Cardiovascular Disease

Risk and Treatment

CVD Classes of Risk Factors

Inherent

Physiological

Psychosocial

Inherent Risk Factors

Inherited Risks Family History of CVD

Genes

Gender to some extent Unclear why

Glucose metabolism We’ll talk in Chapter 11

Ethnicity Reason a likely due to other risks

Physiological Conditions

Hypertension Single biggest risk factor for MI and CVA

Hypercholesterolimia Ratio now seen as more important predictor than cholesterol level

alone HDL should be 22% of total for men and 25% of total for women

Increase HDL Exercise Moderate alcohol consumption

Decrease LDL Less saturated fat More vegetables

Hyperlipidemia – Elevated fat in blood Triglycerides

Psychosocial/Behavioral Factors

Education and Income Negative correlation

Smoking Leading behavioral risk factor Have begun to decline as smoking rates decline

(Chapter 2) Diet Anxiety & Depression

After controlling for other risk factors there is a positive correlation

Type A - Hostility/Anger Marriage and Social Support

Type A Behaviors

Hostile, cynical Judgmental (opinionated) Competitive Time urgent Uses gestures while talking Nodding of head while others are talking Intense

Type A to CVD

Hostility – Cynical mistrust, resentment Predictive but not independent

Anger – Expressed hostility to others Independent predictor Expression of anger is the key

Cardiovascular Reactivity

Physiological and cardiovascular reactivity to acute stress Exaggerated increases in blood pressure, heart rate,

catecholamines, corticosteroids

High levels of these hormones can damage heart and blood vessels Presence of epinephrine (a catecholamine) increases

the formation of clots.

CVR may be part of the difference between AA and Caucasians

Marriage and Social Support

Being single and lacking social support is a risk factor for some Three years after MI, those with high stress and low

social support had four times the death rate. Living alone after one heart attack triples the chances of

having another and dying Loneliness lack of companion related to CVD in elderly. Elevated risk of death from CVD in women who perceive

low support at work and home even when controlling for physiological risk factors.

Public Health Model and CVD

AGENT – Cigarette Smoke, Cholesterol, Saturated Fat

HOST – Hostility/CVR, Family History, African American, Exercise, Income, Education

ENVIRONMENT – Social Support, Awareness,

Treatment

Medical

Psychosocial

Medical Treatment

Risk management - MedicationsControl of high blood pressureControl of lipid abnormalities

Medical Treatment

Initial treatment may involve clot-dissolving medication and close monitoring

Balloon angioplasty Tiny balloon is inserted

into blocked vessel and inflated to open blood vessel

Bypass surgery Use grafted vessel (e.g.,

piece from leg) to bypass blockage in artery to the heart

                                                                                                                                                

Psychosocial Rehabilitation

Exercise Physiological and psychological benefits

Weight management Smoking cessation Dietary changes to control lipids and

cholesterol Reduce excessive alcohol intake Stress management Support groups

Psychosocial Rehabilitation

Exercise is the key component but: 50% drop-out rate within first 6 months

For those who continue benefits include: Improved self concept, perceived health,

sexual activity, involvement in social activities. Those who stop are more likely to:

Smoke, have poorer cardiac function, have higher body weight, be more sedentary, experience greater anxiety and depression.