The Influence of Cognitive Behavioral Intervention for Anger Management on Endothelial Function in Patients With Recent Myocardial Infarction: A Randomized Clinical Trial

Abstract

ObjectiveAnger may cause adverse cardiovascular responses, but the effects of anger management on clinical cardiovascular outcomes are insufficiently understood. We sought to assess the influence of anger management through a cognitive behavioral intervention on endothelial function in patients with a recent myocardial infarction (MI).MethodsPatients with ST-elevation MI and a low anger control score were enrolled during hospitalization in a randomized, parallel, controlled clinical trial. Intervention was anger management with cognitive behavioral techniques implemented by a psychologist in two individual monthly sessions. The primary end point was the between-group difference in the variation of flow-mediated dilation (FMD) in the brachial artery from baseline to the 3-month follow-up. The second end point comprised major cardiovascular events at 24-month follow-up.ResultsA total of 43 patients (age = 56 [9] years; 23.3% women) were randomized to the intervention group and 47 patients (age = 58 [10] years; 19.1% women) to the control group. Baseline clinical characteristics were not statistically different between groups. Both groups showed a significant improvement in anger control from baseline to end point; however, the difference in intergroup variation was not statistically significant. The difference in FMD variation from baseline to the 3-month follow-up was significantly higher in the intervention group. The partial η2 was 0.057 (p = .024), indicating a medium effect size. There was no difference between groups regarding major cardiovascular events.ConclusionsAnger management by cognitive behavioral techniques may improve endothelial function in post-MI patients with low anger control, but it remains unclear via which mechanism these effects occurred. Further studies with larger numbers of patients, assessments of changes in anger, improved comparability of preintervention FMD, and longer follow-up are warranted.Trial Registration:ClinicalTrials.gov identifier: NCT02868216.

Translational Research of the Acute Effects of Negative Emotions on Vascular Endothelial Health: Findings From a Randomized Controlled Study

“…In a recent, small randomized trial of 43 patients with recent ST‐segment–elevation myocardial infarction and low trait anger control, anger management by cognitive behavioral therapy versus control condition led to a greater improvement in EDV at 3‐month follow‐up. 44 However, both groups had an improvement in trait anger control with no statistically significant difference between groups. Therefore, whether the improvement in EDV associated with cognitive behavioral therapy was due to an improvement in anger is unclear.…”

Manejo da raiva em pacientes com infarto agudo do miocárdio (MAPAMI): protocolo do ensaio clínico randomizado

“…Esse protocolo está de acordo com a Resolução 466/12 do CONEP. O ensaio clínico referido neste estudo de protocolo foi registrado no Clinical Trials sob o número NCT 02868216 e realizado de acordo com a Declaração de Helsinque (Schmidt et al, 2022). Todos os participantes assinaram o Termo de Consentimento Livre e Esclarecido, tendo sido desenvolvido em um Hospital terciário de referência em cardiologia no estado do Rio Grande do Sul, Brasil.…”

“…A intervenção de manejo da raiva descrita nesse protocolo mostrou efeito na melhora da função endotelial e os resultados deste ensaio clínico randomizado são descritos detalhadamente em outro artigo (Schmidt et al, 2022). Sugerimos como perspectiva futura adaptar a intervenção que realizamos neste protocolo para a modalidade de sessões em grupos e verificar se haverá o mesmo efeito, podendo assim auxiliar um maior número de pacientes.…”

Influência do Bem-estar Espiritual na Pressão Arterial, Hemodinâmica Central e Função Endotelial

“…7,8 Práticas que busquem o bem-estar espiritual, aliadas ou não à religiosidade, tem sido relacionadas ao bom controle de muitas doenças, 9 além de redução de mortalidade em diversas situações. 10 Existem evidências da associação entre E/R e desfechos positivos em cardiologia, tais como Doença Arterial Coronariana (DAC), 11 Insuficiência Cardíaca (IC) 12 e HA. 13,14 Estudos sobre E/R são ainda incipientes, e a maioria observacionais.…”