Transcendental Meditation and
Secondary Prevention of Cardiovascular Disease
1. Citation
Schneider RH, Grim CE, Rainforth MV, et al.
Stress Reduction in the Secondary Prevention of Cardiovascular Disease: Randomised Controlled Trial.
Published in Circulation: Cardiovascular Quality and Outcomes.
2012
Reference Information
Journal: Circulation: Cardiovascular Quality and Outcomes
Year: 2012
Study Code: H-01
DOI: 10.1161/CIRCOUTCOMES.112.967406
Level of Evidence: Randomised Controlled Trial (RCT)
Peer Reviewed: Yes
2. Research Question
Can regular practice of the Transcendental Meditation technique reduce the risk of major cardiovascular events in people already suffering from coronary heart disease?
3. Participants
- 201 African American men and women
- Existing coronary heart disease
- Average follow up approximately 5.4 years
- Randomly assigned to either:
- Transcendental Meditation
- Health education control group
4. Method
Participants learned either:
- the Transcendental Meditation technique
or
- conventional health education.
Researchers followed both groups for over five years, measuring major cardiovascular outcomes including:
- heart attack
- stroke
- death
along with blood pressure and psychological stress.
5. Key Findings
The study reported an adjusted hazard ratio of 0.52 for the combined outcome of all-cause mortality, non-fatal heart attack and non-fatal stroke in the TM group compared with health education (95% confidence interval 0.29–0.92). This was described as an estimated 48% relative risk reduction.
- Systolic blood pressure was lower in the TM group by approximately 4.9 mmHg.
- The study also reported a reduction in anger expression.
- Greater attendance at TM instruction meetings was associated with better outcomes, but this secondary association does not itself establish causation.
The 48% figure is a relative estimate from this trial in a specific high risk population; it should not be interpreted as an expected benefit for an individual patient or for the general population.
6. Practical Implications
This trial provides evidence that merits further investigation of TM as an adjunct to usual care for African American adults with established coronary heart disease.
It does not show that TM prevents cardiovascular disease in healthy people, and it cannot predict the benefit for an individual patient. Decisions about cardiovascular prevention or treatment should remain with qualified healthcare professionals.
In the study, TM was used alongside usual medical care, not as a replacement for medication, clinical monitoring or established lifestyle and medical treatment.
7. Strengths and Limitations
Strengths
- Peer reviewed randomised controlled trial with an active health education comparison group.
- Average follow up of approximately 5.4 years.
- Measured major clinical events rather than relying only on surrogate outcomes or questionnaires.
- Outcome events were adjudicated by reviewers masked to treatment assignment.
Limitations
- The trial included 201 African American adults with established coronary heart disease; findings cannot automatically be generalised to other populations or to primary prevention.
- The number of primary outcome events was modest, producing uncertainty around the size of the estimated effect.
- Participants could not be blinded to the intervention, and adherence may be related to other health behaviours.
- The trial was conducted in two phases after an interruption in funding, which complicates interpretation.
- A subsequent Cochrane review judged the evidence for cardiovascular clinical events from TM versus active comparators to be low certainty. Larger independent trials are needed.