Behavioral cardiology: Recognizing and addressing the profound impact of psychosocial stress on cardiovascular health

Abstract

Psychosocial stress exerts independent adverse effects on cardiovascular health. The recent INTERHEART study reported that psychosocial stress accounted for approximately 30% of the attributable risk of acute myocardial infarction. Prospective studies consistently indicate that hostility, depression, and anxiety are all related to increased risk of coronary heart disease and cardiovascular death. A sense of hopelessness, in particular, appears to be strongly correlated with adverse cardiovascular outcomes. Time urgency and impatience have not been consistently related to risk of coronary disease, but do increase the likelihood of developing hypertension. Psychosocial stress appears to adversely affect autonomic and hormonal homeostasis, resulting in metabolic abnormalities, inflammation, insulin resistance, and endothelial dysfunction. Additionally, stress is often associated with self-destructive behavior and noncompliance with medications. Psychosocial stress is a highly modifiable risk and many factors have been shown to be protective. These include psychosocial support, regular exercise, stress reduction training, sense of humor, optimism, altruism, faith, and pet ownership. Simple screening questions are available to reliably indicate a patient at risk for psychosocial stress-related health problems.

A Prospective Examination of Antidepressant Use and Its Correlates in Patients With Acute Coronary Syndrome

“…In fact, it has been suggested that the magnitude of this depressive effect is similar to that of traditional cardiac risk factors such as hypertension and dyslipidemia (Das & O'Keefe, 2006).…”

Depression in Primary Care

“…Das et al recently reported findings from the Interheart study, which showed that psychosocial stress was responsible for <30% of the attributable risk of acute myocardial infarction. 2 In particular, a sense of hopelessness appeared to be strongly correlated with adverse cardiovascular outcomes. Similarly, Yusuf et al found that psychosocial factors represented the third greatest risk factor for acute myocardial infarction, after smoking and elevated ApoB/ApoA1 ratios.…”

Évaluation du perfectionnisme prescrit par autrui chez des patients souffrant de maladies cardiovasculaires du Saguenay-Lac-St-Jean et de ses relations avec l'activité physique, les habitudes alimentaires et le bien-être psychologique /

“…En ce qui a trait aux MCV, différentes études ont été conduites s'intéressant généralement aux traits de personnalité des patients coronariens ainsi qu'à leur niveau de stress (Das & O'Keefe, 2006;Haynes, Feinleib, & Kannel, 1980;Herrmann-Lingen & Buss, 2007;Jordan & Bardé, 2007;Molinari, Compare, & Parati, 2006;Myrtek, 2006;Ragland & Brand, 1988;Rozanski, Blumenthal, & Kaplan, 1999;Sparagon et al, 2001). Une étude longitudinale menée en Allemagne auprès de 5114 participants a conclu qu'un locus interne en ce qui concernait le contrôle de la maladie était associé à une diminution du risque d'infarctus du myocarde alors que les autres facteurs de personnalité mesurés n'ont pas été significativement associés à l'infarctus du 16 myocarde et aux AVC (Stiirmer, Hasselbach, & Amelang, 2006).…”

“…Toutefois, l'étiologie de la maladie coronarienne s'imprègne depuis peu de déterminants psychologiques (Das & O'Keefe, 2006;Haynes, Feinleib, & Kannel, 1980;HerrmannLingen & Buss, 2007;Jordan & Bardé, 2007;Molinari, Compare, & Parati, 2006;Myrtek, 2006;Ragland & Brand, 1988;Rozanski, Blumenthal, & Kaplan, 1999;Sparagon et al, 2001). Néanmoins, peu d'études sont menées afin de déterminer si les …”