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首页> 外文期刊>Psychosomatic Medicine: Journal of the American Psychosomatic Society >Psychological risk factors may moderate pharmacological treatment effects among ischemic heart disease patients. Canadian Amlodipine/Atenolol in Silent Ischemia Study (CASIS) Investigators.
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Psychological risk factors may moderate pharmacological treatment effects among ischemic heart disease patients. Canadian Amlodipine/Atenolol in Silent Ischemia Study (CASIS) Investigators.

机译：心理危险因素可能会减轻缺血性心脏病患者的药物治疗效果。加拿大氨氯地平/阿替洛尔在静息缺血研究（CASIS）中的研究者。

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BACKGROUND: Numerous research findings support the proposed connection between such psychological characteristics as stress and hostility and the manifestation of disease. However, less evidence is available concerning the role(s) psychological factors might play in the process of disease recovery. METHODS: Eighty patients with known coronary disease and exercise-induced ischemia underwent treadmill exercise testing and 48-hour ambulatory electrocardiographic monitoring and completed a battery of standardized psychological tests assessing hostility, depression, and daily stress on four occasions during a 12-week pharmacological treatment study. After withdrawal of antiischemic drugs at baseline, patients returned for subsequent tests at 3-week intervals. During the second and third intervals, patients were prescribed one of two antiischemic medications, atenolol or amlodipine, or given a placebo. All patients were then placed on a combination treatment protocol for the 3 weeks before the final testing date. RESULTS: The combination treatment produced highly significant benefits across all measured cardiac variables (20.3% improvement in exercise performance, 13% reduction in reported angina, 64.0% reduction in the frequency of ischemic episodes; for all, p < .01). However, results showed that high baseline levels of daily stress were associated with reliably smaller treatment effects on measures of ischemia frequency and treadmill exercise time and with a significantly greater likelihood of reporting angina after treatment (r = -0.24, -0.25, and -0.33, respectively; p <.05). In addition, high baseline hostility predicted significantly smaller diastolic blood pressure improvements (r = -0.29, p < .05). CONCLUSIONS: These results indicate that psychological risk factors may have globally negative effects on the course of treatment and suggest particular factors that may warrant attention in trials targeting cardiac symptom reduction.
机译：背景：大量研究发现支持压力和敌对等心理特征与疾病表现之间的联系。但是，关于心理因素在疾病恢复过程中可能发挥的作用的证据很少。方法：对80名已知冠心病和运动诱发性缺血的患者进行了跑步机运动测试和48小时动态心电图监测，并在12周的药物治疗中四次完成了一系列标准化的心理测试，评估敌意，抑郁和每日压力研究。在基线停药后，患者每隔3周返回一次以进行后续检查。在第二个和第三个间隔期间，为患者开具两种抗缺血药物之一（阿替洛尔或氨氯地平），或给予安慰剂。然后将所有患者在最终测试日期之前的三周内接受联合治疗。结果：联合治疗在所有测得的心脏变量中产生了非常显着的益处（运动表现改善20.3％，报告的心绞痛减少13％，缺血性发作的频率减少64.0％;总体而言，p <.01）。但是，结果表明，每天较高的基线日常压力与对缺血频率和跑步机运动时间的测量结果可靠地较小的治疗效果相关，并且与治疗后报告心绞痛的可能性显着相关（r = -0.24，-0.25和-0.33 ，分别; p <.05）。此外，较高的基线敌意性预示舒张压的改善明显较小（r = -0.29，p <.05）。结论：这些结果表明心理危险因素可能对治疗过程产生整体负面影响，并建议在针对减少心脏症状的试验中应引起注意的特定因素。

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