March 2017

In this Issue: VA Healthcare for Women Veterans
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Mindfulness-based Stress Reduction for Women at Risk for Cardiovascular Disease

Feature Article

Evidence demonstrates that chronic stress doubles the risk of myocardial infarction and contributes to pro-inflammatory processes implicated in coronary artery disease and stroke. Veterans who have experienced combat are at greater risk for cardiovascular disease (CVD) compared to noncombat Veterans and non-Veterans. However, previous research has focused primarily on male Veterans. This ongoing study is evaluating the effect of Mindfulness Based Stress Reduction (MBSR) on CVD risk among women Veterans. Specifically, investigators will:

• Determine the extent to which MBSR improves psychological well-being, decreases inflammatory burden, and reduces cardiovascular risk in women Veterans; and
• Evaluate protective and risk factors posited to moderate the effect of MBSR on psychological well-being, inflammatory burden and cardiovascular risk (including endothelial dysfunction).

Mindfulness Based Stress Reduction (MBSR) involves intensive training in mindfulness, which promotes positive adaptation to life stress. MBSR also has been found to reduce symptoms of depression and improve quality of life in Veterans experiencing post-traumatic stress disorder (PTSD). Practitioners of MBSR gain increased awareness and insight into the relationship among their thoughts, emotions, and somatic reactivity which can facilitate change in conditioned patterns of emotional reaction. However, only minimal research and no randomized control trials (RCTs) have examined MBSR as an intervention for reducing CVD risk in women Veterans. Further, previous studies have neither examined CVD risk objectively using a well-established CVD risk score nor measured endothelial dysfunction. Endothelial dysfunction is acknowledged to precede atherosclerosis and is a strong predictor of CVD.

Women Veterans between the ages of 18 and 70 years who have at least one cardiovascular disease (CVD) risk factors are being randomized into either an eight-week MBSR program or health education control program. Age, body mass index (BMI), menstrual status, medications, and socioeconomic status will be evaluated as covariates. Thus far, preliminary findings suggest that women Veterans experience high levels of early life adversity, and early life adversity is associated with depressive symptoms as adults.

Impact: MBSR has the potential to improve psychological well-being and reduce cardiovascular disease risk (including improving endothelial function) with improvements sustained for at least six months. Given that CVD is a major cause of mortality, this research also may have broader implications for reducing CVD in the general population

Principal Investigator: Karen Saban, PhD, RN, is part of HSR&D's Center of Innovation for Complex Chronic Healthcare (CINCCH) in Hines, IL.

Mindfulness-based Stress Reduction for Women at Risk for Cardiovascular Disease project abstract