Stress and heart disease: a few basics and heuristic

models

Kop provides a readable account of psychological risk factors for CAD. His model provides a useful way of organising the material on stress and CVD & the material on “vital exhaustion” will be covered later in the lecture on depression.Kop, WJ (1999) Chronic and acute psychological risk factors for clinical manifestations of coronary artery disease. Psychosomatic Medicine, 61, 476-487.

Black and Garbutt are not for the feint hearted. They offer a very complex physiological model of stress, inflammation and CVD. Incorporates a lot of important new information but only for those with background in biology. I shall use model illustratively

Black, PH., & Garbutt, LD (2002). Stress, inflammation and cardiovascular disease. J. of Psychosomatic Res., 52, 1-23

Rozanski paper is very up to date account of stress and heart disease written for cardiologists. I strongly recommend it.

Rozanski, A., Blumenthal, JA., Davidson, KW, Saab, PC., Kubzansky, L (2005). The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice. J. American College of Cardiology., 45, 637-651.

Words you main not have come across

Atheroma, Atherosclerosis, Atherosclerotic plaque

Thrombus

Process of build up of atherosclerotic plaque, plaque rupture and thrombus formation.

What causes a Myocardial Infarction: Plaque rupture and blocked coronary artery

No MI, plaque remains

Unstable situation

Artery blocked, MI results

Black PH Garbutt LD (2003) Stress, inflammation and cardiovascular disease, J Psychosom. Res 52, 1 -23

Heart Rate SBP DBP50

70

90

110

130

150H

R (

bp

m)a

nd

BP (

mm

Hg

)

CV effects of Active Coping taskPatterson et al 1994

Baseline

Stroop

Mental Arithmetic

Psychological stress and platelet activation: Differences in platelet reactivity in healthy men during active and passive stressors. Patterson, S. M.; Zakowski, SG.; Hall, Martica H.;

Health Psychology, Vol 13, 1994. pp. 34-38.

Heart Rate SBP DBP50

70

90

110

130

150H

R (

bp

m)a

nd

BP (

mm

Hg

)

CV effects of Passive Coping taskPatterson et al 1994

Baseline

Combat surgery

Heart surgery

Active Stressor Passive Stressor No Stressor

0

10

20PF4

act

ivit

y (

ng

/ml)

Effects of stress on platelet activityPatterson et al, 1994

Baseline

Stroop

MA

Baseline

Surgery

Surgery

Baseline

Travel film

Travel film

Effects of stress on platelets, and hence clotting & process of atherogenesis. See particularly PF (Platelet Factor) 4

Low work demand High work demand0.06

0.12

0.17

0.23

0.28

0.34p

rog

ress o

f m

axim

al in

tim

al th

ickn

ess

Everson et al, 1997, BMJ, 314, 558-65Work demand, reactivity and progress of athersclerosis

Small BP reaction

Large BP reaction

The diathesis model: stress plus vulnerability