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Cardiovascular Disease

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Heart disease is leading cause of death among women in US. Approximately 500,000 deaths per year ... Estrogen plus progestin, risk of heart disease & stroke ... – PowerPoint PPT presentation

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Title: Cardiovascular Disease


1
Cardiovascular Disease
2
Cardiovascular Disorders
  • Include
  • Coronary Heart Disease (CHD)
  • High blood pressure
  • Stroke

3
Chronic Stress and Cardiovascular Disease
  • Cardiovascular stress-response causes vessels in
    heart to work harder may wear out if condition
    persists
  • If stress causes a rise in BP, then chronic
    stress will cause BP to rise chronically
  • Vicious cycle emerges
  • Thicker muscle layer develops around the
    overworked vessels
  • Vascular resistance and vessel rigidity
  • Chronic increase in BP
  • Ventricular hypertrophy
  • irregular heartbeat
  • Single best predictor of cardiac risk
  • Hypertension

4
Cardiovascular Response to Chronic Stress
  • Atherosclerosis
  • Hardening of the arteries
  • Atherosclerotic plaque
  • Overactive SNS
  • Social stressors and diet
  • Claudication
  • Atherosclerotic plaque that obstructs blood flow
    to the lower half of the body
  • Thrombus
  • Loose plaque torn from the vessel wall that can
    lodge in smaller vessels clogging them
  • Myocardial infarct
  • Accounts for the vast majority of heart attacks
  • Myocardial ischema
  • State when narrowing of the artery is not
    complete and some oxygen, but not enough is
    supplied to the heart causing chest pains
    (angina)
  • Sensitive to acute stressors

5
CHD
  • Chronic increase in BP that accompanies repeated
    stress can cause damage to the smooth inner
    linings of vessels
  • Inflammatory response
  • Inflamed blood vessels are better predictors of
    cardiovascular trouble than cholesterol levels
  • Cells from the immune system, as well as fatty
    cells aggregate at damaged site that can promote
    clogging
  • C-reactive protein (CRP)
  • Blood viscosity

6
Heart Disease
  • Gender
  • Men have heart attacks at higher rates than women
  • Heart disease is leading cause of death among
    women in US
  • Approximately 500,000 deaths per year
  • Increase Incidence
  • Women are twice as likely as men to be left
    disabled
  • Onset of vulnerability delayed about decade in
    women than men
  • Women less likely to bounce back after major
    cardiac episode
  • Predictors
  • Smoking, diet, stress
  • Working taking care of a family

7
Cardiovascular Disease
  • Chronic stress and CHD
  • Occupational stress
  • Low levels of control over ones job AND
    excessive workload (high strain) contribute to
    job stress
  • Framingham Heart Study (longitudinal)
  • Working women were not at greater risk than
    housewives
  • Female clerical workers, working women w/
    children, women w/ nonsupportive bosses more
    likely to develop CHD
  • Risk for CHD increased linearly with number of
    children of working women

8
Heart Disease
  • Hormones play a key role in the development of
    heart disease
  • Stress
  • Increased glucocorticoids
  • Decreased estrogen
  • Menopause
  • Experimental studies
  • Estrogen plus progestin, risk of heart disease
    stroke
  • Type of estrogen used in clinical studies
  • Estrogen protects against the formation of
    atherosclerosis, cannot reverse it

9
Cardiovascular Disorders
  • Risk Factors for Heart Disease
  • Nonmodifiable Factors
  • Age
  • ½ of coronary victims are 65
  • Sex
  • Men
  • Protective factors of female sex hormones
  • Race
  • Family history

10
Cardiovascular Disease
  • Risk Factors for Heart Disease
  • Modifiable Factors
  • Cigarette smoking
  • Obesity
  • High salt intake
  • High blood cholesterol
  • Sedentary lifestyle
  • Hostility and related personality traits
  • Psychosocial stress

11
Cardiovascular Disease
  • Risk Factors for Heart Disease
  • Modifiable Factors
  • Hostility and related personality traits
  • Psychosocial stress
  • Chronic stress
  • Acute stress
  • Social support
  • Individual differences in physiologic reactivity
    to behavioral stressors

12
Cardiovascular Disorders
  • Stress and Coronary Heart Disease
  • Acute stress as a trigger for CHD
  • 2/5 CHD deaths had a stressful life event within
    24 hours of CHD event
  • Such studies are limited by???
  • Classic study by Parkes (1969)
  • Followed widowers and observed a 40 increase in
    mortality in the first 6 mos following
    bereavement
  • ½ of these deaths due to cardiovascular causes
  • of acute MI increased in Tel Aviv week after
    Iraqi missile attacks on Israel compared to week
    before

13
Cardiovascular Disorders
  • Type A behavior pattern, hostility and CHD
  • Rosenmann Friedman (1959)
  • TABP
  • Very competitive
  • Impatience
  • Hostility
  • Until Matthews Haynes (1986)

14
Cardiovascular Disorders
  • Anger, Hostility, and Coronary Heart Disease Risk
  • Predicted morbidity and mortality
  • Higher hostility scores in lower socioeconomic
    groups, higher in men

15
Depression and CHD
  • 1 in 5 CHD patients show clinical signs of
    depression
  • Depressed vs Nondepressed CHD pts
  • Predicted a second heart attack
  • Predicted premature death
  • Mechanism between depression and CHD
  • Health behaviors (compliance)
  • Pathophysiological changes
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