Health Psychology Chapter 9: Cardiovascular Disease

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Health PsychologyChapter 9 Cardiovascular
Disease

• Mansfield University
• Dr. Craig, Instructor

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CVS and its Circulatory Pipes

• Cardiovascular System- purpose
• transport system for nutrients (O2, glucose) and
  removal system for waste (CO2, immune wastes)
• transports system for hormonal regulatory
  processes
• Outgoing Pipes (away from the heart)
• Arteries
• Arterioles
• Capillaries (micro)
• Incoming Pipes (back to the heart)
• Venules (micro)
• Veins

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The Heart

• Myocardium-
• heart muscle
• Aorta- largest arteries
• feeds the myocardium via the coronary arteries
• Natural wear and tear of heart beating
• can lead to scar tissue
• Problems occur when atheromatous plaques bind to
  scars
• lipids (fats) can calcify
• lead to restricted blood flow.

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Cardiovascular Disease

• Atherosclerosis hardening of the arteries
• excessive buildup of plaques impeding blood flow
  to heart or other areas of blood supply
• less volume greater BP
• Arteriosclerosis- loss of elasticity of the
  arteries
• less able to handle high volume of blood
• greater BP pressure
• Ischemia- restricted blood flow
• when coronary arteries are impeded-- called
  Coronary Artery Disease- if damage to heart---
  called CHD
• Effect- Angina Pectoris

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Coronary Artery Disease Continued

• Myocardial Infarction- heart attack
• survival rate about 2/3
• tissue suvival rate 0 at the epicenter
• Surgical Treatment
• Bypass Surgery- CABG (about 500,000 annually)
• see picture on p239
• graft veins form leg on Aorta, and bypass blocked
  areas
• Balloon Angioplasty - PTCA

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CVD (cont.) Assessment

• Stroke
• arterial blockage
• aneurysm
• hemorrhagic stroke
• classic effects- localized loss
• Assessment
• Hypertension Blood Pressure
• Systolic and Diastolic Blood Pressure
• Essential Secondary Hypertension
• Multifactorial Nature
• ECG- measurement of electrical impulse
• stress test- sensitive to approx 50 blockage
• good for looking at nature of angina pectoris
• Angiography- X-ray of coronary arteries in action

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Risk Factors- who is more at risk?

• Framingham Heart Study- identify conditions that
  make one group more likely to contract HD in
  future than another group
• cigarette smoking, cholesterol, hypertension,
  sedentary life style, obesity
• Inherent Risk Factors- not changeable
• Age (Fig 9.8, p 248) , Family History, Sex (Fig
  9.9, p. 249) Ethnic Background (Afr.-American)
• Physiological Risk Factors
• Hypertension
• Serum Cholesterol LDL gt200 HDLlt35

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Risk Factors (continued)

• Behavioral Risk Factors
• Smoking--
• active smoking at least doubles risk
• passive smoking increases risk by 20
• Diet--
• saturated fat consumption adds to cholesterol
  levels
• antioxidants- (Vitamin C., E, Beta Carotene)
• break down free oxygen in the system
• risk decreased in Nurses Health Study
• Dietary Fiber- (fruits vegetables)-
• may protect again coronary heart disease
• Fish Consumption (Omega-3 Oils)- may protect

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Psychosocial Risk Factors and CVD

• Anxiety--
• men and anxiety--- prospective research
• 2x more likely to develop hypertension
• 3x more likely to suffer SCD
• greater risk for non-fatal MI and Angina
• Education Level Income (SES variables)
• education level-- at least 2x risk if no HS educ
• aggravated if also African-American
• income level-
• 10,000/year 2x risk of survival time from CAD
  compared to those making 40,000
• Less than 50k/year, 2x risk of those greater than
  50k/year

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Psychosocial Risk and CVD (continued)

• Marriage/Social Support
• 2-8 times lower risk for development and
  progression of CVD
• low social support equivalent to taking up
  smoking according to James House in Lancet
  Article.
• The Nasty 3 Type A, Hostility and Anger
• Type A Behavior Pattern
• general pattern of behaviors related to increased
  likelihood of development of CVD
• extreme ambitiousness, competitiveness, time
  urgency, impatience as a group unrelated to CVD
• Hostility component appear to be lynch-pin to
  relationship with CVD.

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Hostility, Anger, Expression and CVD

• HOSTILITY- a generally negative attitude toward
  others of some extended duration and scope.
• Cynical hostility (think the worst of people and
  their intentions)- a strong predictor of
  arterial blockage and coronary mortality.
• Cook-Medley Scale (MMPI) or Buss-Durkee Scale
• Also related to risk factor profile (behavioral
  psychosocial)
• Obesity, alcohol consumption, smoking, blood
  pressure, negative life events, social support
  levels.
• When these are controlled statistically
  relationship betw. HO and CVD disappears.
  Therefore it is a secondary factor-- not
  independently related.
• May also affect physiology through Anger
  Expression
• Figure 9.10 Relating Type A, Hostility Anger
  to CVD development

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Anger, Physiology Health

• Anger- unpleasant emotion accompanied by
  physiological arousal usually of short duration
• expressions- Anger-In and Anger-Out
• Anger-Out related to CAD severity--
• maybe a matter of type of expression (outburst or
  controlled)
• CV Reactivity
• angry outbursts---gt large rate and BP increase
• controlled expression--gt smaller HR and BP
  response
• Provoked response (buttons pushed)- men their
  more physiologically (key point) reactive than
  wives
• Suppression Okay then?
• No.. Also related to increase CAD severity
• Key appears to be controlled expression and
  communication!!

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Modifying CVD Risk

• Obviously changing behaviors is KEY!!!
• Major obstacle-- the optimistic bias
• the tendency for people to believe that risk
  factors increase others potential for health
  problems but not their own. No recognition of
  personal risk
• accurate feedback and information
• Hypertension
• medication (side effects and symptom problems)
• obesity, exercise, sodium intake, relaxation
  training (comments on effectiveness)
• Serum Cholesterol
• effects of lowering---gt unclear in normal
  population
• anger behavior-- mood congruent and controlled
  speech