Psychosocial influences on the development and course of coronary heart disease: Current status and implications for research and practice.

Abstract

Psychosocial characteristics predict the development and course of coronary heart disease (CHD). In this review, the authors discussed human and animal research on psychophysiological mechanisms influencing coronary artery disease and its progression to CHD. They then reviewed literature on personality and characteristics of the social environment as risk factors for CHD. Hostility confers increased risk, and a group of risk factors involving depression and anxiety may be especially important following myocardial infarction. Social isolation, interpersonal conflict, and job stress confer increased risk. Psychosocial interventions may have beneficial effects on CHD morbidity and mortality, although inconsistent results and a variety of methodological limitations preclude firm conclusions. Finally, they discussed implications for clinical care and the agenda for future research.Coronary heart disease (CHD) is the leading cause of death in the United States; each year about 450,000 people die from CHD, and 1,000,000 experience an initial or recurrent coronary event (American Heart Association, 2001). Among healthy 40-year olds, between 40% and 50% of men and between 25% and 35% of women will later develop CHD (Lloyd-Jones, Larson, Beiser, & Levy, 1999). Over $100 billion is spent on CHD each year in the United States in direct medical costs, disability payments, and lost productivity (American Heart Association, 2001). This disease involves the three major topics composing behavioral medicine and health psychology, making it a central focus throughout their 30-year history. In the first (i.e., health behavior and prevention), modifiable behavioral risk factors (e.g., smoking, activity level, diet) are important risk factors for the development of CHD (Stamler et al., 1999;Wannamethee, Shaper, Walker, & Ebrahim, 1998), and behavior change is an essential component of prevention. In the second topic (i.e., stress and disease or psychosomatics), other psychological and social factors have more direct effects on the development and course of CHD through the intervening psychobiological effects of stress and negative emotions. In the third (i.e., psychosocial aspects of medical illness and care), established CHD has extensive emotional and social impacts on patients and their families, behavior is a key element of standard care (e.g., medication adherence, dietary change, exercise), and psychosocial interventions are useful additions to traditional medical and surgical treatment.Like the article on CHD in the previous special issue on behavioral medicine in this journal (Thoresen & Powell, 1992), we focused primarily on the second major topic-psychosocial influences on the development and course of CHD. We also reviewed one aspect of the third topic-interventions targeting psychosocial risk factors and their underlying psychophysiological mechanisms. Perhaps the most important implication of research on psychosocial risk factors for coronary disease is that interventions targeting these factors could reduce cardiac morb...

Personality and Physician-Assessed Illness Burden in Older Primary Care Patients Over 4 Years

“…A small portion of the influence of agreeableness upon rate of health decline was due to cholesterol levels, also consistent with prior reports (52). In particular, antagonism, or the tendency to engage in overt interpersonal conflict (17, 20), drove the overall agreeableness effect, consistent with the pathogenic effects of hostility upon elements of the cardiovascular system (6, 54). Hostile older persons probably also abdicate the health benefits of social support (55).…”

“…There are at least three theoretical mechanisms through which personality may operate to influence objective disease load (6,7). First, personality traits are strongly associated with health behaviors such as smoking, diet, and exercise (8).…”

Association between Depression and Anxiety Symptoms and Major Atherosclerosis Risk Factors in Patients with Chest Pain

“…Two indicators of socioeconomic status were educa-(CAD), atherosclerotic plaque rupture, and coronary vasospasm (Tennant and McLean 2001;Smith and Ruiz 2002). The concomitant psychophysiological response in depression and anxiety disorders is increased responsiveness of the sympathetic nervous system and hypothalamicpituitary axis (Shantze et al 1998;Grippo and Johnson 2002).…”

Occupational stress and cardiovascular disease

“…Comprehensive reviews of evidence linking OS to CVD are available to cover the period to the end of the 20th century (see for example, Byrne, 2000;Smith & Ruiz, 2002;Melamed, Shiron, Toker, Berliner, & Shapira, 2006). This paper focuses, therefore, largely on the evidence accumulating from the beginning of this century, accessed either through Pub Med or PsycINFO databases, and favouring studies with large samples, robust designs and theory-driven measures.…”