1. Cardiovascular Disease Risk and Treatment

2. CVD Classes of Risk Factors Inherent Physiological Psychosocial

3. Inherent Risk Factors Inherited Risks Family History of CVD Genes Gender to some extent Unclear why Glucose metabolism We’ll talk in Chapter 11 Ethnicity Reason a likely due to other risks

4. Physiological Conditions Hypertension Single biggest risk factor for MI and CVA Hypercholesterolimia Ratio now seen as more important predictor than cholesterol level alone HDL should be 22% of total for men and 25% of total for women Increase HDL Exercise Moderate alcohol consumption Decrease LDL Less saturated fat More vegetables Hyperlipidemia – Elevated fat in blood Triglycerides

5. Psychosocial/Behavioral Factors Education and Income Negative correlation Smoking Leading behavioral risk factor Have begun to decline as smoking rates decline (Chapter 2) Diet Anxiety & Depression After controlling for other risk factors there is a positive correlation Type A - Hostility/Anger Marriage and Social Support

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

7. Type A to CVD Hostility – Cynical mistrust, resentment Predictive but not independent Anger – Expressed hostility to others Independent predictor Expression of anger is the key

8. Cardiovascular Reactivity Physiological and cardiovascular reactivity to acute stress 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. CVR may be part of the difference between AA and Caucasians

9. Marriage and Social Support Being single and lacking social support is a risk factor for some Three years after MI, those with high stress and low social support had four times the death rate. Living alone after one heart attack triples the chances of having another and dying Loneliness lack of companion related to CVD in elderly. Elevated risk of death from CVD in women who perceive low support at work and home even when controlling for physiological risk factors.

10. Public Health Model and CVD AGENT – Cigarette Smoke, Cholesterol, Saturated Fat HOST – Hostility/CVR, Family History, African American, Exercise, Income, Education ENVIRONMENT – Social Support, Awareness,

11. Treatment Medical Psychosocial

12. Medical Treatment Risk management - Medications Control of high blood pressure Control of lipid abnormalities

13. 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

15. Psychosocial Rehabilitation Exercise Physiological and psychological benefits Weight management Smoking cessation Dietary changes to control lipids and cholesterol Reduce excessive alcohol intake Stress management Support groups

16. Psychosocial 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.