title: Effects of stress reduction on carotid atherosclerosis in hypertensive African Americans.
abstract: OBJECTIVE
  African Americans suffer disproportionately higher cardiovascular disease mortality rates than do whites. Psychosocial stress influences the development and progression of atherosclerosis. Carotid intima-media thickness (IMT) is a valid surrogate measure for coronary atherosclerosis, is a predictor of coronary outcomes and stroke, and is associated with psychosocial stress factors. Stress reduction with the Transcendental Meditation (TM) program decreases coronary heart disease risk factors and cardiovascular mortality in African Americans. B-mode ultrasound is useful for the noninvasive evaluation of carotid atherosclerosis.
  
  
  METHODS
  This randomized controlled clinical trial evaluated the effects of the TM program on carotid IMT in hypertensive African American men and women, aged >20 years, over a 6- to 9-month period. From the initially enrolled 138 volunteers, 60 subjects completed pretest and posttest carotid IMT data. The assigned interventions were either the TM program or a health education group. By use of B-mode ultrasound, mean maximum IMT from 6 carotid segments was used to determine pretest and posttest IMT values. Regression analysis and ANCOVA were performed.
  
  
  RESULTS
  Age and pretest IMT were found to be predictors of posttest IMT values and were used as covariates. The TM group showed a significant decrease of -0.098 mm (95% CI -0. 198 to 0.003 mm) compared with an increase of 0.054 mm (95% CI -0.05 to 0.158 mm) in the control group (P=0.038, 2-tailed).
  
  
  CONCLUSIONS
  Stress reduction with the TM program is associated with reduced carotid atherosclerosis compared with health education in hypertensive African Americans. Further research with this stress-reduction technique is warranted to confirm these preliminary findings.
authors.affiliation: Center for Natural Medicine and Prevention, Maharishi University of Management, College of Maharishi Vedic Medicine, Fairfield, Iowa 52557, USA. amparo@mum.edu
authors.forename: A
authors.initials: A
authors.lastname: Castillo-Richmond
authors.forename: R H
authors.initials: RH
authors.lastname: Schneider
authors.forename: C N
authors.initials: CN
authors.lastname: Alexander
authors.forename: R
authors.initials: R
authors.lastname: Cook
authors.forename: H
authors.initials: H
authors.lastname: Myers
authors.forename: S
authors.initials: S
authors.lastname: Nidich
authors.forename: C
authors.initials: C
authors.lastname: Haney
authors.forename: M
authors.initials: M
authors.lastname: Rainforth
authors.forename: J
authors.initials: J
authors.lastname: Salerno
mesh_terms: D044383:Black People; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000208:ethnology* / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006266:Health Education; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D019122:Meditation; D013315:Stress, Psychological / Q000628:therapy*; D014463:Ultrasonography; D001741:Black or African American