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Cardiovascular Disease

Heart disease is the leading cause of death for both men and women in the U.S., accounting for one in every four deaths in 2006.  Combined with deaths from stroke, cardiovascular disease accounts for more than one-third of deaths in adults.  In addition to mortality, the impact of cardiovascular disease on quality of life, disability and healthcare costs in the U.S. is enormous (estimated to be $316.4 billion in healthcare, lost wages, and disability costs in 2010). 

Our cardiovascular research in the Department of Family Medicine focuses primarily on prevention, specifically on the management of cardiovascular risk factors, most of which is done in the primary care setting.  Recent estimates (from data from 2005-2006) suggest that the risk factors for cardiovascular disease (most of which are influenced at least in part by lifestyle and health behavior) are very prevalent  (see table below).   It is also clear that approximately 37% of adults have two or more of those risk factors. 

Risk Factor

%

Inactivity

39.5

Obesity

33.9

High Blood Pressure

32.1

Cigarette Smoking

20.8

High Cholesterol

15.6

Diabetes

10.1

The current cardiovascular research projects in the Research Division are focused on the management of hypertension.

HYPERTENSION:   Despite enormous progress in the rates of treatment and control of hypertension, nearly half of treated hypertensives still have blood pressure (BP) that is not controlled.   Drug treatment alone has significant limitations for many patients, including cost and concern about side-effects that may limit adherence, particularly in the 2 and 3-drug regimens needed to achieve control for many patients.  Recognizing these limitations, treatment guidelines recommend adjunctive treatments that may play an important role in improving rates of BP control.  Interventions targeting stress-related and other psychosocial factors have not been as widely tested as other interventions for hypertension.

Our current hypertension project (funded by the National Heart, Lung and Blood Institute at NIH) involves conducting a randomized clinical trial testing a non-drug treatment for hypertension, using a device that guides breathing to a very slow range (6-10 breaths/minute).  This intervention is being tested in approximately 400 hypertensives drawn from primary care practices across New Jersey and in New York City.   This project has allowed us the capacity to monitor 24-hour Ambulatory Blood Pressure (ABPM), which is the gold-standard measure for BP.  This work builds on Dr. Clemow’s previous clinical work and research in behavioral and psychosocial interventions for hypertension and in training health professionals to counsel patients around behavioral risk factors to improve hypertension mangement.  She also has an ongoing collaboration with the Center for Behavioral Cardiovascular Health at Columbia University Medical Center, studying the mechanisms by which depression and other psychosocial factors affect recurrent cardiac events in post-ACS patients. 

PUBLICATIONS:

  • Burg MM, Lesperance F, Rieckmann N, Clemow L, Skotzko C, Davidson KW (2008) Treating persistent depressive symptoms in post-ACS patients:  the project COPES phase-I randomized controlled trial. Contemporary Clinical Trials, 29(2):  231-40.
  • Clemow L, Pickering TG, Davidson KW, Liriano C, Gerin W. (2009)  Multi-component stress management for hypertensive employees:  For whom does it work best?  Psychosomatic Medicine, 71(3):  A-127
  • Clemow L, Pickering TG, Davidson KW, Liriano C, Gerin W. (2009)  Multi-component stress management for hypertensive employees:  For whom does it work best?  Psychosomatic Medicine, 71(3):  A-127
  • Davidson KW, Rieckmann N, Clemow L, Schwartz JE, Shimbo D, Medina V, Albanese G, Kronish IM, Hegel M, Burg MM.( 2010) Enhanced depression care for Acute Coronary Syndrome patients with persistent depressive symptoms. Coronary Psychosocial Evaluation Studies (COPES) randomized controlled trial. Archives of  Internal  Med., 170(7):  600-608. 
  • Davidson KW, Burg MM, Kronish IM, Shimbo D, Dettenborn L, Mehran R, Vorchheimer D Clemow L, Schwartz JE, Lespérance F, Rieckmann N. (2010) Anhedonia Predicts Major Adverse Cardiac Events and Mortality in Patients 1 Year after Acute Coronary Syndrome.  Archives of General Psychiatry, 67(5):480-8
  • Ogedegbe G, Pickering TG, Clemow L, Chaplin W, Spruill TM, Albanese GM, Eguchi K, Burg M, Gerin W. (2008) The misdiagnosis of hypertension: the role of patient anxiety.  Archives of Internal Medicine. Dec 8;168(22):2459-65.
  • Pickering TG, Clemow LP (2008)  Paroxysmal hypertension:  The role of stress and psychological factors. Journal of Clinical Hypertension (Greenwich) 10(7): 575-81
  • Spruill TM, Pickering TG, Schwartz JF, Mostofsky E, Ogedegbe G, Clemow L, Gerin W. (2007)  The impact of perceived hypertension status on anxiety and the white coat effect.  Annals of Behavioral Medicine, 34(1): 1-9.

GRANT:                                                                                       

  • Clemow, Lynn PI: "RCT OF CONTROLLED BREATHING EFFECTS ON AMUBULATORY BP" NIH/NHLBI. R01 HL083056-01A2, 09/01/2007 - 08/31/2012  
  • The goal of this study is to test the efficacy of a guided breathing intervention on ambulatory BP in HTN
  • PAST GRANT:
  • Clemow, Lynn: "A Randomized Controlled Trial of the LifeSkills Workshop in Hypertensive Employees" NIH/NHLBI. R43-HL67584-01, 9/1/01 – 8/31/07
  • The goal of this project was to test the effects of a workplace standardized psychoeducational stress and anger management compared to an educational control on blood pressure in hypertensive employees