Researchers then predicted that national cholesterol education programs and other public health measures would decrease the incidence of heart disease during the 80's. But when they returned in 1985, they found that despite decreasing fat intake and smoking rates, the rate of heart disease continued to climb. They concluded that the new way of life was preventing the expected decline in heart disease.

Another study focusing on the effect of community on health was conducted by Dr. George Kaplan of the University of California Medical School in San Francisco. This research project followed thousands of residents of Alameda County, California, for several years, and found social isolation to be a significant risk factor for all diseases including heart disease. Another study conducted in 1993 of patients recovering from heart attacks also found that those with lower amounts of emotional support were nearly three times as likely to die in six months as those with higher levels of emotional support. On the other hand, the Japanese, known for their high degree of social connectedness, evince a low rate of heart disease not only in their native country but also among Japanese-Americans, who retain their traditional culture.

A research project, conducted at the University of California, San Diego, found that depression is inversely associated with the size of the person's network of social support, and a recent health study, "Depressed men twice as likely to develop heart disease," also reported that depressed men are twice as likely to develop heart disease.

In the "Rescuing the Depressed Heart," published in the Duke University Research Magazine 1997-98, Richard Merritt profiles a self-described strong and independent woman struck down by a heart attack who had never been to the hospital except to give birth to her six children. Once out of immediate danger, she became angry, full of fear, with little self-esteem, classic signs of depression. Follow up cognitive-behavior therapy helped her address her symptoms.

Williams also identifies loneliness as a psychological factor that ranks as great a risk for heart disease as high cholesterol levels. Socially isolated people are four times more likely to fall victim to sudden cardiac death as people not socially isolated.

Though known primarily for his strict cholesterol-reducing diet and exercise program, Dr. Dean Ornish's Program for Reversing Heart Disease, Dr. Ornish agrees. "The real epidemic in our culture," he writes, "is not only physical heart disease, but also what I call emotional and spiritual heart disease--that is, the profound sense of loneliness, isolation, alienation, and depression that are so prevalent in our culture with the breakdown of the social structures that used to provide us with a sense of connection and community."

Beyond Body and Mind

A recent and intriguing study, reported at the American Heart Association's annual meeting in 1998, was conducted by Dr. Mitch Krucoff, M.D, another Duke University cardiologist. Called "Monitor and Actualization of Noetic Trainings (MANTRA)," this double-blind study randomly divided 150 angioplasty patients into 30-person groups. Three of the groups received relaxation, guided imagery, or touch therapies. The names of the fourth group were inserted in the Western Wall in Jerusalem and given to Buddhist monks in Nepal, Carmelite nuns in Baltimore, and to groups of Moravians and Christian fundamentalists to pray for them by name. The fifth group received only standard medical care. Patients who received either touch therapy, stress relaxation, or guided imagery showed a 30 to 50 percent trend of improved outcomes during hospitalization compared to patients who didn't receive such therapies.

Although the study of 150 patients was too small to offer statistically significant comparisons, the results "are highly intriguing, and not what most traditional physicians would have expected," concluded Dr. Krucoff. "Our data show beneficial trends. Our goal was to conduct as scientifically rigorous and reasonable a trial as has ever been undertaken to look at what else, besides pills and procedures, might help us treat patients." A larger 1,500-patient trial is expected to start soon.

Prescriptions for a Healthy Heart

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