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Background

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Cardiovascular disease is the leading cause of morbidity and mortality in the developed world. Changes in lifestyles and related risk factors in developing countries, as well as steady progress in combating infectious diseases are quickly making cardiovascular disease the most prevalent illness burden world-wide.

While enormous progress has been made in medical, surgical and primary risk factor reduction approaches to curbing heart disease, a growing understanding of the intricate relationship between disease and the human experience represents an opportunity to reduce cardiovascular disease and the suffering it causes even further. It is well known, for example, that certain emotional states are predictive of mortality and morbidity in patients with heart disease^1-3. Since much can be done to prevent psychological distress, it is reasonable to imagine that doing so would significantly alleviate heart disease and its consequences.

Fortunately, while our mastery of the traditional medical aspects of heart disease is growing, so is our appreciation of the “health enhancing” aspects of a range of important human activities, including engagement with artistic and creative processes. The rigorous evaluation of the relationship between creative engagement, either in the making of art or the appreciation of it, is still in early stages. However, we do know that creative modalities such as music therapy and relaxation techniques reduce stress and anxiety in cardiac patients^4-6 and reduce the likelihood of cardiac events^7-8. Music therapy, massage, guided imagery, therapeutic touch, and stress management instructions have been used successfully to decrease patient anxiety prior to diagnostic cardiac catheterization, providing better patient outcomes^9-10. The use of mood-enhancing or stress-reducing techniques--such as optimism, meditation, counseling, exercise, and imagery--can have a positive effect on reducing the incidence of heart disease¹¹. As more research becomes available on the beneficial effects of artistic and creative engagement on alleviating cardio-toxic emotions and stress, hope grows that there is a tie in to cardiovascular disease prevention.

There is no reason to delay. It’s likely that we can already build upon existing knowledge to provide opportunities for healing in people with heart disease and its related risk factors.

An Integrated Approach

Growing acceptance in the bio-medical world of the important relationship between some of the determinants of heart disease, such as emotions, attitudes, and beliefs, has created a receptivity for integrated approaches to care. Well-developed physiologic research methods, including the measurement of heart rhythm variability, blood tests for markers of heart disease and related processes, as well as socio-biologic assessment tools like surveys and interactive journal methods are readily available to quickly create new and important knowledge. The improved outcomes that can be achieved by introducing active creative engagement as a form of self-care can be readily combined with more traditional bio-medical interventions, rather than be seen as alternatives to them.

We believe a focused and sustained initiative to explore the connection between creative modalities (art) and cardiovascular disease (heart) is well warranted.

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References

1. Malach, M., & Imperato, P.J. (2004). Depression and acute myocardial infarction. Prev Cardiology, 7(2), 83-90.
2. Lespérance, F., Frasure-Smith, N., Talajic, M., & Bourassa, M.G. (2002). Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction. Circulation, 105(9), 1049-1053.
3. Ziegelstein, R. C. (2007). Acute emotional stress and cardiac arrhythmias. JAMA, 298(3), 324-329.
4. Lampert, R., Joska, T., Burg, M.M., et al. (2002). Emotional and physical precipitants of ventricular arrhythmia. Circulation, 106, 1800–1805.
5. Mittleman, M.A., Maclure, M., Sherwood, J.B., et al. (1995). Triggering of acute myocardial infarction onset by episodes of anger. Circulation, 92, 1720-1725.
6. Williams, J.E., Paton, C.C., Siegler, I.C., et al. (2000). Anger proneness predicts coronary heart disease risk: prospective analysis from the atherosclerosis risk in communities (ARIC) study. Circulation, 101, 2034–2039.
7. Van Dixhoom, J. J., & White, A. (2005). Relaxation therapy for rehabilitation and prevention in ischaemic heart disease. European Journal of Cardiovascular Prevention Rehabilitation, 12(3), 193-202.
8. Van Dixhoom, J. J, & Duivenvoorden, H.J. (1999). Effect of relaxation therapy on cardiac events after myocardial infarction: A five-year follow-up study. Journal of Cardiopulmonary Rehabilitation, 19(3), 178-185.
9. McCaffrey, R., & Taylor, N. (2005). Effective anxiety treatment prior to diagnostic cardiac catheterization. Holist Nurs Practice, 19(2), 70-73.
10. White, J. M. (1992). Music therapy: an intervention to reduce anxiety in the myocardial infarction patient. Clin Nurse Spec, 6(2), 58-63.
11. Hill, M., Weber, R., & Werner, S. (2006). The heart-mind connection. Behav Healthcare, 26(9), 30-32.