Answer to Question 1
A large multi-site intervention study of 869 CHD patients found that participation in a three-month stress management program that was part of a combined multicomponent lifestyle intervention program led to reductions of total cholesterol/high density lipoprotein in CHD men participants and lowered levels of triglycerides in CHD men and women participants. Therefore, at least in CHD men and to a certain extent CHD women, stress management appeared to reduce their lipid levels. It appears, however, that the jury is still out regarding the nature of the complicated relationship between stress and serum lipid levels.
Answer to Question 2
Blumenthal et al. demonstrated that exercise and stress management were more effective at reducing emotional distress and cardiovascular risk markers than medical care alone in their randomized controlled trial study. However, one review of 36 trials concluded that stress management alone showed no strong evidence for reducing cardiac mortality even though it was associated with a reduction of non-fatal MIs. The authors also expressed concern about the poor quality of many of the studies examined and saw a tendency toward publication bias of favorable studies. As a result, they expressed skepticism about the validity of some of the results that showed beneficial outcomes for stress management. Evidence for the use of exercise-based rehabilitation programs for CHD is more supportive and on average these programs result in a 31 reduction in cardiac-related mortality for those with CHD.