Health Psychology

and the Heart

Health Psychology

and the HeartCardiovascular

Disease Cardiovascular

Disease

You should know:You should know:• What cardiovascular disease is• What causes cardiovascular disease• What you can do help prevent cardiovascular

disease• Relationship between personality and heart

disease• Strategies for coping with CVD

• What cardiovascular disease is• What causes cardiovascular disease• What you can do help prevent cardiovascular

disease• Relationship between personality and heart

disease• Strategies for coping with CVD

CVD = Heart disease (#1) + stroke (#3) – and

hypertension

Cardiovascular disease kills about one million

people in the United States each year.

CVD = Heart disease (#1) + stroke (#3) – and

hypertension

Cardiovascular disease kills about one million

people in the United States each year.

A Look at Cardiovascular Disease

A Look at Cardiovascular Disease

Annual U.S. Cardiovascular Disease Mortality

Annual U.S. Cardiovascular Disease Mortality

CVD has been the leading cause of death in the United States every year since 1900, with the exception of 1918, when there was a worldwide flu pandemic

What Is Cardiovascular Disease?

What Is Cardiovascular Disease?

What is Cardiovascular Disease?What is Cardiovascular Disease?

• Cardiovascular disease is an umbrella term that refers to any of a number of diseases affecting the heart and blood vessels.

• Cardiovascular disease is an umbrella term that refers to any of a number of diseases affecting the heart and blood vessels.

Examples of CVDExamples of CVD• Hypertension—a common, often asymptomatic disorder

characterized by elevated blood pressure persistently exceeding 140/90 mm Hg.

• Coronary Heart Disease—a general term that describes diseases of the heart caused by atherosclerotic deposits, or plaque, that result in a narrowing of the coronary arteries.

• Atherosclerosis – A chronic disease in which cholesterol and other fats are deposited

to the inner walls of the coronary arteries, reducing circulation to the heart

• Hypertension—a common, often asymptomatic disorder characterized by elevated blood pressure persistently exceeding 140/90 mm Hg.

• Coronary Heart Disease—a general term that describes diseases of the heart caused by atherosclerotic deposits, or plaque, that result in a narrowing of the coronary arteries.

• Atherosclerosis – A chronic disease in which cholesterol and other fats are deposited

to the inner walls of the coronary arteries, reducing circulation to the heart

Examples -- continuedExamples -- continued• Angina Pectoris

– A condition of extreme chest pain caused by a restriction of the blood supply to the heart

• Myocardial Infarction– A heart attack; the permanent death of heart tissue in

response to an interruption of blood supply• Stroke

– A cerebrovascular accident that results in damage to the brain due to lack of oxygen

– Diving Bell and the Butterfly– My stroke of insight (Jill Bolte Taylor – book and podcast)

• Angina Pectoris– A condition of extreme chest pain caused by a restriction of

the blood supply to the heart• Myocardial Infarction

– A heart attack; the permanent death of heart tissue in response to an interruption of blood supply

• Stroke– A cerebrovascular accident that results in damage to the

brain due to lack of oxygen– Diving Bell and the Butterfly– My stroke of insight (Jill Bolte Taylor – book and podcast)

What Causes Cardiovascular

Disease?

What Causes Cardiovascular

Disease?

Risk Factors for Cardiovascular Disease

Risk Factors for Cardiovascular Disease

• The Framingham Heart Study (1948 – Present)

– Landmark prospective study of demographic, biological, psychological risk factors in CVD

• Uncontrollable Risk Factors– Age, gender, family history, race/ethnicity– Testosterone

• Elevates LDL (bad) cholesterol– Estrogen

• Neutralizes oxygen free radicals that may contribute to vascular damage

• Controllable Risk Factors– Hypertension, body weight, diet, smoking, Type II diabetes, stress / hostility

• The Framingham Heart Study (1948 – Present)

– Landmark prospective study of demographic, biological, psychological risk factors in CVD

• Uncontrollable Risk Factors– Age, gender, family history, race/ethnicity– Testosterone

• Elevates LDL (bad) cholesterol– Estrogen

• Neutralizes oxygen free radicals that may contribute to vascular damage

• Controllable Risk Factors– Hypertension, body weight, diet, smoking, Type II diabetes, stress / hostility

What Causes CVD?What Causes CVD?Risk Factor #1: Smoking

– Reduces the amount of oxygen that can reach the body’s cells

– Increases blood pressure due to nicotine ingestion

Risk Factor #1: Smoking

– Reduces the amount of oxygen that can reach the body’s cells

– Increases blood pressure due to nicotine ingestion

What Causes CVD?What Causes CVD?Risk Factor #2: High Blood Cholesterol

–Fatty molecule (lipid)–Lipoproteins transport

cholesterol in the bloodstream (LDL vs HDL)

–LDL accumulates WITHIN artery walls, oxidizes, then inflammation occurs

Risk Factor #2: High Blood Cholesterol

–Fatty molecule (lipid)–Lipoproteins transport

cholesterol in the bloodstream (LDL vs HDL)

–LDL accumulates WITHIN artery walls, oxidizes, then inflammation occurs

What Causes CVD?What Causes CVD?Risk Factor #3:High Blood Pressure

– Arteries harden and become scarred from excess pressure

– High blood pressure is considered to be 140 mm Hg / 90 mm Hg

Risk Factor #3:High Blood Pressure

– Arteries harden and become scarred from excess pressure

– High blood pressure is considered to be 140 mm Hg / 90 mm Hg

What Causes CVD?What Causes CVD?Risk Factor #4:Physical Inactivity

– Contributes to obesity, high blood pressure, and a low level of HDL cholesterol

Risk Factor #4:Physical Inactivity

– Contributes to obesity, high blood pressure, and a low level of HDL cholesterol

What Causes CVD?What Causes CVD?Risk Factor #5:ObesityRisk Factor #5:Obesity

What Causes CVD?What Causes CVD?Risk Factor #6:Psychosocial factors

– (will discuss later)

Risk Factor #6:Psychosocial factors

– (will discuss later)

What Causes CVD?What Causes CVD?Risk Factor #7:

Diabetes– About two-thirds of people with diabetes

eventually die of heart or blood vessel disease.

Risk Factor #7:

Diabetes– About two-thirds of people with diabetes

eventually die of heart or blood vessel disease.

Multiple Risk FactorsMultiple Risk Factors• The danger of heart attack

increases significantly by the number of risk factors present.

• The danger of heart attack increases significantly by the number of risk factors present.

63 66

98113

136

175

202

288

Source: Framingham Heart Study, Section 37: The Probability of Developing Certain Cardiovascular Diseases in Eight Years at Specified Values of some Characteristics. (Aug. 1987)

NONENONE CIGARETTESCIGARETTES CIGARETTES & CHOLESTEROLCIGARETTES & CHOLESTEROL

CIGARETTES, CHOLESTEROL,

HIGH BLOOD PRESSURE

CIGARETTES, CHOLESTEROL,

HIGH BLOOD PRESSURE

MALES

FEMALES

Example: 55-year-old male and female

Average risk = 100

MALES

FEMALES

Example: 55-year-old male and female

Average risk = 100

What can you do to combat CVD?

What can you do to combat CVD?

Quit Smoking! Quit Smoking!

• In just 20 minutes after quitting, blood pressure decreases

• After 24 hours, the chance of heart attack decreases

• In just a year after quitting, the excess risk of coronary heart disease is decreased to half that of a smoker

• In just 20 minutes after quitting, blood pressure decreases

• After 24 hours, the chance of heart attack decreases

• In just a year after quitting, the excess risk of coronary heart disease is decreased to half that of a smoker

Eat RightEat Right• Diet directly affects

the development of atherosclerosis

• Fat intake should be no more than 30% of calories

• Saturated fat should be less than 10% of calories

• Diet directly affects the development of atherosclerosis

• Fat intake should be no more than 30% of calories

• Saturated fat should be less than 10% of calories

Get ActiveGet Active

Get Screened Get Screened

BP, cholesterol BP, cholesterol

•Personality Factors•Stress

•Depression•Social Support

•SES

Address Psychosocial Factors

Address Psychosocial Factors

Psychosocial Factors in CVDPsychosocial Factors in CVD

• Personality Factors– Type A – Friedman & Rosenman’s term for competitive,

hurried, hostile people who may be at increased risk for developing CVD

– Type B – More relaxed people who are not pressured by time

considerations

• Personality Factors– Type A – Friedman & Rosenman’s term for competitive,

hurried, hostile people who may be at increased risk for developing CVD

– Type B – More relaxed people who are not pressured by time

considerations

Physiological DifferencesPhysiological Differences

• Type A’s have more:– rapid blood clotting– higher cholesterol and triglyceride levels under

stress– greater autonomic arousal, elevated heart rate, and

blood pressure in the face of challenging events– “combat ready” hyperreactivity

• Type A’s have more:– rapid blood clotting– higher cholesterol and triglyceride levels under

stress– greater autonomic arousal, elevated heart rate, and

blood pressure in the face of challenging events– “combat ready” hyperreactivity

Narrowing it DownNarrowing it Down• Later Studies of Type A Reveal Mixed Results

– Type A too global– Focus on three specific components: hurriedness, competitiveness,

hostility– Hostility turns out to be key– Hostility components

• Cynicism• Anger• Aggression

– 20/20 Video (Dr. Redford Williams)

• Later Studies of Type A Reveal Mixed Results– Type A too global– Focus on three specific components: hurriedness, competitiveness,

hostility– Hostility turns out to be key– Hostility components

• Cynicism• Anger• Aggression

– 20/20 Video (Dr. Redford Williams)

Research StudiesResearch Studies

• Correlational study: Men with high Ho scores have more coronary artery blockages

• UNC Medical Student Study– Followed med students for 25 years– Those with higher Hostility scores (“Ho” from

the MMPI) were 5 x more likely to have developed CHD)

• Correlational study: Men with high Ho scores have more coronary artery blockages

• UNC Medical Student Study– Followed med students for 25 years– Those with higher Hostility scores (“Ho” from

the MMPI) were 5 x more likely to have developed CHD)

UNC Medical Student StudyUNC Medical Student Study

Research StudiesResearch Studies

• Atherosclerosis Risk in Communities (ARIC) Study– Massive study of 13,000 middle-aged men and women– People who scored highest on an anger scale were 2-

3 times as likely to have a heart attack or stroke than those with the lowest score

• Atherosclerosis Risk in Communities (ARIC) Study– Massive study of 13,000 middle-aged men and women– People who scored highest on an anger scale were 2-

3 times as likely to have a heart attack or stroke than those with the lowest score

Why Do Hostility and Anger Promote CVD?Why Do Hostility and Anger Promote CVD?• Psychophysiological Reactivity Model

– Ed Suarez study• Ho survey• Harassment during mental arithmetic task• Video (Christine – MIIT study)

• Psychophysiological Reactivity Model – Ed Suarez study

• Ho survey• Harassment during mental arithmetic task• Video (Christine – MIIT study)

Diathesis-Stress Diathesis-Stress

Why Do Hostility and Anger Promote CVD?Why Do Hostility and Anger Promote CVD?• Psychophysiological Reactivity Model

– Hostility and anger act slowly to damage the arteries and heart through unhealthy increases in blood pressure, blood levels of free fatty acids, changes in cholesterol, and outpourings of epinephrine, cortisol, and other stress hormones

• Health Behaviors and less social support

• Psychophysiological Reactivity Model – Hostility and anger act slowly to damage the

arteries and heart through unhealthy increases in blood pressure, blood levels of free fatty acids, changes in cholesterol, and outpourings of epinephrine, cortisol, and other stress hormones

• Health Behaviors and less social support

After CVD: Preventing RecurrencesAfter CVD: Preventing Recurrences

• Stress management following a CV episode lowers rates of mortality and morbidity (see Blumenthal study)

• Recurrent Coronary Prevention Program (RCPP)– Cognitive and behavioral techniques to help CVD

patients modify hostility, hurriedness, and negative emotions reduced risk of a second MI and total mortality rates by 50%

• Stress management following a CV episode lowers rates of mortality and morbidity (see Blumenthal study)

• Recurrent Coronary Prevention Program (RCPP)– Cognitive and behavioral techniques to help CVD

patients modify hostility, hurriedness, and negative emotions reduced risk of a second MI and total mortality rates by 50%

Modifying Hostility and AngerModifying Hostility and Anger

• How to do it (small group exercise)• Redford Williams’ road-map approach (video)• Type A and exercise (Swoap article)

• How to do it (small group exercise)• Redford Williams’ road-map approach (video)• Type A and exercise (Swoap article)