Author + information
- Carl J. Lavie, MD, FACC⁎ ( and )
- Richard V. Milani, MD, FACC
- ↵⁎Department of Cardiac Rehabilitation and Prevention, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, Louisiana 70121
The recent review by Rozanski et al. (1) outlined the important role of behavioral and psychosocial risk factors in the pathogenesis and expression of cardiovascular (CV) diseases, particularly coronary artery disease (CAD). Although the investigators briefly mentioned the potential for exercise training to improve prognosis in patients with depression, as well as the role of adding psychosocial intervention to standard cardiac rehabilitation programs to reduce subsequent major CAD events (1,2), they mainly emphasized the role of behavioral and psychopharmacologic interventions.
Formal phase II cardiac rehabilitation and exercise training programs, however, are known to produce marked benefits on exercise capacity, plasma lipids, obesity indices, inflammation, metabolic syndrome, autonomic function, blood viscosity and rheology, measures of ventricular repolarization dispersion, subsequent hospitalization costs, as well as major CV morbidity and mortality (3–5). In addition to producing over 50% reductions in the prevalence of depressive symptoms (6–9), we have also demonstrated that formal cardiac rehabilitation programs, with general but without specific psychosocial intervention, also produced nearly 50% reductions in both prevalence of hostility symptoms (10,11) and high levels of anxiety symptoms (12) as well as markedly reducing somatization and all aspects of psychological distress. In our studies, patients with adverse behavioral factors generally had other adverse CAD risk profiles, including low exercise capacities, hypertriglyceridemia, low high-density lipoprotein cholesterol levels, elevated plasma glucose, and reduced quality of life scores compared with patients without these adverse psychological factors, and all these parameters markedly improved following formal cardiac rehabilitation and exercise training programs.
We agree with Rozanski et al. (1) that further emphasis on the emerging importance of psychosocial and behavioral risk factors is needed and that a sophisticated healthcare delivery system may be needed to optimize intervention in these disorders. However, we also believe that greater physician input is needed to increase referrals, attendance, and completion of the readily available and proven, yet greatly underutilized, cardiac rehabilitation and exercise training programs to enhance psychosocial and behavioral adaptation and the secondary prevention of CAD.
- American College of Cardiology Foundation
- Rozanski A.,
- Blumenthal J.A.,
- Davidson K.W.,
- et al.
- Lavie C.J.,
- Milani R.V.,
- Littman A.B.
- Milani R.V.,
- Lavie C.J.,
- Mehra M.R.