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Is the Age-Old Practice of Meditation a Good Complement to Comprehensive Patient-Centered Cardiovascular Risk Reduction?

Disclosure: None
Pub Date: Thursday, Sept. 28, 2017
Author: Ruth Lindquist, PhD, RN, FAHA, FAAN
Affiliation: University of Minnesota School of Nursing and the Earl Baaken Center for Spirituality and Healing

Citation

Levine GN, Lange RA, Bairey-Merz CN, Davidson RJ, Jamerson K, Mehta PK, Michos ED, Norris K, Ray IB, Saban KL, Shah T, Stein R, Smith SC Jr; on behalf of the American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; and Council on Hypertension. Meditation and cardiovascular risk reduction: a scientific statement from the American Heart Association. J Am Heart Assoc. 2017;6:e002218. DOI: 10.1161/JAHA.117.002218

Article Text

A national U.S. survey reported that an estimated 8% of the general population surveyed had practiced meditation,1 and it has been reported that up to 14-24% of patients with CVD have used forms of mind-body therapies or meditation.2 Thus, it is reasonable to expect that patients in context of cardiovascular care may ask, “Are there benefits to meditation as an adjunct to my recommended medical care?” “Is it safe for me?” “Could it improve my cardiovascular health?” “Could meditation prevent my disease from progressing or prolong my life?” The newly released American Heart Association Scientific Statement authored by Levine and colleagues, focusing on the use of meditation for cardiovascular risk reduction, provides us with timely, useful, unbiased, scientific information to help us formulate answers to these questions. The authors of the statement, after a systematic and scientific examination of the published data concerning the potential benefits of meditation conclude in their summary that, “Studies of meditation suggest a possible benefit on cardiovascular risk, although the overall quality and in some cases the quantity of study data is modest.”2 In this statement, authors provide definitions and descriptions of meditation, and a useful summary of evidence regarding risk-related outcomes of meditative practices.
 

What is the Scientific Evidence?

Scientific literature about meditation has exponentially expanded in recent years.  A 2012-2017 search of medical databases found 178 systematic reviews or meta-analyses on meditation, some directly exploring the effects of meditation on CVD.3 The data presented in the new scientific statement on meditation presents a comprehensive for summary of the evidence related to cardiovascular risk reduction. The review of evidence of this statement is limited to studies of sitting meditation, to separate the effects from potential confounds of risk reduction of other more active types of meditation with a physical component.
 

Limitations of the Data

A strength of this statement is its unbiased review and appraisal of a very wide range of evidence, and its explication of methodological limitations that characterize the evidence base. The data reviewed and the studies that have generated them are generally fraught with limitations that include small, non-randomized samples, attrition/drop-outs, lack of long-term evidence, small weak designs, and the heterogeneity of the outcome measures and the interventions. Other limitations include single centers, non-representative samples, and inability to blind. Lack of replication and replicability, and publication bias are also cited by the authors of the statement as weaknesses of the evidence base. In some cases, multimodal intervention made it difficult to attribute outcomes to meditation. The variability in the length of the interventions and the durations of the follow-up presented additional challenges to the synthesis of the studies reviewed. Despite the methodological limitations, the positive trends in the data noted by the authors are intriguing. The statement is well-toned. Meditation is neither endorsed nor discounted regarding its potential role in cardiovascular risk reduction in this comprehensive review of evidence within this scientific statement. The use of meditation for cardiovascular risk reduction clearly lacks strong evidence and convincing findings to support a recommendation that meditative practices ought to be included in practice guidelines. However, although the evidence in the area is weak, the overall positive trends of data cause us pause. The statement cited evidence that some forms of meditation have been found to have long-term brain effects, affecting attention, emotion and positive effect, and resulting in changes in brain structure and functioning.1
 

Meditating on the Statement

What is outstanding in the paper is the summary that gives clear direction for researchers and practitioners alike: Studies suggest a possible benefit on cardiovascular risk; ACC/AHA guidelines should continue to be followed; meditation may be considered as an adjunct to guideline-directed risk reduction; more study on meditation and cardiovascular risk is recommended; and recommendations for future research are identified to strengthen the designs, rigor and the credibility of outcomes.1
 

Potential Use of the Scientific Statement: Does Meditation Have a Role in CVD Prevention?

The scientific statement is written with remarkable clarity in a frank and non-judgmental tone. It is an up-to-date comprehensive synthesis of evidence related to the effects of meditation on cardiovascular disease risk. The statement opens the door for further research in this area—an area that has and is of interest to our population in the United States with the large numbers of the US population using meditation and other forms of complementary and alternative therapies as reported by the National Health Interview Survey1 and other sources such as NCCIH.4 The practice of meditation in any form may be foreign to some practicing healthcare providers. Provider familiarity with meditation practices may be helpful in the discussions with patients following the identification of cardiovascular risk or cardiac event, when patients ask, “Could the practice of meditation help?” The statement provides a great source of foundational knowledge to answer this question. Discomfort with or lack of knowledge about meditation on the part of a provider can be addressed through the broader inclusion of members of an interdisciplinary team who may be more familiar with complementary therapies such as meditation. The potential for meditation to help patient to self-regulate, reduce depression and improve positive affect that has been shown in some studies may go far to assist in patients’ adaptation to the diagnosis of risk, or their adjustment post cardiac event. Since cardiovascular disease is often termed a disease of lifestyle, it is reasonable that lifestyle approach including meditation may be considered as an adjunct to medical therapy. Indeed, the role of lifestyle choices in contributing to heart disease development and progression and importance of changes in lifestyle, specifically commitment to a heart healthy lifestyle to lower CVD risk, has long been advocated by the American Heart Association and other organizations.5,6 This scientific statement can be useful to help us counsel our patients; we can use this as a resource to share what is known and not known and assist them in their decision-making. Although meditation may not be a practice for which we can promise benefits, in context of the provider-patient relationship, we can evaluate with the patient the potential role meditation could play in context of their lifestyle and recovery. It is reasonable to expect that the length and extent to which patients use meditation may impact results, however, data from one longitudinal study showed that even short-term use may have lasting effects.7
 

Resources for Practice

There is a wide-range of books, CDs, courses and online resources for patients and providers who are interested in meditation. There are also portable applications available for those interested, although they vary widely in cost and quality.3 A recent systematic review of mindfulness meditation apps identified 23 in English language that were accessible and inexpensive, including one of high quality with efficacy data.3,8 
 

Bottom Line

The evidence for meditation falls short of its inclusion in a guideline for cardiovascular diseases risk reduction; definitive answers regarding the benefits of meditation to cardiovascular disease risk remain in future research. More research is warranted and required to more fully understand the potential benefits of meditation. However, we need to answer the questions of our patients today—sometimes with imperfect data, and sometimes with only partial evidence. This scientific statement goes far to arm us with some substantive information for our responses; it is a resource for responses that can be unbiased and patient-centered. It may take more than medication to treat the effects that this devastating disease has on individuals.

References

  1. Use of complementary health approaches in the U.S. National Health Interview Survey. National Center for Complementary and Integrative Health. National Institute of Medicine. https://nccih.nih.gov/research/statistics/NHIS/2012/mind-body/meditation. 2012.  Accessed June 13, 2017.
  2. Levine GN, Lange RA, Bairey-Merz CN, Davidson RJ, Jamerson K, Mehta PK, Michos ED, Norris K, Ray IB, Saban KL, Shah T, Stein R, Smith SC Jr; on behalf of the American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; and Council on Hypertension. Meditation and cardiovascular risk reduction: a scientific statement from the American Heart Association. J Am Heart Assoc. 2017;6:e002218. DOI: 10.1161/JAHA.117.002218.
  3. Gross CR, Christopher MS, Reilly-Spong M. Meditation. (in press). In R. Lindquist, MF Tracy & M. Snyder (Eds.). Complementary & Alternative Therapies in Nursing (8th ed.). New York, NY: Springer Publishing.
  4. National Center for Complementary and Integrative Health [NCCIH]. Retrieved from:  https://nccih.nih.gov .   Accessed June 13, 2017. 
  5. American Heart Association. Lifestyle changes for heart attack prevention. Retrieved from: http://www.heart.org/HEARTORG/Conditions/HeartAttack/LifeAfteraHeartAttack/Lifestyle-Changes-for-Heart-Attack-Prevention_UCM_303934_Article.jsp#.WTF0jDOZNBw.  Accessed June 13, 2017.
  6. Center for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. Retrieved from: https://www.cdc.gov/heartdisease/behavior.htm.  Accessed June 13, 2017.
  7. Alexander CN, Langer EJ, Newman RI, Chandler HM, Davies JL. Transcendental meditation, mindfulness, and longevity: an experimental study with elderly. J Pers Soc Psychol 1989; 57:950-64.
  8. Mani M, Kavanagh DJ, Hides L, Stoyanov SR. Review and evaluation of mindfulness-based iPhone apps. JMIR Mhealth Uhealth. 2015;3(3), e82. Doi:10.2196/mhealth.4328.

-- The opinions expressed in this commentary are not necessarily those of the editors or of the American Heart Association --