Stress is linked to exaggerated cardiovascular reactivity. 1) Stress 2) Hostility 3) Social Support. Evidence of association between these

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1 Psychosocial Factors & CHD Health Psychology Psychosocial Factors 1) Stress 2) Hostility 3) Social Support Evidence of association between these psychosocial factors and CHD Physiological Mechanisms Stress is linked to exaggerated cardiovascular reactivity 1

2 1) Influence the Development of CHD -Higher Cardiovascular Reactivity: -may damage Endothelial lining of the arteries -Is an initiating factor in the atherogenic process Animal Models (e.g., Manuck, Kaplan, & Clarkson, 1983; Psychosomatic Medicine) -exposed monkey s to stress (threat of capture and handling) 2) Precipitate the onset of dangerous cardiac conditions in diseased populations. -Krantz et al Greater stress reaction = more severe Myocardial ischemia (aka: deficiency in the flow of blood) 2

3 Ethnicity & Gender African Americans disporportionaly exposed to chronic stress (e.g.: low SES) and as a result, CHD Racial gap b/w African American and Whites CHD deaths has increased (Zheng, Croft, & Williams, 2002) CHD leading killer of Women in the U.S. More women than men die of CHD Hostility Type A Personality Competitive striving for achievement Time urgency Hostility & Aggression Western Collaborative Group Study -Type A individual 2 times more likely to develop CHD Hostility Negative belief in others Feelings of Anger Annoyance Resentment Verbal or Physical Aggression More consistently related to risk for mortality than the general Type A construct 3

4 Hostility 3 Possible Links to CHD 1. Greater increases in cardiovascular reactivity during interpersonal stressors 2. Engage in less healthy behaviors 3. May not benefit as much from social support Social Support 1) Influence Risk for developing CHD -Women Health Study: decline in social support = more likely to develop hypertension 2) Beneficial for people who already have CHD -Berkman et al. (1991): After heart attack low emotional support = 3x greater risk of dying over the next 6 months Social Support Helps people cope with stress which in turn influences CHD. Gerin et al. (1992) : Social support during conflict discussion associated with lower cardiovascular reactivity 4

5 Social Support Marriage - Good -Helgeson (1991) husbands who reported that they disclosed to their wives were less likely to die and/or be re-hospitalized within the next year following a myocardial infarction. Marriage Bad -Orth-Gomer et al. (2000) Women who reported significant marital distress were 3 times more likely to experience recurrent coronary events Social Support Other people give meaning to life Increase our motivation to stay healthy via relevant health behaviors. They can also directly influence us via social control. Living with Heart Disease 4,000 People have a heart attack every day in the U.S. Gripping / vice like chest pain Pain in shoulders, neck, or arms Lightheadedness Sweating Shortness of breath 5

6 Living with Heart Disease Call 911 immediately Within 1 hour of symptoms to be treated with clot busting drugs. Of those with Heart attack: ~50% die Those who survive: 90% Survive at least 1 year 85% Survive 2 or more years Living with Heart Disease Lifestyle changes: Losing weight Exercising Reducing dietary fat and cholesterol Challenging and take an emotional toil Fear of uncertain future Anxiety and Depression ~ 50% of patients dropout of exercise programs within 6 months Living with Heart Disease Psychosocial Intervention: Dean Ornish et al. (1990) A) Mostly vegetarian diet B) Moderate exercise (walking) C) Stress management D) Group support and counseling E) Smoking cessation 1 year follow-up: Intervention group some Reversal of coronary arteriosclerosis Control group (usual care e.g.: dietary advice) got worse 6

7 Cooperative Learning Exercise 12a Question: Treating cardiovascular reactivity to stress. Duration: 20 mins. Written Assignment: Yes. Instruction: As you have just learned, stress may influence the development and exacerbation of cardiovascular disease by increasing cardiovascular reactions to stress. Of course, there are standard pharmacological ways to treat cardiovascular disease. For instance, beta-blockers can reduce cardiovascular changes during stress. What do you think of the idea of giving individuals who have lots of stress cardiovascular medication to prevent heart disease? What would be some arguments in favor and against such an approach? Take about 20 mins to discuss these issues and provide a written group account of your discussion