1. Health Psychology and the Heart
Cardiovascular Disease
Wellness Councils of America © 2001

2. 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 You’ll Learn Today
In this presentation, you will gain knowledge on five critical components concerning cardiovascular disease.
These elements are aimed to give you a better understanding about CVD, and more importantly, what you can do to combat this disease.
Wellness Councils of America © 2001

3. A Look at Cardiovascular Disease
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
Unfortunately, cardiovascular disease has not gotten much better since 1991.
In 1992, heart disease killed more Americans than did lung, colon, prostate, and breast cancer combined.
In 1997, 59,000,000 Americans had been estimated to have one or more forms of cardiovascular disease.
In 1999, cardiovascular disease accounted for more than 40% of the nation’s deaths.
Wellness Councils of America © 2001

4. 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
Wellness Councils of America © 2001

5. What Is Cardiovascular Disease?

6. 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.
What is Cardiovascular Disease?
Cardiovascular disease includes a number of diseases that affect the heart and blood vessels. Some of these conditions include:
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. Heart attacks and chest pain fall under the category of coronary heart disease.
Stroke—arterial blockage that inhibits blood flow to the brain.
Wellness Councils of America © 2001

7. Examples 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

8. Examples -- 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)

9. What Causes Cardiovascular Disease?

10. 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
Wellness Councils of America © 2001

11. 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
Smokers have twice the risk of heart attacks than nonsmokers.
Smoking is estimated to be responsible for 20% of all deaths due to heart disease.
On average cigarettes cut about 7 years from a person’s life expectancy.
Wellness Councils of America © 2001

12. 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
Over 1/2 of American adults have high blood cholesterol.
High blood cholesterol increases the risk of heart disease by a factor of 2.4.
Wellness Councils of America © 2001

13. 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
1 in 4 adults has high blood pressure.
31.6% don’t know they have it.
Total costs for hypertension are $22 billion a year.
Wellness Councils of America © 2001

14. 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
60% of adults are not physically active on a regular basis—an additional 25% are completely sedentary.
Those who are physically inactive are 1.5 to 2.5 times more likely to develop coronary heart disease.
Wellness Councils of America © 2001

15. What Causes CVD? Risk Factor #5: Obesity Risk Factor #5 Obesity
The US is the most overweight nation in the world—1 in 3 Americans are obese.
People who are seriously overweight are more than three times as likely to have coronary artery disease as people of normal weight.
Wellness Councils of America © 2001

16. What Causes CVD? Risk Factor #6: Psychosocial factors
(will discuss later)
Risk Factor #6
Stress
72% of Americans experience frequent stress-related physical or mental conditions that greatly increase health care costs.
30% of workers report mental stress is the work condition that most endangers their health.
The relative risk of a heart attack is 2.3 times higher than usual in the two hours following an outburst of anger.
Wellness Councils of America © 2001

17. 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
Adults with diabetes have heart disease death rates about two to four times as high as those of adults without diabetes.
The risk of stroke is two to four times higher in people with diabetes.
An estimated 60 to 65% of people with diabetes have high blood pressure.
Wellness Councils of America © 2001

18. CIGARETTES & CHOLESTEROL CIGARETTES, CHOLESTEROL, HIGH BLOOD PRESSURE
Multiple Risk Factors
The danger of heart attack increases significantly by the number of risk factors present.
MALES
FEMALES
Example: 55-year-old male and female
Average risk = 100
Multiple Risk Factors
Studies and statistics have shown that carrying more than one risk factor greatly increases your likelihood of suffering from a heart attack.
NONE
CIGARETTES
CIGARETTES & CHOLESTEROL
CIGARETTES, CHOLESTEROL, HIGH BLOOD PRESSURE
Source: Framingham Heart Study, Section 37: The Probability of Developing Certain Cardiovascular Diseases in Eight Years at Specified Values of some Characteristics. (Aug. 1987)
Wellness Councils of America © 2001

19. What can you do to combat CVD?

20. 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
Quitting smoking is not an easy task, but keep the following in mind:
Former smokers achieve a 50 to 70% reduction in heart disease risk within five years of quitting.
Taking advantage of worksite smoking cessation programs and pharmaceutical interventions—they can make a huge difference.
Wellness Councils of America © 2001

21. Eat 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
Eating a healthy diet is essential to managing weight and ultimately controlling CVD. In fact, maintaining an ideal weight can reduce the risk of coronary artery disease by 35 to 55%.
At work, employees should opt for low-fat, low-calorie foods available in your cafeteria and in your vending machines.
Concentrating on “five a day” (five servings of fruit and vegetables) is a great way to help keep a healthy and balanced diet.
Check out The National Cancer Institute’s five a day program out at
Wellness Councils of America © 2001

22. Get Active
Physical activity is key when combating CVD—in fact, those who are physically active reduce their heart attack risk by 35 to 55%.
Wellness Councils of America © 2001

23. Get Screened BP, cholesterol
Health screenings and health risk appraisals (HRA’) are key indicators of health status. They help give an idea of what health issues need to be addressed.
Keep in mind that screenings and check-ups should be administered by a doctor or health specialist—grocery store or pharmacy blood pressure monitors should not take the place of a professional visit.
Wellness Councils of America © 2001

24. Address Psychosocial Factors
Personality Factors
Stress
Depression
Social Support
SES
As previously mentioned, stress is a major risk factor for CVD. In fact, 43% of all adults suffer adverse health effects due to stress—roughly 90 million people.
However, by implementing simple strategies into our daily routine, stress can be effectively controlled.
Wellness Councils of America © 2001

25. Psychosocial 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

26. Physiological 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

27. Narrowing 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)

28. Research 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)

29. UNC Medical Student Study

30. Research 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

31. Why Do Hostility and Anger Promote CVD?
Psychophysiological Reactivity Model
Ed Suarez study
Ho survey
Harassment during mental arithmetic task
Video (Christine – MIIT study)

32. Diathesis-Stress

33. 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

34. After 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%

35. Modifying Hostility and Anger
How to do it (small group exercise)
Redford Williams’ road-map approach (video)
Type A and exercise (Swoap article)
Wellness Councils of America © 2001