Chapter Thirteen: Heart Disease, Hypertension, Stroke, and Type II Diabetes

1. Chapter Thirteen:Heart Disease, Hypertension, Stroke, and Type II Diabetes

2. Chapter Outline • Coronary heart disease • Hypertension • Stroke • Type II diabetes

3. Coronary Heart Disease (CHD) Narrowing of coronary arteries • Caused by atherosclerosis Risk factors • High cholesterol • High blood pressure • Elevated levels of inflammation • Diabetes • Cigarette smoking • Obesity • Lack of exercise

4. Figure 13.1 - Atherosclerosis (Source: National Heart, Lung, and Blood Institute, 2010a)

5. Metabolic Syndrome • Helps predict heart attacks when identified • Diagnosed when a person has: • Obesity centered around the waist • High blood pressure • Low levels of HDL • Difficulty metabolizing blood sugar • High levels of triglycerides

6. Biological Reactivity to Stress • Plays a role in the development of CHD • Cumulative effects lead to damage of the endothelial cells • Reflected in a prolonged recovery period

7. Stress and CHD • Chronic and acute stress is linked to CHD and adverse clinical events • Interacts with genetic factors to increase likelihood of CHD • Associated with increased inflammatory activity

8. Factors that Can Cause Stress Low economic status Bad family environment Lack of social support Illness Workplace related stress Loss of control over life Social instability Urbanization

9. Women and CHD • Leading cause of death in women in developed nations • Estrogen prevents early onset of CHD • Reduces sympathetic nervous system arousal • Lowers incidence of high blood pressure and neuroendocrine and metabolic responses • Risk increases after menopause

10. Personality, Cardiovascular Reactivity, and CHD • Negative emotions increase risk for metabolic syndrome and CHD • Hostility can occur from: • Insecure and negative feelings • Bad child rearing practices • Bad family environment • Genetic factors

11. Personality, Cardiovascular Reactivity, and CHD Hostile emotions • Linked with higher incidence of CHD • Leads to interpersonal conflicts and reduced social support • Is a social manifestation of cardiovascular reactivity Hostile individuals • Show a weak antagonistic response to sympathetic activity • Show larger and longer-lasting blood pressure responses

12. Depression and CHD • Depression affects the development, progression, and mortality from CHD • Linked to risk factors for: • Coronary heart disease • Metabolic syndrome • Inflammation and likelihood of a heart attack • Heart failure among the elderly and mortality after coronary artery bypass graft surgery

13. Other Psychosocial Risk Factors and CHD Vigilant coping Anxiety Vital exhaustion Hostility Social isolation

14. Management of Heart Disease • Role of delay - One of the reasons for high rates of mortality and disability following heart attacks • Initial treatment • Coronary artery bypass graft (CABG) surgery to treat blockage of major arteries • Patients are closely monitored following myocardial infarction (MI)

15. Management of Heart Disease • Anxiety predicts complications during the hospital phase • Reinfarction and recurrent ischemia • Cardiac rehabilitation: Helps patients to attain their optimal physical, medical, psychological, social, emotional, vocational, and economic status

16. Management of Heart Disease • Treatment by medication • Self-administration of beta-adrenergic blocking agents • Aspirin - Prescribed for people recovering from or at risk for heart attacks • Statins - Prescribed for patients following an acute coronary event • Patients are given dietary instructions and put on an exercise program

17. Management of Heart Disease • Stress management - Patients are taught to recognize stressful situations and avoid or manage stress • Targeting depression - Cognitive-behavioral therapy is used • Social support • Predicts exercise tolerance • Targeted for intervention during recovery

18. Management of Heart Disease • Problems of social support • Primary relationships are threatened • Conflict over changes in lifestyle can increase marital strife • Cardiac invalidism: Patients and their spouses see the patient’s abilities as lower than they actually are • Consequence of MI

19. Management of Heart Disease • Evaluation of cardiac rehabilitation • Patients’ risks for heart disease can be reduced by interventions that target weight, blood pressure, smoking, and quality of life • Psychosocial treatments for psychosocial issues should be added to standard cardiac rehabilitation programs

20. Hypertension • Cardiovascular disease (CVD): Occurs when the supply of blood through the vessels is excessive • Cardiac output is too high • Occurs in response to peripheral resistance • Is a risk factor for other disorders • Heart disease and kidney failure

21. Hypertension • Can affect cognitive functioning if untreated • Measured by the levels of systolic and diastolic blood pressure • Causes • 90% is of unknown origin • 5% by failure of the kidneys

22. Hypertension • Risk factors • Childhood temperament and blood pressure reactivity • Gender • Genetic factors • Emotional factors • Family environment • Stress

23. Stress and Hypertension among African Americans • Tied to stress of racial discrimination and low SES • Hereditary factors • Prevalent in people with lower income • Obesity • John Henryism: Personality predisposition to cope actively with psychosocial stressors

24. Treatment of Hypertension • Drug treatments • Low-sodium diet • Reduction of alcohol • Weight-reduction in overweight patients • Exercise • Caffeine restriction

25. Treatment of Hypertension • Cognitive-behavioral treatments • Biofeedback • Progressive muscle relaxation • Hypnosis • Meditation • Deep breathing and imagery • Anger management

26. Treatment of Hypertension • Evaluation of cognitive-behavioral interventions • Reduce drug requirements • Best approach to the management of hypertension - Combination of cognitive-behavioral techniques and drugs • Problems - Hidden disease • Diagnosis occurs during standard medical examinations as the disease is symptomless

27. Stroke • Results from a disturbance in blood flow to the brain • Causes • Blood flow to localized areas of the brain is interrupted • Cerebral hemorrhage

28. Table 13.1 - Stroke Warning Signs Source: American Heart Association, 2004a.

29. Risk Factors for Stroke High blood pressure Heart disease Cigarette smoking High red blood cell count Transient ischemic attacks Negative emotions Sudden change in posture to a startling event Psychological distress

30. Stroke • Consequences • Motor problems • Cognitive problems • Emotional problems • Rehabilitative interventions • Medication • Psychotherapy • Cognitive remedial training

31. Stroke • Movement therapies • Use of structured, stimulating environments to challenge capabilities • Neurorehabilitation - Rewiring the brain so that areas of the brain other than the one affected by the stroke can come to take on those functions

32. Symptoms of Type II Diabetes Frequent urination Fatigue and dryness of the mouth Impotence Irregular menstruation Loss of sensation Frequent infection of the skin, gums, or urinary system Pain or cramps in legs, feet, or fingers Slow healing of cuts and bruises Intense itching and drowsiness

33. Table 13.2 - Risk Factors for Type II Diabetes Source: American Diabetes Association, 2012.

34. Health Implications of Type II Diabetes Coronary heart disease Blindness among adults Kidney failure Foot ulcers Eating disorders Nervous system damage Alzheimer’s disease Vascular dementia Difficulties in sexual functioning Risk for depression Cognitive dysfunction Risk of heart attack and stroke

35. Type II Diabetes • Sensitive to the effects of stress • Self-management • Dietary intervention - Reduce sugar and carbohydrate intake • Patients are encouraged to: • Achieve normal weight • Exercise • Improves adherence

36. Type II Diabetes • Interventions • Cognitive-behavioral interventions • Weight control improves glycemic control • Self-management and problem-solving skills • Social skills training • Behavior modification • Pharmacological therapy • Lifestyle intervention and medication can greatly reduce the incidence of diabetes