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Stress and heart disease: a few basics and heuristic models.

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1 Stress and heart disease: a few basics and heuristic models

2 Lecture 6. References. An excellent introduction to the field is provided by Andrew Steptoe 1998 “Psychophysiological basis of disease” in D & M Johnston, Health Psychology Vol 8 of Comprehensive Clinical Psychology. In library under series title. Kop provides readable account of psychological risk factors for CAD. His model provides the outline for the course & the material on “vital exhaustion” will be covered later. Kop, WJ (1999) Chronic and acute psychological risk factors for clinical manifestations of coronary artery disease. Psychosomatic Medicine, 61, 476-487.

3 Lecture Refs A good up to date general reference Krantz DS & McCeney MK (2002) Effect of psychological and social factors on organic disease: a critical assessment of research on coronary heart disease. Annual Review Psychology, 53, 341-369. I recommend that you read this paper. A flavour of research on stress and blood clotting can be found in Patterson et al, 1994. Psychological stress and platelet activation: differences in platelet reactivity in healthy men during active and passive stressors. Health Psychology, 13, 34-38.

4 Words you main not have come across Arteriosclerosis Atheroma, Atherosclerosis, Atherosclerotic plaque Thrombus

5 What causes a Myocardial Infarction: Plaque rupture and blocked coronary artery No MI, plaque remains Unstable situation Artery blocked, MI results

6 Process that make it more likely a thrombus (clot) forms

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




11 Does acute stress make MI more likely? Effects of earthquake on MI and D-dimer (biological measure that relates to clotting processes).

12 Kop 1999

13 Stress, cardiovascular reactivity and essential hypertension

14 Stress, reactivity and essential hypertension Reading. A good general source on hypertension is the chapter on “Cardiovascular disorders” by Krantz & Lundgren in Johnston & Johnston, Health Psychology. Page 189-217. Steptoe book (Psychological factors in Cardiovascular Disease)always worth reading. Chapters 1 and 8 relevant. Remember this book 20 years old.


16 Cardiovascular Reactivity (CR). Things that should be true if CR is a risk factor Is it an individual difference variable? Is it reliable? Is it one factor? Does it generalise?

17 Details from Kamarck et al (1992). No need to read paper

18 Steptoe & Vogele 1991 Reliability of CV response to mental stress testing Test-retest correlations HR.62 SBP.52 DBP.30

19 Cardiovascular Reactivity. Issues. Is it an individual difference variable? Is it reliable? Is it one factor? Does it generalise?

20 Kamarck 1992 again. Most corr. large and positive

21 Cardiovascular Reactivity. Issues. Is it an individual difference variable? Is it reliable? Is it one factor? Does it generalise?

22 From Johnston et al 1994; a) generalisation, b) beta adrenergic

23 Anastasiades & Johnston (1991)

24 Correlation of laboratory reactivity and HR variability in the field. SD of HR SD of HR (allowing for activity, posture).23 (p<.08).24 (p<.07) Johnston 2004, n=60, Average lab reactivity

25 Median split on laboratory reactivity HR Control HR Tutorial Low Reactors81.488.6 High Reactors78.796.6 Johnston, 2004. HR response to presenting in Tutorial

26 High Reactors Low Reactors Johnston, 2004, Relationship between subjective arousal & HR in HI and LO cardiac reactors



29 Does reactivity predict hypertension Markovitz 1998 3908 participants aged 18-30 followed up for 5 years. BP reactions to active & passive tasks assessed at start. SBP response to active challenge predicted significant rise in BP in men. Men whose SBP increased during video game by more than 30 mm Hg twice as likely to have rise in BP as men with average reaction of 10 mm Hg Findings from other studies mixed. Most reliable findings on beta-adrenergic tasks.

30 CV Reactivity. Causal role in disease? Risk marker Direct cause Indirect manifestation of causal factor

31 Stress, cardiovascular reactivity and coronary heart disease.

32 Lecture 7. Reading Manuck & Kaplans studies of stress in monkeys hard to get in Aberdeen libraries. Original study in: Kaplan JR, Manuck SB et al, 1983 Social stress and atherosclerosis in normocholesterolemic monkeys. Science, 220, 733-734.




36 Manuck, monkeys treated with beta blockade




40 The diathesis model: stress plus vulnerability

41 Kamarck 1998 Cross sectional study showing simple relationship between BP reactivity and atherosclerosis

42 Mittleman, 1995

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