1. Health Psychology Chapter 9: Cardiovascular Disease/Strokes/Diabetes Oct 31-Nov 7, 2007 Classes #29-32

2. Cardiovascular Disease  Friedman and Rosenman (1959) Type A vs. Type B

3. Heart Disease  Due to narrowing or blocking of the coronary arteries.  Angina pectoris painful cramp in chest, arm, neck, or back due to brief blockage of oxygenated blood to the heart. More often during exercise, stress, cold temperature, digesting large fat meal. Little or no permanent damage

4. Heart Disease  Myocardium Muscle tissue around the heart  Myocardium infarction (heart attack) Prolonged blockage of blood to an area of the heart resulting in muscle tissue damage.  Symptoms of a heart attack Pressure in chest, fullness, squeezing pain. Pain spreading to shoulders, neck, or arms Lightheadedness, fainting, sweating, nausea

5. Who Is At Risk of Heart Disease?  Prevalence increases with age, particularly after 45 years of age  Prior to 50s, 60s, men at greater risk than women but increases in women after menopause.  More women than men are likely to die from a heart attack  Blacks at higher risk, Asians at lower risk

6. Heart Disease Risk Factors  High blood pressure  Family history  Cigarette smoking  High LDL and total cholesterol levels  Physical inactivity  Diabetes  Obesity  Stress

7. Why high blood pressure a risk factor?  Heart has to work harder.  Since heart muscle is working harder, it can become enlarged.  Wear and tear on the arterial wall can increase the likelihood of lipid and calcium deposits adhering to the arterial wall. This leads to hardening of the arteries.

8. Type A Behaviors  Hostile, cynical  Judgmental (opinionated)  Competitive  Time urgent  Uses gestures while talking  Nodding of head while others are talking  Intense

9. Physiological Reactivity  Physiological and cardiovascular reactivity to acute stress (“hot reactors”). Exaggerated increases in blood pressure, heart rate, catecholamines, corticosteroids  High levels of these hormones can damage heart and blood vessels  Presence of epinephrine (a catecholamine) increases the formation of clots.

10. Framingham's Heart Study (1948)  Uncontrollable Risk Factors Family History and Age Gender Race and Ethnicity  Controllable Risk Factors Hypertension Obesity Cholesterol level

11. When do heart attacks occur?  Less likely during sleep.  Among the employed, more often on a Monday between 6 and 11 am. In part due to waking and becoming active shortly after dreaming which increases BP. In part because of circadian rhythm effects, increases in arousal hormones and blood pressure.

12. Medical Treatment  Initial treatment may involve clot- dissolving medication and close monitoring  Balloon angioplasty Tiny balloon is inserted into blocked vessel and inflated to open blood vessel  Bypass surgery Use grafted vessel (e.g., piece from leg) to bypass blockage in artery to the heart

13. Medical Treatment  Medications (e.g., beta blockers, calcium channel blockers) to protect heart and improve function.  Risk management Control of high blood pressure Control of lipid abnormalities

14. Rehabilitation  Promote recovery and reduce risk of another attack  Heart disease is chronic condition requiring ongoing management.

15. Rehabilitation Includes:  Exercise Physiological and psychological benefits  Weight management  Smoking cessation  Lipid and BP management include dietary changes to control lipids  Reduce excessive alcohol intake  Stress management

16. Rehabilitation  Exercise is the key component but: 50% drop-out rate within first 6 months  For those who continue benefits include: Improved self concept, perceived health, sexual activity, involvement in social activities.  Those who stop are more likely to: Smoke, have poorer cardiac function, have higher body weight, be more sedentary, experience greater anxiety and depression.

17. What is a stroke?  Tissue damage to area of the brain due to disruption in blood supply, depriving that area of the brain of oxygen.

18. Symptoms of a Stroke  Sudden weakness or numbness of the face, arm, or leg (usually on one side of the body) dimness or loss of vision (usually one eye) Loss of speech or trouble talking or understanding speech Unexplained, severe headache Dizziness, unsteadiness, or sudden fall

19. Causes of Strokes 1. Infarction – blockage in cerebral artery that cuts off or reduces blood supply a) Thrombosis – blood clot b) Embolus – piece of plaque becomes lodged in the artery. 2. Hemorrhage – happens suddenly. Less frequent than infarction but more damaging and more likely to cause death.

20. Stroke Risk Factors  Rare up to age 55, than risk increases sharply with age (doubling with each decade).  More common in men but women more likely to die from them.  Rates highest among blacks and lowest among Asians.  Family history

21. Stroke Risk Factors  High blood pressure  Cigarette smoking  Heart disease, diabetes, and their risk factors such as obesity and physical inactivity.  High red blood cell count (making the blood thicker and likelier to clot).  Mini-strokes – transient ischemic attacks (TIA)

22. Effects of a Stroke  Some motor, sensory, cognitive, or speech impairment usually occurs  Limitations may be permanent but lessen in severity over time.  Younger patients recover better  Impairments caused by hemorrhages more easily overcome than those caused by infarctions.

23. Effects of Stroke  Motor impairments often due to paralysis on one side of the body (side opposite to brain damage). After about 6 weeks of rehab about 50% of patients can perform independently (many with cane or walker).  Language, learning, memory, and perception problems depend on location of the injury.

24. Effects of Stroke  Left-hemisphere damage more commonly associated with language problems called aphasia. Receptive aphasia – difficulty understanding verbal information. Expressive aphasia – difficulty producing and using language.  Damage to right side of brain often associated with difficulties in visual processing and emotions.

25. Psychosocial Aspects of Stroke  Denial is common Unclear whether psychological or physiological basis. This ambiguity also applies to depression when it occurs after a stroke.  Less than ½ of the patients return to work following a stroke.

26. Diabetes Survey on 2,000 People with Diabetes (Fall 2001)  Findings: 68% do not consider cardiovascular disease to be complication of diabetes 50%+ don’t feel risk for heart condition or stroke 60% don’t feel at risk for high blood pressure or cholesterol Awareness lowest among elderly, minorities 2

27. Diabetes-CVD Facts  More than 65% of all deaths in people with diabetes are caused by cardiovascular disease.  Heart attacks occur at an earlier age in people with diabetes and often result in premature death. 3

28. Diabetes-CVD Facts  Up to 60% of adults with diabetes have high blood pressure.  Nearly all adults with diabetes have one or more cholesterol problems, such as: high triglycerides low HDL (“good”) cholesterol high LDL (“bad”) cholesterol 4

29. The Good News…  By managing the ABCs of diabetes, people with diabetes can reduce their risk for heart disease and stroke. A stands for A1C B stands for Blood pressure C stands for Cholesterol 5

30. Ask About Your A1C  A1C measures average blood glucose over the last three months.  Get your A1C checked at least twice a year. A1C Goal = less than 7% 6

31. Key Steps for Lowering A1C  Eat the right foods.  Get daily physical activity.  Test blood glucose regularly.  Take medications as prescribed. 7

32. Beware of Your Blood Pressure  High blood pressure raises your risk for heart attack, stroke, eye problems and kidney disease.  Get your blood pressure checked at every visit. Target BP = less than 130/80 8

33. Key Steps for Lowering Blood Pressure  Eat more fruits and vegetables!  Reduce the amount of salt in diet.  Lose weight.  Lower alcohol intake.  Quit smoking.  Take blood pressure pills. many people require more than one pill 9

34. Check Your Cholesterol  Several kinds of blood fats: LDL (“bad”) cholesterol - can narrow or block blood vessels HDL (“good”) cholesterol - helps remove cholesterol deposits Triglycerides - can raise your risk for heart attacks/stroke 10

35. Key Steps for Controlling Your Cholesterol  Eat less saturated fat Foods high in saturated fat: fatty meats, high- fat dairy products, tropical oils  Eat foods high in fiber Examples: oatmeal, beans, peas, citrus fruits  Take cholesterol-lowering medication  Exercise regularly 12

36. Meal Planning  Work with a dietitian to develop your own, personalized meal plan to help you:  Lose weight, if needed.  Choose foods low in saturated fat.  Count carbohydrates (carbs). 13

37. Exercise A little bit goes a long way:  Try being more active throughout the day. Examples: work in the garden, play with the kids, take the stairs  Walk - work up to at least 30 minutes of walking on most days; you can even split this into a 10-minute walk after each meal. 14

38. Other Strategies  Get help to quit smoking.  Talk to your health care provider about taking aspirin and other medications to reduce your risk for heart disease and stroke. 15

39. General Tips Take steps to lower your risk of D-CVD complications: A1C < 7. Blood pressure < 130/80. Cholesterol (LDL) < 100. Cholesterol (HDL) > 40 (men) and > 50 (women). Triglycerides < 150. Get help to quit smoking. Be active. Make healthy food choices. Talk to your doctor about medication. 18

40. Credits  http://www.psych.yorku.ca/jirvine/3440/lectures/lecture9_termin alillness_heartdisease_stroke_files/lecture9_terminalillness_heart diesease_stroke.ppt.ppt http://www.psych.yorku.ca/jirvine/3440/lectures/lecture9_termin alillness_heartdisease_stroke_files/lecture9_terminalillness_heart diesease_stroke.ppt.ppt  http://www.diabetes.org/uedocuments/MaketheLinkPowerpoint.p pt http://www.diabetes.org/uedocuments/MaketheLinkPowerpoint.p pt