Other abnormalities asso-ciated with the IRS include impaired ﬁbrinolysisand increased coagulability,
Insulin resistance (ie, resistanceto insulin-stimulated glucose uptake) is thought tobe the primary underlying defect and a cardinalfeature linking the IRS with CVD.
Increased sympathetic activity, enhanced cardio- vascular reactivity, and reduced parasympathetictone have also been strongly implicated in thepathogenesis of IRS
and in the developmentand progression of atherosclerosis
and car-diovascular disease.
In addition, recent re-search offers compelling evidence that chronic psy-chological stress and negative affective statescontribute signiﬁcantly to the pathogenesis andprogression of insulin resistance,
and other IRS-related conditions
and ul-timately, increase risk for CVD morbidity andmortality.
Not only can IRS-related conditions be exacer-bated by lifestyle variables, such as smoking, lack of exercise, and poor diet, but these conditions caninteract with one another in a destructive man-ner,
likely accounting for their synergistic effecton CVD risk.
Thus, a vicious cycle is initiated, which, as time goes on, becomes increasingly dif-ﬁcult to treat, highlighting the importance of early intervention. Given that IRS-related conditions af-fect a large percentage of the U.S. population,
are now reaching epidemic proportions world- wide,
and are powerful predictors of CVD mor-bidity and mortality,
investigating potentialcost-effective strategies for reducing IRS-relatedrisk factors for CVD is clearly warranted.In light of the strong inﬂuence of psychosocialfactors on the development of both IRS and CVD,the role of sympathetic activation in the pathogen-esis of insulin-resistant states, and the mutually exacerbating effects of these and other IRS-relatedrisk factors, mind-body therapies may have consid-erable potential in the prevention and treatment of CVD. Of particular interest in this regard is yoga,an ancient mind-body discipline that has been widely used in India for the management of hyper-tension, diabetes, and related chronic insulin resis-tance conditions
and may hold promise as atherapeutic intervention and health promotionmeasure for Western populations as well. Originat-ing in India over 4000 years ago, the practice of yoga has been rising steadily in western industrial-ized countries during recent decades.
Of the 7major branches of Hindu yoga, Hatha (or forceful) yoga, Raja (or classical) yoga, and Mantra yoga areperhaps the best known and most widely practicedforms. Mantra yoga, emphasizing the use of speciﬁcsounds or chants to achieve mental and spiritualtransformation, has been popularized in the Westby Maharishi Mahesh Yogi, the founder of Tran-scendental Meditation (TM). Both Hatha yoga andRaja yoga emphasize speciﬁc postures (asanas), in-cluding both active and relaxation poses, as well asbreath control (pranayama), concentration (dha-rana), and meditation (dhyana). Hatha yoga, thebranch of yoga most commonly practiced in the Western industrialized world and which itself in-cludes many different styles (eg, Iyengar, Kun-dalini, Ashtanga, Integral, and Bikram yoga), alsoincorporates mantras or chants, cleansing exercises(kriyas), and speciﬁc hand gestures (mudras). Yoga is an economical, noninvasive practice thathas become increasingly popular in the UnitedStates as a means of potentially relieving stress,enhancing health, and improving ﬁtness.
Withno appreciable side effects and multiple collaterallifestyle beneﬁts,
yoga seems safe, is simpleto learn, and can be practiced even by elderly, ill, ordisabled individuals.
Requiring little in the way of equipment or professional personnel, yoga alsoseems easy and inexpensive to maintain, with somestudies indicating excellent long-term adher-ence,
even in Western populations.
Most im-portantly, there is a growing body of researchsuggesting that practice of yoga may reduce IRS-related risk factors for CVD, and may attenu-ate signs, reduce complications, and improve theprognosis of those with frank or underlying dis-ease.
However, despite yoga’s growing popularity andapparent promise as a safe and cost-effective inter- vention for populations with CVD or at risk forCVD, systematic reviews are lacking. In this article, we critically review the published scientiﬁc litera-ture regarding the effects of yoga on IRS-relatedanthropometric and physiologic indices of CVDrisk and on cardiovascular clinical outcomes, takinginto account the major limitations and biases of these studies. We also brieﬂy discuss mechanismsthat may mediate the reported effects of yoga onCVD risk.
November–December 2005 Vol. 18 No. 6 http://www.jabfp.org