Stress and heart disease: a few basics and heuristic models
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Transcript of Stress and heart disease: a few basics and heuristic models
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Stress and heart disease: a few basics and heuristic
models
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Kop provides a readable account of psychological risk factors for CAD. His model provides a useful way of organising the material on stress and CVD & the material on “vital exhaustion” will be covered later in the lecture on depression.Kop, WJ (1999) Chronic and acute psychological risk factors for clinical manifestations of coronary artery disease. Psychosomatic Medicine, 61, 476-487.
Black and Garbutt are not for the feint hearted. They offer a very complex physiological model of stress, inflammation and CVD. Incorporates a lot of important new information but only for those with background in biology. I shall use model illustratively
Black, PH., & Garbutt, LD (2002). Stress, inflammation and cardiovascular disease. J. of Psychosomatic Res., 52, 1-23
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Rozanski paper is very up to date account of stress and heart disease written for cardiologists. I strongly recommend it.
Rozanski, A., Blumenthal, JA., Davidson, KW, Saab, PC., Kubzansky, L (2005). The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice. J. American College of Cardiology., 45, 637-651.
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Words you main not have come across
Atheroma, Atherosclerosis, Atherosclerotic plaque
Thrombus
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Process of build up of atherosclerotic plaque, plaque rupture and thrombus formation.
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What causes a Myocardial Infarction: Plaque rupture and blocked coronary artery
No MI, plaque remains
Unstable situation
Artery blocked, MI results
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Black PH Garbutt LD (2003) Stress, inflammation and cardiovascular disease, J Psychosom. Res 52, 1 -23
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Heart Rate SBP DBP50
70
90
110
130
150H
R (
bp
m)a
nd
BP (
mm
Hg
)
CV effects of Active Coping taskPatterson et al 1994
Baseline
Stroop
Mental Arithmetic
Psychological stress and platelet activation: Differences in platelet reactivity in healthy men during active and passive stressors. Patterson, S. M.; Zakowski, SG.; Hall, Martica H.;
Health Psychology, Vol 13, 1994. pp. 34-38.
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Heart Rate SBP DBP50
70
90
110
130
150H
R (
bp
m)a
nd
BP (
mm
Hg
)
CV effects of Passive Coping taskPatterson et al 1994
Baseline
Combat surgery
Heart surgery
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Active Stressor Passive Stressor No Stressor
0
10
20PF4
act
ivit
y (
ng
/ml)
Effects of stress on platelet activityPatterson et al, 1994
Baseline
Stroop
MA
Baseline
Surgery
Surgery
Baseline
Travel film
Travel film
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Effects of stress on platelets, and hence clotting & process of atherogenesis. See particularly PF (Platelet Factor) 4
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Low work demand High work demand0.06
0.12
0.17
0.23
0.28
0.34p
rog
ress o
f m
axim
al in
tim
al th
ickn
ess
Everson et al, 1997, BMJ, 314, 558-65Work demand, reactivity and progress of athersclerosis
Small BP reaction
Large BP reaction
The diathesis model: stress plus vulnerability
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