Transcript Taking Good Health to Heart

Health
Psychology and
the Heart
Cardiovascular
Disease
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
A Look at Cardiovascular
Disease
CVD = Heart disease (#1)
+ stroke (#3) – and
hypertension
Cardiovascular disease
kills about one million
people in the United
States each year.
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?
• Cardiovascular
disease is an
umbrella term
that refers to
any of a number
of diseases
affecting the
heart and blood
vessels.
Examples 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
Examples -- 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)
What Causes
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
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
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
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
What Causes CVD?
Risk Factor #4:
Physical Inactivity
– Contributes to obesity,
high blood pressure,
and a low level of HDL
cholesterol
What Causes CVD?
Risk Factor #5:
Obesity
What Causes CVD?
Risk Factor #6:
Psychosocial
factors
– (will discuss later)
What Causes CVD?
Risk Factor #7:
Diabetes
– About two-thirds of people with diabetes
eventually die of heart or blood vessel
disease.
Multiple Risk Factors
288
• The danger of heart attack
increases significantly by the
number of risk factors present.
MALES
175
136
FEMALES
Example: 55-year-old male and female
Average risk = 100
202
63
NONE
98
113
66
CIGARETTES
CIGARETTES &
CHOLESTEROL
Source: Framingham Heart Study, Section 37: The Probability of Developing Certain Cardiovascular
Diseases in Eight Years at Specified Values of some Characteristics. (Aug. 1987)
CIGARETTES,
CHOLESTEROL,
HIGH BLOOD
PRESSURE
What can you do to
combat CVD?
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
Eat 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
Get Active
Get Screened
BP, cholesterol
Address Psychosocial
Factors
•Personality Factors
•Stress
•Depression
•Social Support
•SES
Psychosocial 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
Physiological 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
Narrowing 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)
Research 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)
UNC Medical Student Study
Research 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
Why Do Hostility and
Anger Promote CVD?
• Psychophysiological Reactivity Model
– Ed Suarez study
• Ho survey
• Harassment during mental arithmetic task
• Video (Christine – MIIT study)
Diathesis-Stress
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
After 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%
Modifying Hostility
and Anger
• How to do it (small group exercise)
• Redford Williams’ road-map approach (video)
• Type A and exercise (Swoap article)