Post on 26-Dec-2015
Health Psychology
and the Heart
Health Psychology
and the HeartCardiovascular
Disease Cardiovascular
Disease
You should know:You should know:• What cardiovascular disease is• What causes cardiovascular disease• What you can do help prevent cardiovascular
disease• Relationship between personality and heart
disease• Strategies for coping with CVD
• What cardiovascular disease is• What causes cardiovascular disease• What you can do help prevent cardiovascular
disease• Relationship between personality and heart
disease• Strategies for coping with CVD
CVD = Heart disease (#1) + stroke (#3) – and
hypertension
Cardiovascular disease kills about one million
people in the United States each year.
CVD = Heart disease (#1) + stroke (#3) – and
hypertension
Cardiovascular disease kills about one million
people in the United States each year.
A Look at Cardiovascular Disease
A Look at Cardiovascular Disease
Annual U.S. Cardiovascular Disease Mortality
Annual U.S. Cardiovascular Disease Mortality
CVD has been the leading cause of death in the United States every year since 1900, with the exception of 1918, when there was a worldwide flu pandemic
What Is Cardiovascular Disease?
What Is Cardiovascular Disease?
What is Cardiovascular Disease?What is Cardiovascular Disease?
• Cardiovascular disease is an umbrella term that refers to any of a number of diseases affecting the heart and blood vessels.
• Cardiovascular disease is an umbrella term that refers to any of a number of diseases affecting the heart and blood vessels.
Examples of CVDExamples of CVD• Hypertension—a common, often asymptomatic disorder
characterized by elevated blood pressure persistently exceeding 140/90 mm Hg.
• Coronary Heart Disease—a general term that describes diseases of the heart caused by atherosclerotic deposits, or plaque, that result in a narrowing of the coronary arteries.
• Atherosclerosis – A chronic disease in which cholesterol and other fats are deposited
to the inner walls of the coronary arteries, reducing circulation to the heart
• Hypertension—a common, often asymptomatic disorder characterized by elevated blood pressure persistently exceeding 140/90 mm Hg.
• Coronary Heart Disease—a general term that describes diseases of the heart caused by atherosclerotic deposits, or plaque, that result in a narrowing of the coronary arteries.
• Atherosclerosis – A chronic disease in which cholesterol and other fats are deposited
to the inner walls of the coronary arteries, reducing circulation to the heart
Examples -- continuedExamples -- continued• Angina Pectoris
– A condition of extreme chest pain caused by a restriction of the blood supply to the heart
• Myocardial Infarction– A heart attack; the permanent death of heart tissue in
response to an interruption of blood supply• Stroke
– A cerebrovascular accident that results in damage to the brain due to lack of oxygen
– Diving Bell and the Butterfly– My stroke of insight (Jill Bolte Taylor – book and podcast)
• Angina Pectoris– A condition of extreme chest pain caused by a restriction of
the blood supply to the heart• Myocardial Infarction
– A heart attack; the permanent death of heart tissue in response to an interruption of blood supply
• Stroke– A cerebrovascular accident that results in damage to the
brain due to lack of oxygen– Diving Bell and the Butterfly– My stroke of insight (Jill Bolte Taylor – book and podcast)
What Causes Cardiovascular
Disease?
What Causes Cardiovascular
Disease?
Risk Factors for Cardiovascular Disease
Risk Factors for Cardiovascular Disease
• The Framingham Heart Study (1948 – Present)
– Landmark prospective study of demographic, biological, psychological risk factors in CVD
• Uncontrollable Risk Factors– Age, gender, family history, race/ethnicity– Testosterone
• Elevates LDL (bad) cholesterol– Estrogen
• Neutralizes oxygen free radicals that may contribute to vascular damage
• Controllable Risk Factors– Hypertension, body weight, diet, smoking, Type II diabetes, stress / hostility
• The Framingham Heart Study (1948 – Present)
– Landmark prospective study of demographic, biological, psychological risk factors in CVD
• Uncontrollable Risk Factors– Age, gender, family history, race/ethnicity– Testosterone
• Elevates LDL (bad) cholesterol– Estrogen
• Neutralizes oxygen free radicals that may contribute to vascular damage
• Controllable Risk Factors– Hypertension, body weight, diet, smoking, Type II diabetes, stress / hostility
What Causes CVD?What Causes CVD?Risk Factor #1: Smoking
– Reduces the amount of oxygen that can reach the body’s cells
– Increases blood pressure due to nicotine ingestion
Risk Factor #1: Smoking
– Reduces the amount of oxygen that can reach the body’s cells
– Increases blood pressure due to nicotine ingestion
What Causes CVD?What Causes CVD?Risk Factor #2: High Blood Cholesterol
–Fatty molecule (lipid)–Lipoproteins transport
cholesterol in the bloodstream (LDL vs HDL)
–LDL accumulates WITHIN artery walls, oxidizes, then inflammation occurs
Risk Factor #2: High Blood Cholesterol
–Fatty molecule (lipid)–Lipoproteins transport
cholesterol in the bloodstream (LDL vs HDL)
–LDL accumulates WITHIN artery walls, oxidizes, then inflammation occurs
What Causes CVD?What Causes CVD?Risk Factor #3:High Blood Pressure
– Arteries harden and become scarred from excess pressure
– High blood pressure is considered to be 140 mm Hg / 90 mm Hg
Risk Factor #3:High Blood Pressure
– Arteries harden and become scarred from excess pressure
– High blood pressure is considered to be 140 mm Hg / 90 mm Hg
What Causes CVD?What Causes CVD?Risk Factor #4:Physical Inactivity
– Contributes to obesity, high blood pressure, and a low level of HDL cholesterol
Risk Factor #4:Physical Inactivity
– Contributes to obesity, high blood pressure, and a low level of HDL cholesterol
What Causes CVD?What Causes CVD?Risk Factor #5:ObesityRisk Factor #5:Obesity
What Causes CVD?What Causes CVD?Risk Factor #6:Psychosocial factors
– (will discuss later)
Risk Factor #6:Psychosocial factors
– (will discuss later)
What Causes CVD?What Causes CVD?Risk Factor #7:
Diabetes– About two-thirds of people with diabetes
eventually die of heart or blood vessel disease.
Risk Factor #7:
Diabetes– About two-thirds of people with diabetes
eventually die of heart or blood vessel disease.
Multiple Risk FactorsMultiple Risk Factors• The danger of heart attack
increases significantly by the number of risk factors present.
• The danger of heart attack increases significantly by the number of risk factors present.
63 66
98113
136
175
202
288
Source: Framingham Heart Study, Section 37: The Probability of Developing Certain Cardiovascular Diseases in Eight Years at Specified Values of some Characteristics. (Aug. 1987)
NONENONE CIGARETTESCIGARETTES CIGARETTES & CHOLESTEROLCIGARETTES & CHOLESTEROL
CIGARETTES, CHOLESTEROL,
HIGH BLOOD PRESSURE
CIGARETTES, CHOLESTEROL,
HIGH BLOOD PRESSURE
MALES
FEMALES
Example: 55-year-old male and female
Average risk = 100
MALES
FEMALES
Example: 55-year-old male and female
Average risk = 100
What can you do to combat CVD?
What can you do to combat CVD?
Quit Smoking! Quit Smoking!
• In just 20 minutes after quitting, blood pressure decreases
• After 24 hours, the chance of heart attack decreases
• In just a year after quitting, the excess risk of coronary heart disease is decreased to half that of a smoker
• In just 20 minutes after quitting, blood pressure decreases
• After 24 hours, the chance of heart attack decreases
• In just a year after quitting, the excess risk of coronary heart disease is decreased to half that of a smoker
Eat RightEat Right• Diet directly affects
the development of atherosclerosis
• Fat intake should be no more than 30% of calories
• Saturated fat should be less than 10% of calories
• Diet directly affects the development of atherosclerosis
• Fat intake should be no more than 30% of calories
• Saturated fat should be less than 10% of calories
Get ActiveGet Active
Get Screened Get Screened
BP, cholesterol BP, cholesterol
•Personality Factors•Stress
•Depression•Social Support
•SES
Address Psychosocial Factors
Address Psychosocial Factors
Psychosocial Factors in CVDPsychosocial Factors in CVD
• Personality Factors– Type A – Friedman & Rosenman’s term for competitive,
hurried, hostile people who may be at increased risk for developing CVD
– Type B – More relaxed people who are not pressured by time
considerations
• Personality Factors– Type A – Friedman & Rosenman’s term for competitive,
hurried, hostile people who may be at increased risk for developing CVD
– Type B – More relaxed people who are not pressured by time
considerations
Physiological DifferencesPhysiological Differences
• Type A’s have more:– rapid blood clotting– higher cholesterol and triglyceride levels under
stress– greater autonomic arousal, elevated heart rate, and
blood pressure in the face of challenging events– “combat ready” hyperreactivity
• Type A’s have more:– rapid blood clotting– higher cholesterol and triglyceride levels under
stress– greater autonomic arousal, elevated heart rate, and
blood pressure in the face of challenging events– “combat ready” hyperreactivity
Narrowing it DownNarrowing it Down• Later Studies of Type A Reveal Mixed Results
– Type A too global– Focus on three specific components: hurriedness, competitiveness,
hostility– Hostility turns out to be key– Hostility components
• Cynicism• Anger• Aggression
– 20/20 Video (Dr. Redford Williams)
• Later Studies of Type A Reveal Mixed Results– Type A too global– Focus on three specific components: hurriedness, competitiveness,
hostility– Hostility turns out to be key– Hostility components
• Cynicism• Anger• Aggression
– 20/20 Video (Dr. Redford Williams)
Research StudiesResearch Studies
• Correlational study: Men with high Ho scores have more coronary artery blockages
• UNC Medical Student Study– Followed med students for 25 years– Those with higher Hostility scores (“Ho” from
the MMPI) were 5 x more likely to have developed CHD)
• Correlational study: Men with high Ho scores have more coronary artery blockages
• UNC Medical Student Study– Followed med students for 25 years– Those with higher Hostility scores (“Ho” from
the MMPI) were 5 x more likely to have developed CHD)
UNC Medical Student StudyUNC Medical Student Study
Research StudiesResearch Studies
• Atherosclerosis Risk in Communities (ARIC) Study– Massive study of 13,000 middle-aged men and women– People who scored highest on an anger scale were 2-
3 times as likely to have a heart attack or stroke than those with the lowest score
• Atherosclerosis Risk in Communities (ARIC) Study– Massive study of 13,000 middle-aged men and women– People who scored highest on an anger scale were 2-
3 times as likely to have a heart attack or stroke than those with the lowest score
Why Do Hostility and Anger Promote CVD?Why Do Hostility and Anger Promote CVD?• Psychophysiological Reactivity Model
– Ed Suarez study• Ho survey• Harassment during mental arithmetic task• Video (Christine – MIIT study)
• Psychophysiological Reactivity Model – Ed Suarez study
• Ho survey• Harassment during mental arithmetic task• Video (Christine – MIIT study)
Diathesis-Stress Diathesis-Stress
Why Do Hostility and Anger Promote CVD?Why Do Hostility and Anger Promote CVD?• Psychophysiological Reactivity Model
– Hostility and anger act slowly to damage the arteries and heart through unhealthy increases in blood pressure, blood levels of free fatty acids, changes in cholesterol, and outpourings of epinephrine, cortisol, and other stress hormones
• Health Behaviors and less social support
• Psychophysiological Reactivity Model – Hostility and anger act slowly to damage the
arteries and heart through unhealthy increases in blood pressure, blood levels of free fatty acids, changes in cholesterol, and outpourings of epinephrine, cortisol, and other stress hormones
• Health Behaviors and less social support
After CVD: Preventing RecurrencesAfter CVD: Preventing Recurrences
• Stress management following a CV episode lowers rates of mortality and morbidity (see Blumenthal study)
• Recurrent Coronary Prevention Program (RCPP)– Cognitive and behavioral techniques to help CVD
patients modify hostility, hurriedness, and negative emotions reduced risk of a second MI and total mortality rates by 50%
• Stress management following a CV episode lowers rates of mortality and morbidity (see Blumenthal study)
• Recurrent Coronary Prevention Program (RCPP)– Cognitive and behavioral techniques to help CVD
patients modify hostility, hurriedness, and negative emotions reduced risk of a second MI and total mortality rates by 50%
Modifying Hostility and AngerModifying Hostility and Anger
• How to do it (small group exercise)• Redford Williams’ road-map approach (video)• Type A and exercise (Swoap article)
• How to do it (small group exercise)• Redford Williams’ road-map approach (video)• Type A and exercise (Swoap article)