Meditation Improves Endothelial Function in Metabolic Syndrome



[center]March 18, 2011 (San Antonio, Texas) —
Meditation may help improve endothelial function in patients with
metabolic syndrome, potentially reducing cardiovascular risk, new
research suggests.
Presented here at the American Psychosomatic Society 69th Annual
Scientific Meeting, a randomized trial in a group of African American
patients with metabolic syndrome showed significant improvement in
endothelial function in those randomly assigned to a year-long
meditation program compared with their counterparts who underwent a
program of health education alone.
"We found there was a significant difference between the consciously
resting meditation group and the health education group in the
flow-mediated dilation, which measures endothelial function," principal
investigator Kofi Kondwani, PhD, National Center for Primary Care,
Morehouse School of Medicine, Atlanta, Georgia, told Medscape Medical News.

Dr. Kofi Kondwani

A risk factor for coronary heart disease, the clinical manifestations
of metabolic syndrome include hypertension, hyperglycemia, high
triglycerides, reduced high-density lipoprotein, and abdominal obesity. A
diagnosis of metabolic syndrome is contingent on an individual having 3
or more of these risk factors.
According to the investigators, the etiology of metabolic syndrome is
complex, but psychological stress appears to play a role, possibly
through overactivation of stress hormones. They also note that
endothelial dysfunction, which is also influenced by stress, is a major
consequence of metabolic syndrome.
In addition, metabolic syndrome is a major health concern in the
African American population — particularly among African American
women — and is increasing in prevalence, paralleling the US obesity
epidemic.
Particular Problem for African Americans
According to Dr. Kondwani, it has been shown that meditation can be
effective in reducing psychological stress and improving some
cardiovascular risk factors. However, he added, whether it can improve
endothelial function in the setting of metabolic syndrome is unknown.
He noted that although metabolic syndrome and cardiovascular disease
are important health issues in general, the major health disparities
that exist in the African American population make it a particular
concern in this population.
"If we could find some simple, easy, cost-effective approach to reduce
some of these risk factors — whether it is blood pressure or
endothelial function — that could be adopted in the community on a
large scale we may be able to have a positive impact on the health of
African Americans," he said.
A joint initiative between Morehouse Medical School and Emory
University, the study randomly assigned 65 African American patients age
30 to 65 to undergo consciously resting meditation (CRM) (n = 32), a
12-month meditation program developed by Dr. Kondwani, or a 12-month
health education program (n = 33). At study outset there were no
significant differences in demographic characteristics or cardiovascular
risk factors between the 2 groups.
The CRM group received three 90-minute sessions of initial
instructor-led training. They returned once a week for the following 3
weeks, then once every 2 weeks for 2 months, and finally once per month
for the remainder of the study. In the interim they were assigned "home
rest" assignments that involved meditating for 15 to 20 minutes twice a
day.
Improvements in Blood Pressure, Weight, Triglycerides
The study's primary outcome measure was endothelial function assessed
by brachial artery flow-mediated dilation (FMD) at baseline and 6 and
12 months. A secondary outcome was arterial stiffness, measured by
pulse-wave velocity.
Trend tests were performed to assess changes in outcome measures and
metabolic syndrome factors across the 3 study time points. The
investigators found that FMD significantly improved from baseline in the
CRM group (2.10 ± 0.79; P = .009) but that improvement was smaller in the health education group (1.36 ± 0.80; P = .09). Dr. Kondwani said there was no difference in arterial stiffness in the groups.
The researchers also found favorable and statistically significant
trends in 3 metabolic syndrome risk factors in the CRM group but not in
the health education group: diastolic blood pressure (change, -6.24 ±
2.75 mm Hg; P = .03), weight (-2.52 ± 1.16 kg; P = .03), and triglyceride levels (-32 ± 15 mg/dL; P = .04).
Dr. Kondwani also pointed out that certain psychological factors,
including some measures of depression, significantly improved in both
study groups. This indicates that "that just because an intervention has
an impact on patients' psychological well-being doesn't necessarily
mean it is going to change their physiology."
These findings, he added, suggest that physicians should not hesitate
to encourage their patients to learn meditation. "It will not hurt and
invariably it will help. They also shouldn't get hung up on the type of
meditation. It's highly likely that even if patients weren't trained in
meditative practice but just sat quietly for 20 minutes twice a day
there would be benefit, "said Dr. Kondwani.
Dr. Kondwani said that his group hopes to replicate the study's findings in a larger trial with 150 participants in each arm.
"Wonderful" Form of Stress Management
Commenting on the study for Medscape Medical News, Lorenzo
Cohen, PhD, a professor in the Department of Behavioral Science and
director of the Integrative Medicine Program at M.D. Anderson Cancer
Center in Houston, Texas, said it is well known that psychological
stress has a profound effect on many biological functions.
"In our work we know that stress can directly impact certain
cancer-related biological systems. We believe it is very important to
provide different forms of stress management to patients to help relieve
the psychological stress they experience due to life-threatening
illness and that one wonderful form of stress management is meditation,"
Dr. Cohen said in an interview.
He added that it was not surprising to him that meditation had a
positive effect on endothelial function or other measures of metabolic
syndrome.
"We know that metabolic syndrome is related to inflammatory processes
and we know that stress can increase inflammatory processes. We also
know of course that meditation decreases these processes so it would
make sense that it has the potential to be a useful adjunct to the
treatment of this syndrome," said Dr. Cohen.
Dr. Cohen noted that in recent years meditation has gained a great
deal of acceptance by the medical community and patients alike and is
widely accessible.
Ideally, he said, it is useful to have an instructor teach patients
how to meditate in order to optimize practice. However, he added, the
tools of the information age, including Web-based programs and audio
materials, can also be "quite useful."
He said in his experience there has been some resistance among
patients because of a belief that meditation is associated with
religion. However, he added, once they are informed that it is taught in
a secular manner, this concern is assuaged.
Dr. Kondwani has disclosed no relevant financial relationships.
American Psychosomatic Society (APS) 69th Annual Scientific Meeting: Abstract 1639. Presented March 10, 2011.