The effect of group-based cognitive behavioral therapy on inflammatory biomarkers in patients with coronary heart disease—results from the SUPRIM-trial

Erik M. G.  Olsson; Fredrika  Norlund; Ronnie  Pingel; Gunilla  Burell; Mats  Gulliksson; Anders  Larsson; Bo  Karlsson; Kurt  Svärdsudd; Claes  Held

doi:10.1080/03009734.2018.1490829

Erik M. G. Olsson Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden http://orcid.org/0000-0002-1591-7407
Fredrika Norlund Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden http://orcid.org/0000-0001-8895-5247
Ronnie Pingel Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden http://orcid.org/0000-0002-4140-1981
Gunilla Burell Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden http://orcid.org/0000-0002-8258-8703
Mats Gulliksson Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden http://orcid.org/0000-0002-0517-470X
Anders Larsson Department of Medical Sciences, Biomedical Structure and Function, Uppsala University, Uppsala, Sweden http://orcid.org/0000-0003-3161-0402
Bo Karlsson Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden http://orcid.org/0000-0002-4566-5079
Kurt Svärdsudd Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden http://orcid.org/0000-0002-8925-9670
Claes Held Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden http://orcid.org/0000-0001-9402-7404

DOI: https://doi.org/10.1080/03009734.2018.1490829

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

Abstract

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.

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The effect of group-based cognitive behavioral therapy on inflammatory biomarkers in patients with coronary heart disease—results from the SUPRIM-trial

Abstract

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