated the difference between EEG activity in TM and MM and compared both with relaxation (46). These findings demonstrated significant mean amplitude frequency differences between the two meditation conditions and relaxation at all bandwidths and at numerous cortical sites, as well as significant differences between concentration and mindfulness at all bandwidths. The authors interpreted their results as indicating that TM and MM represent unique forms of consciousness and are not merely varying degrees of a state of relaxation (46). Impact of Meditation on Cardiac Disease Process and Risk Factors (Clinical) Clinical research on the health-related outcomes of meditation practice is still in its early development, and there is a need for more controlled studies (23). However, the mounting evidence discussed earlier in this chapter, which indicates that a meditation program can result in the sustained lowering of BP, heart rate, cardiac output, and TPR in nonclinical samples (8,9,27,28,39,42,43), suggests the need for further clinical research . Schneider and colleagues conducted one of the more rigorous clinical studies on health-related outcome (47). This randomized, controlled, single-blind trial, with 3-mo follow-up, tested the efficacy of two stresseducation approaches to the treatment of mild hypertension in older African Americans. Subjects were randomly assigned to one of three study groups: the TM program, progressive muscle relaxation (PMR), or a lifestyle modification education control (EC) program. TM significantly reduced both systolic and diastolic pressures, as did PMR. However, the reductions in systolic and diastolic blood pressures were significantly greater in the TM group than in the PMR group. TM was approximately twice as effective as PMR in reducing blood pressure.
Chapter 8 / Meditation and CVD 129 Castillo-Richmond (48) studied the same patient population and evaluated the effects of the TM meditation program on carotid intimamedia thickness (IMT), a valid surrogate measure for coronary atherosclerosis. IMT is a predictor of coronary outcomes and stroke and is associated with psychosocial stress factors (48). This randomized controlled clinical trial evaluated the comparison of TM vs an education control program on IMT during a 6–9-mo period. After controlling for age and pretest IMT values, analyses showed a statistically significant decrease in posttest IMT values for subjects in the TM group, compared with an increase in the values of the control group. These results suggest that stress reduction with the TM program is associated with reduced carotid atherosclerosis in African Americans with hypertension, compared to health education (48). Zamarra and colleagues investigated the effects of TM on the incidence of exercise-induced myocardial ischemia in patients with known coronary artery disease (CAD) (49). In this small (21-subject) randomized, controlled, single-blind, pilot study, subjects were assigned to the TM program group or to a wait-list control group. At baseline and at the completion of the intervention (8 mo later), patients underwent symptom-limited exercise tolerance tests. Compared with the control group participants, the patients who participated in the TM program demonstrated significantly greater exercise tolerance, higher maximal workload, and delayed onset of ST-segment depression (49). Psychological Impact of Meditation In addition to the well-documented physiologic effects of meditation, researchers have begun to measure the impact such practice may have on psychological variables. Numerous studies have shown that depression and anxiety are associated with increased risk of CAD and adverse cardiac events (50–54). Symptoms such as subjective feelings of stress, depression, anxiety, panic attacks, and chronic pain have all been the focus of meditation research. Again, the research in this area suffers from small sample sizes and few controlled studies. Additional methodological problems, such as the use of unvalidated measures and failure to control for concurrent treatments limit the ability to confidently draw conclusive evidence from these studies. However, overall, the preliminary evidence supports some usefulness of meditation in decreasing these symptoms. Research in this area has been predominantly conducted using the MM technique. For excellent reviews of the treatment literature, more extensive than is possible here, see refs. 22 and 23. The results of three randomized, controlled studies of MBSR in nonclinical samples suggest that this intervention may be effective in
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Complementary and Alternative Cardi
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CONTEMPORARY CARDIOLOGY CHRISTOPHER
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© 2004 Humana Press Inc. 999 River
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vi Preface physician or other healt
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viii Contents 10 Massage Therapy an
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x Contributors ERIN L. OLIVO, PhD
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Chapter 1 / CAM and CVD 1 1 Complem
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Chapter 1 / CAM and CVD 3 patients
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Chapter 1 / CAM and CVD 5 The crite
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Chapter 1 / CAM and CVD 7 disease c
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Chapter 1 / CAM and CVD 9 analyses,
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12 Alternative Cardiovascular Medic
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Index 279 INDEX A N-Acetylcysteine
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Index 281 taurine studies, 106 Conj
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Index 283 Homeopathic medicine, see
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Index 285 funding of studies, 148 g
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Contemporary Cardiology COMPLEMENTA
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