Article

Meditation and Cardiovascular Health: What is the Link?

Register or Login to View PDF Permissions
Permissions× For commercial reprint enquiries please contact Springer Healthcare: ReprintsWarehouse@springernature.com.

For permissions and non-commercial reprint enquiries, please visit Copyright.com to start a request.

For author reprints, please email rob.barclay@radcliffe-group.com.
Average (ratings)
No ratings
Your rating

Abstract

Meditation as a form of body–mind interaction for primary and secondary prevention in cardiovascular disease has been discussed critically in the past. However, data that aimed to link this intervention to a reduction of various aspects of cardiovascular disease, rendering it a potential part of a cost-effective treatment approach in patients at risk, remain scarce and inconclusive. This article aims to provide an overview of currently available evidence in the literature and the potential impact of meditation on cardiovascular health. However, the data highlighted in this article cannot render with certainty directly reproducible effects of meditation on patients’ cardiovascular disease profiles. Meditation may be suggested only as an additional link in the chain of primary and secondary prevention until future research provides sufficient data on this topic.

Disclosure:The authors have no conflicts of interest to declare.

Received:

Accepted:

Correspondence Details:Alexander Niessner, Department of Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. E: alexander.niessner@muv.ac.at

Copyright Statement:

The copyright in this work belongs to Radcliffe Medical Media. Only articles clearly marked with the CC BY-NC logo are published with the Creative Commons by Attribution Licence. The CC BY-NC option was not available for Radcliffe journals before 1 January 2019. Articles marked ‘Open Access’ but not marked ‘CC BY-NC’ are made freely accessible at the time of publication but are subject to standard copyright law regarding reproduction and distribution. Permission is required for reuse of this content.

Cardiovascular disease is a major cause of morbidity and mortality worldwide. While traditional treatment protocols follow physical or pharmaceutical interventions, the mental approach of meditation has been used for centuries to induce beneficial changes to the patients’ cardiovascular risk profile. However, scientific refurbishment of this technique has in the past raised questions of legitimation. Therefore, we aimed at providing an overview of currently available evidence in the literature, and subsequently conclude on the potential impact of meditation on cardiovascular health.

Meditation: A Multifaceted Practice

Meditation practice is an active mental process involving the pursuit of awareness, attention, concentration and general focus of the practitioner’s mind.1 It can be described as a form of mental training with the aim of regulating cognition and emotion; a specific directing of attention and awareness is meant to influence mental and somatic events.2 Meditation dates back several thousand years, and has a religious (Buddhist and Hindu) connotation and background. It has been used to improve stress management, therefore rendering it feasible to use in a strict therapeutic approach.3–6

A broad variety of meditation practices have been described; however, “focused attention meditation”, “open monitoring meditation”, “compassion meditation” and “loving kindness meditation” roughly form the main styles. Most forms are intended to be practised once or twice daily.2,7 A short description of the different core meditation strategies is given in Table 1.

Methods

Following a predefined search protocol (input combinations of the term “meditation” and the following: “hypertension”, “blood pressure”, “atherosclerosis”, “endothelial”, “metabolic”, “insulin”, “myocardial”, “ischaemia”, “smoking”, “tobacco”, “stress”, “lifestyle” and “prevention”), the databases PubMed/MEDLINE, EMBASE, CENTRAL and Google Scholar were searched for eligible articles (Figure 1). The search was conducted at the end of February 2019. In addition, articles from the reference list of retrieved articles or reviews were screened to detect further sources. Duplicates and papers found to be non-relevant were removed. All selected publications were read in detail as a full text or abstract. All research reporting on the influence of meditation on cardiovascular risk reduction was included. Two independent authors screened and reviewed the included information. Data on practices similar to meditation, such as yoga or various forms of martial arts, were excluded due to their dominant physical character. Eligible original research and reviews were included within the consensus of this manuscript. Based on little evidence in this field, a pooled analysis of different kinds of meditation was performed.

Meditation Style Examples

Article image

Flowchart of the Search Protocol Used and Included Studies

Article image

Meditation and its Impact on (Patho-)physiology

Neurology and Psychology

A broad variety of hypothetical and potential effects of meditation on neurophysiology and neuroanatomy have been published so far.7,8 Anatomical and structural changes, such as tissue augmentation of the cerebral cortex, subcortical grey and white matter, as well as the cerebellum and brain stem, were discussed, and an increasing number of studies suggest that different meditation practices show distinct patterns of brain activity.1,7,9,10 Moreover, improvement in the subjectively experienced levels of general stress, depression and quality of sleep have been reported.8,11–22 Additionally, alterations on a neurophysiological level have been suggested. However, due to a lack of sufficient sample size and randomisation, suchlike series must be assessed carefully and interpreted with caution.7,10,20,23,24 Complex data derived from neuroimaging, such as PET or functional MRI, are promising to produce deeper insight, but are yet to be fully understood.10

Tobacco Use

While smoking poses one of the major causes of both the development and progression of cardiovascular disease, its cessation has proved to be a highly effective primary and secondary approach for improved cardiovascular health.25 Meditation as a technique for smoking cessation and/or prevention might be more successful than traditional interventions in this regard.7,26–29 Tang et al. suggested that these results might originate from increased activity in the anterior cingulate and prefrontal cortex.30 Classic study limitations, such as small sample sizes (between 200 and 300 participants) and lack of follow-up, render this topic a subject of future additional research. However, a potential benefit of meditation in improving the compliance and adherence of smoking cessation can be assumed based on the current evidence.

Blood Pressure

Several randomised trials have evaluated the effect of meditation on arterial hypertension, with varying effects from a reduction of a mean of 21.9 (±8.3)/16.7 (±4.6) mmHg after 8 weeks of meditation treatment to no significant benefit, as shown by Blom et al. in the Hypertension Analysis of stress Reduction using Mindfulness meditatiON and Yoga (HARMONY) trial.18,31–39 Of note, it needs to be highlighted that styles of meditation, which additionally cover physical activity, appear to be even more effective in this regard.7 Whereas the American Heart Association recommends meditation to be considered as an alternative approach to lower patients’ blood pressure, the high variation of study results suggests meditation to be considered as a mere supplement to pharmacotherapeutic hypertension management, physical lifestyle changes and dietary interventions at this juncture.7,40

Myocardial Ischaemia

In patients presenting with stabile angina, research suggests a reproducible benefit of meditation on exercise duration and total possible workload.41–43 However, as those findings rely on a purely subjective perception of participants, literature lacks a more objectifiable study design including evaluation of myocardial ischaemia by cardiac imaging or cardiac biomarkers. Considering such study designs, Dal Lin et al. investigated the impact of meditation on markers of inflammation and echocardiographic findings in patients after myocardial infarction. As the first investigation on this specific topic using objectifiable endpoints, they observed a decrease in the inflammatory burden and improvements in various echocardiographic measures, such as stroke volume, in the meditation intervention group.44

Metabolic Syndrome

Evidence of the effects of meditation on factors of the metabolic syndrome is scarce.45 There are reports of an intervention of meditation leading to improved insulin resistance and possible links to reduced expression of genes linked to general inflammatory response.46 Similar reports cover an enhanced expression of genes associated with mitochondrial function and insulin secretion after a meditation intervention.47 However, based on limited data and diverging results on this issue, no clear conclusions can be drawn.

Atherosclerosis and Endothelial Function

In an investigation by Castillo-Richmond et al., atherosclerosis progression – measured by carotid intima thickness via ultrasound – was reported to possibly be reduced by a meditation programme.7,48 Endothelial function itself – measured by evaluating brachial artery endothelial vasomotor response – has not yet been shown to be effectively influenced my meditation.46,49

Prevention of Cardiovascular Disease

In terms of the effect of meditation on the primary prevention of cardiovascular risk, considerable heterogeneity between investigations and overall small sample sizes of various available data prevent profound conclusions on this topic.7,50 Moreover, the overall quality and power of studies investigating the relationship of meditation and secondary prevention of cardiovascular disease remain considerably low. The potential benefits of an intervention such as a meditation programme on quality of life or blood pressure as endpoints, suggesting a reduction of general cardiovascular risk, must be further researched.7,49,51

Conclusion

Available data suggest a potential influence of meditation interventions on various factors of cardiovascular disease. However, many methodological issues have been raised in the past, and future research on this topic must strive for large, randomised trials with sufficient follow-up periods. The investigators’ bias of enthusiasm or even a positive predisposition towards meditation or alternative medical methods in general must be eliminated from further studies.7,52 The heterogenous data may be explained by the different impact of the variously described meditation techniques, which additionally poses a field of interest for future research.53 In clinical practice, meditation as an intervention may be suggested to patients at cardiovascular risk in addition to conservative treatment protocols because of its non-invasive and cost-effective nature. In particular, as recommended by the European Society of Cardiology, treating psychosocial factors can counteract stress, depression and anxiety, and therefore facilitate behaviour change and improve general quality of life.54,55 The link between meditation and cardiovascular health may yet have to be scientifically confirmed, but to mentally engage with the body might be a first step towards a more individualised way of modern medicine.

Quintessence of this Expert Opinion

  • Heterogenous data suggest a link between meditation interventions and cardiovascular disease.
  • Meditation can be suggested to patients in addition to conservative treatment or prophylactic protocols.
  • In particular, meditation can help to reduce stress, depression and anxiety.

References

  1. Luders E, Kurth F. The neuroanatomy of long-term meditators. Curr Opin Psychol 2018;28:172–8.
    Crossref | PubMed
  2. Raffone A, Marzetti L, Del Gratta C, et al. Toward a brain theory of meditation. Prog Brain Res 2019;244:207–32.
    Crossref | PubMed
  3. Kaliman P, Alvarez-López MJ, Cosín-Tomás M, et al. Rapid changes in histone deacetylases and inflammatory gene expression in expert meditators. Psychoneuroendocrinology 2014;40:96–107.
    Crossref | PubMed
  4. Kalra S, Priya G, Grewal E, et al. Lessons for the health-care practitioner from Buddhism. Indian J Endocrinol Metab 2018;22:812–7.
    Crossref | PubMed
  5. Zieff G. Ancient roots – modern applications: mindfulness as a novel intervention for cardiovascular disease. Med Hypotheses 2017;108:57–62.
    Crossref | PubMed
  6. Sieverdes JC, Adams ZW, Nemeth L, et al. Formative evaluation on cultural tailoring breathing awareness meditation smartphone apps to reduce stress and blood pressure. Mhealth 2017;3:44.
    Crossref | PubMed
  7. Levine GN, Lange RA, Bairey-Merz CN, et al. Meditation and cardiovascular risk reduction: a scientific statement from the American Heart Association. J Am Heart Assoc 2017;6:pii:e002218.
    Crossref | PubMed
  8. Lipschitz DL, Kuhn R, Kinney AY, et al. Reduction in salivary α-amylase levels following a mind-body intervention in cancer survivors-an exploratory study. Psychoneuroendocrinology 2013;38:1521–31.
    Crossref | PubMed
  9. Kurth F, Cherbuin N, Luders E. Promising links between meditation and reduced (brain) aging: an attempt to bridge some gaps between the alleged fountain of youth and the youth of the field. Front Psychol 2017;8:860.
    Crossref | PubMed
  10. Fox K, Dixon M, Nijeboer S, Girn M, et al. Functional neuroanatomy of meditation: A review and meta-analysis of 78 functional neuroimaging investigations. Neurosci Behav Rev 2016;65:208–28.
    Crossref | PubMed
  11. Tang Y-Y, Ma Y, Wang J, et al. Short-term meditation training improves attention and self-regulation. Proc Natl Acad Sci U S A 2007;104:17152–6.
    Crossref | PubMed
  12. Black DS, O’Reilly GA, Olmstead R, et al. Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial. JAMA Intern Med 2015;175:494–501.
    Crossref | PubMed
  13. Klatt MD, Buckworth J, Malarkey WB. Effects of low-dose mindfulness-based stress reduction (MBSR-ld) on working adults. Health Educ Behav 2009;36:601–14.
    Crossref | PubMed
  14. Pace TWW, Negi LT, Adame DD, et al. Effect of compassion meditation on neuroendocrine, innate immune and behavioral responses to psychosocial stress. Psychoneuroendocrinology 2009;34:87–98.
    Crossref | PubMed
  15. Speca M, Carlson LE, Goodey E, Angen M. A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosom Med 2000;62:613–22.
    Crossref | PubMed
  16. Goyal M, Singh S, Sibinga EM, et al. Meditation programs for psychological stress and well-being: A systematic review and meta-analysis. JAMA Intern Med 2014;174(3):357–68.
    Crossref
  17. Momeni J, Omidi A, Raygan F, Akbari H. The effects of mindfulness-based stress reduction on cardiac patients’ blood pressure, perceived stress, and anger: a single-blind randomized controlled trial. J Am Soc Hypertens 2016;10:763–71.
    Crossref | PubMed
  18. Fátima Rosas Marchiori M de, Kozasa EH, Miranda RD, et al. Decrease in blood pressure and improved psychological aspects through meditation training in hypertensive older adults: A randomized control study. Geriatr Gerontol Int 2015;15:1158–64.
    Crossref | PubMed
  19. Rosenkranz MA, Davidson RJ, Maccoon DG, et al. A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation. Brain Behav Immun 2013;27:174–84.
    Crossref | PubMed
  20. Epel ES, Puterman E, Lin J, et al. Meditation and vacation effects have an impact on disease-associated molecular phenotypes. Transl Psychiatry 2016;6:e880.
    Crossref | PubMed
  21. Ionson E, Limbachia J, Rej S, et al. Effects of Sahaj Samadhi meditation on heart rate variability and depressive symptoms in patients with late-life depression. Br J Psychiatry 2018:1–7.
    Crossref | PubMed
  22. Gotink RA, Vernooij MW, Ikram MA, et al. Meditation and yoga practice are associated with smaller right amygdala volume: the Rotterdam study. Brain Imaging Behav 2018;12:1631–9.
    Crossref | PubMed
  23. Jacobs TL, Epel ES, Lin J, et al. Intensive meditation training, immune cell telomerase activity, and psychological mediators. Psychoneuroendocrinology 2011;36:664–81.
    Crossref | PubMed
  24. Creswell JD, Irwin MR, Burklund LJ, et al. Mindfulness-based stress reduction training reduces loneliness and pro-inflammatory gene expression in older adults: a small randomized controlled trial. Brain Behav Immun 2012;26:1095–101.
    Crossref | PubMed
  25. Jha P, Ramasundarahettige C, Landsman V, et al. 21st-century hazards of smoking and benefits of cessation in the United States. N Engl J Med 2013;368:341–50.
    Crossref | PubMed
  26. Davis JM, Fleming MF, Bonus KA, Baker TB. A pilot study on mindfulness based stress reduction for smokers. BMC Complement Altern Med 2007;7:2.
    Crossref | PubMed
  27. Davis JM, Goldberg SB, Anderson MC, et al. Randomized trial on mindfulness training for smokers targeted to a disadvantaged population. Subst Use Misuse 2014;49:571–85.
    Crossref | PubMed
  28. Davis JM, Manley AR, Goldberg SB, et al. Randomized trial comparing mindfulness training for smokers to a matched control. J Subst Abuse Treat 2014;47:213–21.
    Crossref | PubMed
  29. Brewer JA, Mallik S, Babuscio TA, et al. Mindfulness training for smoking cessation: results from a randomized controlled trial. Drug Alcohol Depend 2011;119:72–80.
    Crossref | PubMed
  30. Tang Y-Y, Tang R, Posner MI. Brief meditation training induces smoking reduction. Proc Natl Acad Sci U S A 2013;110:13971–5.
    Crossref | PubMed
  31. Manikonda JP, Störk S, Tögel S, et al. Contemplative meditation reduces ambulatory blood pressure and stress-induced hypertension: a randomized pilot trial. J Hum Hypertens 2008;22:138–40.
    Crossref | PubMed
  32. Hughes JW, Fresco DM, Myerscough R, et al. Randomized controlled trial of mindfulness-based stress reduction for prehypertension. Psychosom Med 2013;75:721–8.
    Crossref | PubMed
  33. Gregoski MJ, Barnes VA, Tingen MS, et al. Breathing awareness meditation and LifeSkills Training programs influence upon ambulatory blood pressure and sodium excretion among African American adolescents. J Adolesc Health 2011;48:59–64.
    Crossref | PubMed
  34. Schneider RH, Grim CE, Rainforth MV, et al. Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in blacks. Circ Cardiovasc Qual Outcomes 2012;5:750–8.
    Crossref | PubMed
  35. Nidich SI, Rainforth MV, Haaga DAF, et al. A randomized controlled trial on effects of the Transcendental Meditation program on blood pressure, psychological distress, and coping in young adults. Am J Hypertens 2009;22:1326–31.
    Crossref | PubMed
  36. Bai Z, Chang J, Chen C, Li P, et al. Investigating the effect of transcendental meditation on blood pressure: a systematic review and meta-analysis. J Hum Hypertens 2015;29:653–62.
    Crossref | PubMed
  37. Ponte Márquez PH, Feliu-Soler A, Solé-Villa MJ, et al. Benefits of mindfulness meditation in reducing blood pressure and stress in patients with arterial hypertension. J Hum Hypertens 2019;33:237–47.
    Crossref | PubMed
  38. Palta P, Page G, Piferi RL, et al. Evaluation of a mindfulness-based intervention program to decrease blood pressure in low-income African-American older adults. J Urban Health 2012;8:308–16.
    Crossref | PubMed
  39. Blom K, Baker B, How M, et al. Hypertension Analysis of Stress Reduction Using Mindfulness Meditation and Yoga: Results From the Harmony Randomized Controlled Trial. Am J Hypertens 2014;27:122–9.
    Crossref | PubMed
  40. Ospina MB, Bond K, Karkhaneh M, et al. Meditation practices for health: state of the research. Evid Rep Technol Assess (Full Rep) 2007:1–263.
    PubMed
  41. Zamarra JW, Schneider RH, Besseghini I, et al. Usefulness of the transcendental meditation program in the treatment of patients with coronary artery disease. Am J Cardiol 1996;77:867–70.
    Crossref | PubMed
  42. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990;336:129–33.
    Crossref | PubMed
  43. Cunningham C, Brown S, Kaski JC. Effects of transcendental meditation on symptoms and electrocardiographic changes in patients with cardiac syndrome X. Am J Cardiol 2000;85:653–5.
    Crossref | PubMed
  44. Dal Lin C, Marinova M, Rubino G, et al. Thoughts modulate the expression of inflammatory genes and may improve the coronary blood flow in patients after a myocardial infarction. J Tradit Complement Med 2018;8:150–63.
    Crossref | PubMed
  45. Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001;24:683–9.
    Crossref | PubMed
  46. Paul-Labrador M, Polk D, Dwyer JH, et al. Effects of a randomized controlled trial of transcendental meditation on components of the metabolic syndrome in subjects with coronary heart disease. Arch Intern Med 2006;166:1218–24.
    Crossref | PubMed
  47. Bhasin MK, Dusek JA, Chang B-H, et al. Relaxation response induces temporal transcriptome changes in energy metabolism, insulin secretion and inflammatory pathways. PLoS ONE 2013;8:e62817.
    Crossref | PubMed
  48. Castillo-Richmond A, Schneider RH, Alexander CN, et al. Effects of stress reduction on carotid atherosclerosis in hypertensive African Americans. Stroke 2000;31:568–73.
    Crossref | PubMed
  49. Younge JO, Gotink RA, Baena CP, et al. Mind-body practices for patients with cardiac disease: a systematic review and meta-analysis. Eur J Prev Cardiol 2015;22:1385–98.
    Crossref | PubMed
  50. Hartley L, Mavrodaris A, Flowers N, et al. Transcendental meditation for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2014:CD010359.
    Crossref | PubMed
  51. Olex S, Newberg A, Figueredo VM. Meditation: should a cardiologist care? Int J Cardiol 2013;168:1805–10.
    Crossref | PubMed
  52. Ospina MB, Bond K, Karkhaneh M, et al. Clinical trials of meditation practices in health care: characteristics and quality. J Altern Complement Med 2008;14:1199–213.
    Crossref | PubMed
  53. Schneider RH, Fields JZ, Salerno JW. Editorial commentary on AHA scientific statement on meditation and cardiovascular risk reduction. J Am Soc Hypertens 2018;12:e57–e58.
    Crossref | PubMed
  54. Richards SH, Anderson L, Jenkinson CE, et al. Psychological interventions for coronary heart disease: Cochrane systematic review and meta-analysis. Eur J Prev Cardiol 2018;25:247–59.
    Crossref | PubMed
  55. Piepoli MF, Hoes AW, Agewall S, et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J 2016;37:2315–81.
    Crossref | PubMed