What is the clinical evidence from this study?

Study design: RCT. Population: Coronary Heart Disease with Bipolar Disorder (n=34). Intervention: Mindfulness-Based Stress Reduction vs. treatment as usual. Primary outcome: Anxiety symptoms as measured by HAMA (null, 95% CI 2.55-6.08, p=0.010).

What question did this study set out to answer?

This study aims to explore mood disorders in coronary heart disease patients and assess the efficacy of mindfulness-based stress reduction for those with bipolar disorder.

March 13, 2026Open Access

Mindfulness-Based Stress Reduction for Patients with Coronary Heart Disease and Bipolar Disorder: An 8-Week Comparative Study

Key Result

Mindfulness-Based Stress Reduction significantly reduced anxiety symptoms, with HAMA scores of 4.31 in the intervention group compared to 7.69 in the treatment as usual group (p=0.010).

Key Points

This study aims to explore mood disorders in coronary heart disease patients and assess the efficacy of mindfulness-based stress reduction for those with bipolar disorder.
Screened 390 coronary heart disease patients for mood disorders using the Hamilton Depression Rating Scale.
Conducted psychiatric evaluations per DSM-5 criteria for diagnosis confirmation.
Compared mood disorder prevalence between CHD patients and randomized 34 bipolar disorder patients for intervention.
Administered 8-week mindfulness-based stress reduction program to bipolar disorder patients and compared to treatment as usual.
56% of screened patients met criteria for a mood disorder, with unipolar depression being the most common.
MBSR significantly reduced anxiety symptoms compared to treatment as usual, shown by lower HAMA scores.
MBSR improved autonomic function, indicated by a significant change in LF/HF ratio compared to treatment as usual.
100% of MBSR participants showed improvement in NYHA class, compared to 37.5% in the control group.

Study Design

Type

RCT (n=34)

Blinding

null

Randomization

1:1

Multicenter

Structured PICO

Does an 8-week Mindfulness-Based Stress Reduction (MBSR) program improve psychological symptoms and autonomic function in patients with coronary heart disease and comorbid bipolar disorder?

Population

34 adults (age ≥ 30 years) with coronary heart disease (confirmed by angiography/CTA showing ≥50% stenosis with anginal symptoms) and comorbid bipolar disorder (DSM-5 criteria). Mean age 60.1, 29.4% female, based in China. Excluded patients with severe cognitive impairment, active malignancy, severe liver/kidney disease, or active mania/psychosis.

Intervention

Mindfulness-Based Stress Reduction (MBSR) program for 8 weeks (weekly 2.5-hour sessions including 90-minute guided practice and 60-minute group discussion, plus 45 minutes of daily individual practice) added to standard cardiological care.

Comparator

Treatment as usual (TAU) consisting of standard cardiological care without any additional psychological intervention.

Outcome

Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A) scores at 8 weeks post-treatment.patient reported

An 8-week mindfulness-based stress reduction program significantly improves anxiety and autonomic balance in patients with coronary heart disease and comorbid bipolar disorder.

Main Result

Effect estimate: null (95% CI 2.55-6.08)

Absolute Event Rate: 4.31% vs 7.69%

p-value: p=0.010

Limitations

Small sample size
Short duration of intervention

Abstract

Background: Coronary heart disease (CHD) frequently co-occurs with mood disorders (MDs), yet the predictors of this comorbidity and effective interventions remain insufficiently studied.This two-phase study investigated (1) the clinical characteristics of mood disorders in CHD patients, and (2) the efficacy of Mindfulness-Based Stress Reduction (MBSR) for CHD patients with bipolar disorder (BD).Methods: In this mixed-methods study, 390 CHD patients (diagnosed via coronary angiography/CTA) were screened for mood disorders using the Hamilton Depression Rating Scale (HAMD 7), followed by diagnostic confirmation (psychiatric evaluation using DSM-5 criteria).The observational phase compared CHD patients with (n=219) and without (n=171) mood disorders, while the interventional phase randomized 34 BD patients to receive either an 8week MBSR program (n=17) or treatment as usual (TAU; n=17).Outcome measures included psychological symptoms (HAMD/HAMA), autonomic function (HRV), and cardiac status (NYHA/CCS class).Results: Among screened patients, 56% (n=219) met criteria for a mood disorder (only depressive symptoms: n=22; unipolar depression: n=163; bipolar disorder: n=34).Group comparisons revealed a statistically significant difference in LF/HF ratio across mood disorder groups (P=0.037), with the BD cohort showing a higher mean ratio (2.03 0.38).Although cardiac function markers showed no group differences, MBSR significantly improved anxiety symptoms (HAMA: 4.31 vs. 7.69, p=0.010) and autonomic regulation (LF/HF ratio: 1.49 vs.1.82, p=0.002) compared to TAU.A greater proportion of MBSR participants showed improvement in NYHA class (100% vs 37.5%), though the between-group comparison was not statistically significant (p=0.075).Conclusion: Mood disorders are highly prevalent in CHD patients, with BD associated with distinct clinical features and autonomic dysfunction.MBSR is a promising intervention for improving psychological and autonomic outcomes in this comorbid population, supporting its integration into comprehensive cardiac rehabilitation programs.

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