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

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

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

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

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. 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

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

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)

What Causes 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 Wellness Councils of America © 2001

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

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

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

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

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

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

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

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

What can you do to combat CVD?

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

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 www.5aday.gov/ Wellness Councils of America © 2001

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

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

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

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

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

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)

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)

UNC Medical Student Study

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

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

Diathesis-Stress

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

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%

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