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The effect of group-based cognitive behavioral therapy on inflammatory biomarkers in patients with coronary disease: results from the SUPRIM-trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.ORCID iD: 0000-0002-1591-7407
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.ORCID iD: 0000-0001-8895-5247
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.ORCID iD: 0000-0002-4140-1981
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
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2018 (English)In: Upsala Journal of Medical Sciences, Supplement, ISSN 0300-9726, Vol. 123, no 3, p. 167-173Article in journal (Refereed) Published
Abstract [en]

Background: The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) is a prospective randomized controlled trial of a group-based cognitive behavioral therapy (CBT) stress management program for coronary heart disease (CHD) patients. The intervention reduced the risk of fatal or non-fatal first recurrent cardiovascular (CV) events. The aim of the present study was to analyze if the positive effects of the CBT program on clinical outcomes could have been mediated by changes in biomarkers for inflammation.

Methods: Altogether 362 patients with CHD were randomly assigned to intervention or usual care. The inflammatory biomarkers (VCAM-1, TNF-R1, TNF-R2, PTX3, and hs-CRP) were serially assessed at five time points every six months from study start until 24 months later, and analyzed with linear mixed models.

Results: Baseline levels of the inflammatory markers were near normal, indicating a stable phase. The group-based CBT stress management program did not significantly affect the levels of inflammatory biomarkers in patients with CHD. Three out of five (VCAM-1, TNF-R2, and PTX3) inflammatory biomarkers showed a slight increase over time in both study groups, and all were positively associated with age.

Conclusion: Group-based CBT stress management did not affect biomarkers for inflammation in patients with CHD. It is therefore unlikely that inflammatory processes including these biomarkers were mediating the effect the CBT program had on the reduction in CV events. The close to normal baseline levels of the biomarkers and the lack of elevated psychological distress symptoms indicate a possible floor effect which may have influenced the results.

Keywords: Biomarkers, CBT, CHD, inflammation, stress management

Place, publisher, year, edition, pages
2018. Vol. 123, no 3, p. 167-173
National Category
General Practice
Identifiers
URN: urn:nbn:se:uu:diva-356841DOI: 10.1080/03009734.2018.1490829ISI: 000446977000005PubMedID: 30086659OAI: oai:DiVA.org:uu-356841DiVA, id: diva2:1237330
Funder
Vårdal Foundation, V96-160Vårdal Foundation, V98-403Vårdal Foundation, 2014-0114Swedish Heart Lung Foundation, E010-95Swedish Heart Lung Foundation, E019-96Swedish Heart Lung Foundation, E019-98Swedish Heart Lung Foundation, E010-00Swedish Heart Lung Foundation, E009-01Swedish Heart Lung Foundation, E45-04Swedish Heart Lung Foundation, K-97-21x-12256-01ASwedish Heart Lung Foundation, K98-21X-12256-02BSwedish Heart Lung Foundation, K99-21X-12256-03CSwedish Heart Lung Foundation, 2009-1093Swedish National Board of Health and Welfare, 1471-601:Var95-161Forte, Swedish Research Council for Health, Working Life and Welfare, F0196/99Forte, Swedish Research Council for Health, Working Life and Welfare, 2001-1049Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4947Available from: 2018-08-08 Created: 2018-08-08 Last updated: 2018-12-10Bibliographically approved

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Olsson, ErikNorlund, FredrikaPingel, RonnieBurell, GunillaGulliksson, MatsLarsson, AndersKarlsson, BoSvärdsudd, KHeld, Claes
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