PITTSBURGH -- Angioplasty patients who handle their recovery with a positive attitude are less likely to have a second coronary event, according to a new study by a Carnegie Mellon University researcher.
The study, directed by Psychology Professor Vicki Helgeson, appears in the August issue of the journal Psychosomatic Medicine. It is the first to examine the positive psychological variables that might affect new coronary events among angioplasty patients.
The study shows that patients who scored low on measures of self-esteem, optimism and feelings of control over their lives were two and a half times more likely to experience a second coronary event.
"Our work demonstrates that people who respond to a first coronary event by establishing a sense of control over their health, restoring damaged self-esteem and developing a positive outlook, may reduce their risk of a subsequent coronary event," Helgeson said. "This is one of the few studies to show that someone's psychological state may affect the occurrence of new coronary events that are likely caused by restenosis."
Restenosis is the recurrence of blockage in the arteries leading to the heart among people who have had an angioplasty.
The researchers defined coronary events as heart attack, the need for another angioplasty or bypass surgery. Helgeson and research associate Heidi Fritz, a post-doctoral fellow at the University of Pittsburgh, questioned 298 patients (199 male and 99 female) who had successfully undergone angioplasty. Angioplasty, a minimally invasive procedure, has been used for nearly two decades to treat coronary artery disease by relieving blockage in major arteries leading to the heart.
The admission diagnoses for the 298 patients were coronary artery disease, unstable angina or chest pain, acute myocardial infarction or a failed treadmill test. Their angioplasties were defined as successful primarily if the artery was opened 50 percent. Angioplasty was also considered to be successful if the blockage did not reocclude while the patient was still in the hospital.
To assess patient attitudes, Helgeson and Fritz interviewed all the patients and measured their responses using three components of cognitive adaptation theory -- self-esteem, optimism and control. The Rosenberg global self-esteem scale, the Life Orientation Test, which measures optimism, and the Pearlin and Schooler scale, which measures general feelings of personal control, were used to assess the patients' mental outlook.
The results of interviews, coupled with a six-month follow-up, showed that patients who exhibited a positive regard for themselves, an optimistic outlook for the future and a belief that they could make necessary lifestyle changes, might have altered the course of their diseases.
What the study suggested but could not determine was the source of a more provocative mind-body question -- does a patient's psychological state have a direct effect on the physiological processes leading to new coronary events' Because doctors do not completely understand what causes restenosis, Helgeson said it is worth questioning whether psychological factors could trigger more damage to the heart's arteries.
"The idea for the study came from my long-standing interest in cognitive adaptation theory, which gives some insight into how people adjust to chronic illness," Helgeson said. "I am interested, specifically, in how people's attitudes might influence their psychological adjustment to illness as well as the recurrence of physical events.
"Our study certainly suggests that health care professionals can try to identify people who are at risk for subsequent events and perhaps monitor their health behavior. The results also have implications for what kind of therapy patients may want to undergo. An intervention based on enhancing people's feelings of control and giving people tools to exert control over their illnesses seems like a good starting point." The National Institutes of Health funded the study.
NOTE TO EDITORS: Psychosomatic Medicine is the official peer-reviewed journal of the American Psychosomatic Society, published bimonthly. For information about the journal, contact Joel E. Dimsdale, MD, editor-in-chief, at 619-543-5468.