Efficacy of psychological interventions on clinical outcomes of coronary artery disease: Systematic review and meta-analysis

Inés Magán*, Rosa Jurado-Barba, Laura Casado, Haley Barnum, Anne Jeon, Adrian V. Hernandez, Héctor Bueno

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

10 Scopus citations


OBJECTIVES: Psychological factors influence clinical outcomes in patients with coronary artery disease (CAD). Therefore, psychological interventions (PIs) may have beneficial effects in these patients. We evaluated the efficacy of PIs based on cognitive-behavioral therapy (CBT) and positive psychology therapy (PPT) on clinical and laboratory outcomes in CAD.

METHODS: Randomized controlled trials evaluating CBT or PPT in CAD patients published until May 2020 were systematically reviewed and analyzed. Primary outcomes were all-cause mortality, cardiovascular mortality, any cardiovascular event, myocardial infarction (MI), stroke, coronary revascularization, angina, and readmission. Random effects meta-analyses using the inverse variance method were performed. Effects were expressed as risk ratios (RR) or standardized mean difference (SMD) with 95% confidence intervals (CIs).

RESULTS: Twenty-five trials were included (n = 8119); 22 evaluating the effects of multi-component CBT (n = 7909), and three PPT (n = 210). Thirteen RCTs were at high risk of bias due to limitations in randomization or blinding. Compared with control groups any cardiovascular event (RR 0.82; 0.70 to 0.97; 5 studies), MI (RR 0.72; 0.52 to 0.98; 9 studies), and angina duration and intensity (SMD -0.64; -0.98 to -0.30; 4 studies; and -0.64; -1.17 to -0.11; 2 trials) were significantly reduced with PIs at the end of follow-up. PIs had no effect on other primary outcomes, laboratory or anthropometrical results and presented a moderate to high heterogeneity.

CONCLUSIONS: CBT- and PPT-based PIs reduce the risk of cardiovascular events, MI and angina in patients with CAD. Future research should assess the individual role of CBT and PPT in CAD populations.

Original languageEnglish
Article number110710
Pages (from-to)110710
JournalJournal of Psychosomatic Research
Early online date25 Dec 2021
StatePublished - Feb 2022


  • Clinical outcomes
  • Cognitive-behavioral therapy
  • Coronary artery disease
  • Meta-analysis
  • Positive psychology therapy
  • Psychological intervention
  • Coronary Artery Disease/therapy
  • Humans
  • Psychosocial Intervention
  • Cognitive Behavioral Therapy
  • Myocardial Infarction/therapy


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