Coronary Angioplasty, Restenosis & Hostility |
Mark Goodman, Ph.D., M.A.
Behavioral Medicine
West Orange, NJ 07052
(973)731-4521 (phone/voicemail)
“Pilot Findings of a Percutaneous
Transluminal Coronary Angioplasty Restenosis Prone Prevention Program,”
Mayo Clinic Proceedings, May, 1997;72,487.
“Hostility Predicts Restenosis After
Percutaneous Transluminal Coronary Angioplasty,”
Mayo Clinic Proceedings, August, 1996;71(8),729-734.
“Identification and Treatment of
Psychosocial Risk Factors for Coronary Artery Disease”
Mayo Clinic Proceedings, (Editorial, August 1996;71(8),817-819).
KH: Can you share other lifestyle modifications that may be of benefit in reducing restenosis? MG: Lifestyle modifications are the goals. Research has shown us that a biological risk-factor may be modified/reduced as much as 20% through behavioral change. Smoking, the choice to consume high fat vs. a low fat diet, exercise, alcohol consumption, hypertension control as well as compliance with risk-factor reducing pharmacologics are all behaviors. Behavioral medicine has to do with changing behaviors to achieve a beneficial medical outcome. Behavioral medicine’s concerns are health promotion and disease prevention. Having multi-disciplinary training, one area I always address is quality of sleep. Sleep-wake cycles disorders are common in these patients who are so success driven, and this disorder negatively affects diet, mood, compliance, immunocompetence, and strains interpersonal relationships. In reqard to diet, I teach my patients how to shop for healthier foods in the supermarkets, and even how to determine healthier alternative when dining out or eating fast foods! KH: How do you determine if your program
is successful and what is the time frame of this determination? MG: Restenosis following PTCA-balloon dilation is most likely to occur within 6 months, according to the literature. I waited 18 months before reporting my restenosis prevention findings because I believe this was the minimum time necessary to demonstrate clinically useful significance. Cardiologists and other physicians (as well as my PTCA patients who have not progressed to CABG) tell me they consider these pilot results to be a very positive finding. Statistically, my results are even more impressive given the small sample size, thus attesting to the “robustness” and large “effect size” that this behavioral measure has in capturing and predicting a disease hard-endpoint. I would arbitrarily set a time limit of 3 years without restenosis in evaluating whether treatment has truly been successful. Patients consider my prevention program successful even if they are able to postpone CABG and further clinical cardiac events. |
KH: What are the side effects of your program, if any? MG: None, other than restenosis, which might have occurred anyway. KH: What is the cost of this behavioral intervention program? MG: The assessment identification of this risk-factor via telephone or in-person interview using the same verbally administered assessments as I used in the August, 1996 Mayo Clinic Proceedings article is $300 for a 1-hour consultation. This allows adequate time to respond to questions and provide explanations and, of course education. The Restenosis Prevention Program, at $300/ per hour is comprised of approximately 8-12 hours. The fee can range from $2400-$3600 depending upon the number, and degree of severity of cardiac risk-factors requiring treatment modification intervention. The Restenosis Prevention program can be compressed into a weekend, if necessary. I am not a participating provider with any health care insurance companies, and require pre-payment in advance to reserve treatment Program time. However, my fee may potentially be reimbursable directly to the patient. KH: What study needs to be done next to confirm your findings? MG: A prospective study with treatment cases matched
to controls on all demographics (i.e. age, gender, race, body mass index,
traditional risk factors and hostility scores) including degree and
site of arterial restenosis with my intervention program manipulated
as the independent variable. It would be important to verify a dose
response linear relationship between more intervention and more resistance
to angioplasty failure for those identified with this risk-factor. Moreover,
unlike in pharmacologic studies, blinding subjects to the hypothesis
and covarying out variable rates of human learning are difficult in
pure behavioral interventions. I am certainly amenable to suggestions
from other clinical researchers. |
KH: Are there any other factors, especially nutritional, that may help reduce the likelihood of restenosis after percutaneous angioplasty? MG: Absolutely! Clinical Pearls News had a
brief article in 1997 on the protective role of vitamin C in preventing
PTCA restenosis. My Prevention Program includes consultation with each
of my patients cardiologist regarding the latest in nutritional pharmacology
with antioxidants, fish oils, parasympathomimetics, etc.. |
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