Complementary Alternative Cardiovascular Medicine
Complementary Alternative Cardiovascular Medicine
Complementary Alternative Cardiovascular Medicine
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
Chapter 8 / Meditation and CVD 129<br />
Castillo-Richmond (48) studied the same patient population and<br />
evaluated the effects of the TM meditation program on carotid<br />
intimamedia thickness (IMT), a valid surrogate measure for coronary<br />
atherosclerosis. IMT is a predictor of coronary outcomes and stroke and<br />
is associated with psychosocial stress factors (48). This randomized<br />
controlled clinical trial evaluated the comparison of TM vs an education<br />
control program on IMT during a 6–9-mo period. After controlling for<br />
age and pretest IMT values, analyses showed a statistically significant<br />
decrease in posttest IMT values for subjects in the TM group, compared<br />
with an increase in the values of the control group. These results suggest<br />
that stress reduction with the TM program is associated with reduced<br />
carotid atherosclerosis in African Americans with hypertension, compared<br />
to health education (48).<br />
Zamarra and colleagues investigated the effects of TM on the incidence<br />
of exercise-induced myocardial ischemia in patients with known<br />
coronary artery disease (CAD) (49). In this small (21-subject) randomized,<br />
controlled, single-blind, pilot study, subjects were assigned to the<br />
TM program group or to a wait-list control group. At baseline and at the<br />
completion of the intervention (8 mo later), patients underwent symptom-limited<br />
exercise tolerance tests. Compared with the control group<br />
participants, the patients who participated in the TM program demonstrated<br />
significantly greater exercise tolerance, higher maximal<br />
workload, and delayed onset of ST-segment depression (49).<br />
Psychological Impact of Meditation<br />
In addition to the well-documented physiologic effects of meditation,<br />
researchers have begun to measure the impact such practice may have on<br />
psychological variables. Numerous studies have shown that depression<br />
and anxiety are associated with increased risk of CAD and adverse cardiac<br />
events (50–54). Symptoms such as subjective feelings of stress,<br />
depression, anxiety, panic attacks, and chronic pain have all been the<br />
focus of meditation research. Again, the research in this area suffers<br />
from small sample sizes and few controlled studies. Additional methodological<br />
problems, such as the use of unvalidated measures and failure<br />
to control for concurrent treatments limit the ability to confidently draw<br />
conclusive evidence from these studies. However, overall, the preliminary<br />
evidence supports some usefulness of meditation in decreasing<br />
these symptoms. Research in this area has been predominantly conducted<br />
using the MM technique. For excellent reviews of the treatment<br />
literature, more extensive than is possible here, see refs. 22 and 23.<br />
The results of three randomized, controlled studies of MBSR in<br />
nonclinical samples suggest that this intervention may be effective in