title: Stress reduction prolongs life in women with coronary disease: the Stockholm Women's Intervention Trial for Coronary Heart Disease (SWITCHD).
abstract: BACKGROUND
  Psychosocial stress may increase risk and worsen prognosis of coronary heart disease in women. Interventions that counteract women's psychosocial stress have not previously been presented. This study implemented a stress reduction program for women and investigated its ability to improve survival in women coronary patients.
  
  
  RESULTS
  Two hundred thirty-seven consecutive women patients, aged 75 years or younger, hospitalized for acute myocardial infarction, coronary artery bypass grafting, or percutaneous coronary intervention were randomized to a group-based psychosocial intervention program or usual care. Initiated 4 months after hospitalization, intervention groups of 4 to 8 women met for a total of 20 sessions that were spread over a year. We provided education about risk factors, relaxation training techniques, methods for self-monitoring and cognitive restructuring, with an emphasis on coping with stress exposure from family and work, and self-care and compliance with clinical advice. From randomization until end of follow-up (mean duration, 7.1 years), 25 women (20%) in the usual care and 8 women (7%) in the stress reduction died, yielding an almost 3-fold protective effect of the intervention (odds ratio, 0.33; 95% CI, 0.15 to 0.74; P=0.007). Introducing baseline measures of clinical prognostic factors, including use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, calcium-channel blockers, and statins into multivariate models confirmed the unadjusted results (P=0.009).
  
  
  CONCLUSIONS
  Although mechanisms remain unclear, a group-based psychosocial intervention program for women with coronary heart disease may prolong lives independent of other prognostic factors.
authors.affiliation: Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden. k.orth-gomer@ki.se
authors.forename: Kristina
authors.initials: K
authors.lastname: Orth-Gomér
authors.forename: Neil
authors.initials: N
authors.lastname: Schneiderman
authors.forename: Hui-Xin
authors.initials: HX
authors.lastname: Wang
authors.forename: Christina
authors.initials: C
authors.lastname: Walldin
authors.forename: May
authors.initials: M
authors.lastname: Blom
authors.forename: Tomas
authors.initials: T
authors.lastname: Jernberg
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D003324:Coronary Artery Disease / Q000401:mortality / Q000451:nursing / Q000523:psychology / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance; D010353:Patient Education as Topic; D016016:Proportional Hazards Models; D011615:Psychotherapy, Group; D012064:Relaxation Therapy / Q000451:nursing; D018570:Risk Assessment; D012307:Risk Factors; D012648:Self Care; D013315:Stress, Psychological / Q000150:complications / Q000401:mortality / Q000451:nursing / Q000628:therapy*; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D016387:Women's Health