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Health Psychology and the 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.

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Health Psychology and the Heart

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  1. Health Psychology and the Heart CardiovascularDisease

  2. 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

  3. 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.

  4. 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

  5. What Is Cardiovascular Disease?

  6. 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.

  7. 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

  8. 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)

  9. What Causes Cardiovascular Disease?

  10. 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

  11. 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

  12. 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

  13. 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

  14. What Causes CVD? Risk Factor #4:Physical Inactivity • Contributes to obesity, high blood pressure, and a low level of HDL cholesterol

  15. What Causes CVD? Risk Factor #5:Obesity

  16. What Causes CVD? Risk Factor #6:Psychosocial factors • (will discuss later)

  17. What Causes CVD? Risk Factor #7: Diabetes • About two-thirds of people with diabetes eventually die of heart or blood vessel disease.

  18. Multiple Risk Factors • The danger of heart attack increases significantly by the number of risk factors present. MALES FEMALES Example: 55-year-old male and female Average risk = 100 CIGARETTES CIGARETTES, CHOLESTEROL, HIGH BLOOD PRESSURE CIGARETTES & CHOLESTEROL NONE Source: Framingham Heart Study, Section 37: The Probability of Developing Certain Cardiovascular Diseases in Eight Years at Specified Values of some Characteristics. (Aug. 1987)

  19. What can you do to combat CVD?

  20. 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

  21. 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

  22. Get Active

  23. Get Screened BP, cholesterol

  24. Address Psychosocial Factors • Personality Factors • Stress • Depression • Social Support • SES

  25. 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

  26. 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

  27. 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)

  28. 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)

  29. UNC Medical Student Study

  30. 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

  31. Why Do Hostility and Anger Promote CVD? • Psychophysiological Reactivity Model • Ed Suarez study • Ho survey • Harassment during mental arithmetic task • Video (Christine – MIIT study)

  32. Diathesis-Stress

  33. 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

  34. 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%

  35. Modifying Hostility and Anger • How to do it (small group exercise) • Redford Williams’ road-map approach (video) • Type A and exercise (Swoap article)

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