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Cardiovascular Disease (CVD)

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Disorders of the heart and blood vessel system, including stroke (peripheral) and coronary heart disease

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Coronary Heart Disease (CHD)

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#1 killer A chronic disease in which the arteries that supply the heart become narrowed or clogged

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Atherosclerosis

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Chronic disease in which cholesterol and other fats are deposited to inner walls of the coronary arteries, reducing circulation to the heart

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Atherogenesis

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Atheromatous plaques form in arteries inner lining (caused from inflammation: walls of arteries are inflamed cause damage to the cell walls which result in heart attack)

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Arteriosclerosis

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"Hardening of the arteries," chronic disease in which blood vessels lose their elasticity -Contributes toward hypertension and high blood pressure

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Angina pectoris

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A condition of extreme chest pain caused by a restriction of the blood supply to the heart (risk factor of heart attack; pain caused by less oxygenated blood being released to the heart)

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Myocardial infarction

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A heart attack; the permanent death of heart tissue in response to an interruption of blood supply

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Stroke

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A cerebrovascular accident that results in damage to the brain due to lack of oxygen (Depending upon how much damage there is, stroke victims can typically get some functioning back)

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Ischemia

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blockage in blood vessels to the brain due to blood clot, cholesterol deposits

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Hemorrhage

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bursting of blood vessels (massive amount of blood goes to brain which can cause brain cells to die) (Brain swelling against skull can cause damage)

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Electrocardiogram (EKG)

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A measure of the electrical discharges that emanate from the heart Includes stress test and echocardiogram

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Stress test

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checks to see if there's any irregularities while heart is pumping

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Echocardiogram

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Uses sound waves of heart beating against the chest which gives off echo of the heart ("Picture of the heart" -Reveals tissue damage, blood clots, problems with valves -Determines whether there is aneurism)

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Coronary angiography

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Diagnostic test in which dye is injected so that x-rays can reveal any obstructions in the coronary arteries (Dye gives image as to whether there is blockage in arteries and extent of blockage Definitive way to diagnose athlersclerosis)

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Cardiac medications

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Beta-blockers calcium-channel blockers vasodilators anticoagulants (prevent forming of blood clots) thrombolytic agents (medication that detects blood clots and quickly dissolves it)

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Coronary artery bypass graft

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Form of surgery in which a small piece of healthy vein is grafted around a blocked coronary artery (if blockage is bad enough, bypass surgery must be done) *Use to be only way blockage of arteries is treated *Blocked artery cut from blood supply to become dead, then graft healthy vein over artery for blood to flow through healthy vein

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Coronary angioplasty

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Surgery in which an inflatable catheter is used to open a blocked coronary artery (catheter inflates to open up artery, then is entered in to keep artery open)

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Framingham's Risk Factors for Cardiovascular Disease

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(See slideshow and notes)

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Framingham Heart Study

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(began 1948) -Study where we first learned about cholesterol, risk factors, etc. -Landmark prospective study of demographic, biological and psychological risk factors in CVD

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Uncontrollable risk factors

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*Identified from Framingham Heart Study Age (older you get, higher risk of cardiovascular disease) gender family history (strongly predicts cardiovascular disease) race/ethnicity

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Controllable risk factors

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*Identified from Framingham Heart Study Hypertension, body, weight, diet, smoking (Things we can change/ do something about)

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Gender differences in CVD

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May be due to sex hormones

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Testosterone

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-Linked with aggressiveness, competitiveness and other behaviors that may contribute to CVD -Levels peak during early adulthood, just when gender difference immortality peaks

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Estrogen

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-Helps elevate "good cholesterol" (HDL) -Helps clean out arteries

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Mortality Rates for CVD and Breast Cancer

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(See slideshow and notes) -Women are more likely to die from cardiovascular disease than breast cancer -Most common killer in women, yet not #1

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Gender differences in CVD recovery

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-Women are twice as likely as men to die following a heart attack -Women with CVD tend to be older than men with CVD (10-15 years after with chronic conditions) -CVD tends to be diagnosed earlier in men than in women (underrepresentation of women in clinical trials) -Men receive more aggressive diagnostic and treatment procedures

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Race and ethnicity

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(See slideshow and next notecards for details)

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Who are at increased risk of CVD?

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Compared with white Americans, African-Americans are at increased risk of CVD -African American women are less likely to be diagnosed for more aggressive treatment/diagnosis

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Who are at lower risk of CVD?

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Asian and Latin-Americans are at lower risk of CVD -Some reasons involve healthier food choices, exercise by walking around, more physical jobs, low stress levels due to strong family routes and support

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Do socioeconomic factors effect CVD?

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People of low SES tend to have more total CVD risk factors, including high-fat diets, lack of exercise, smoking, lack of access to health care and stressful life experience -Financial difficulties can cause higher rates of divorce

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Chicago Heart Association Detection Project

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Men with the healthiest lifestyles had a life expectancy 9 years longer than other men in their age group

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Hypertension

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A sustained elevation of diastolic and systolic blood pressure (140/90) -Over a period of time

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Primary (essential) hypertension

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Exact cause is unknown (most causes of hypertension are not really known)

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Causes of hypertension

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-No single cause, but rather the interaction of biological, psychological and social factors -Obesity, lack of exercise, dietary salt and excessive stress can produce hypertension in biologically predisposed people -Also related to anxiety and anger, especially in middle-aged men -Prevalence varies widely among racial and ethnic groups (more in African-American men compared with European American men) *Excessive/chronic stress can lead to higher risk of hypertension *Biological predisposition for higher risk of hypertension *Biological + behavior factors = much higher risk

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Cardiovascular Reactivity

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An individual's characteristic reaction to stress, including changes in heart rate, blood pressure and hormones *Looking at how strong of stress response person has *Some people have stronger reaction towards stress due to nervous system

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Obesity

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-Abdominal obesity promotes the greatest risk of CVD -This explains why men have greater risk of CVD *Most of weight centered in abdomen for men (hips for women) *Lower levels of HDL; higher triglyceride levels *Thicker, narrow artery walls (blood has hard time getting through blood vessels)

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Risk factor of cholesterol levels

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Depends on how high or how low cholesterol levels are

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Total cholesterol level of 240 or greater

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Doubles the risk of CVD

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Total cholesterol level below 200

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Lowers the risk of CVD

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High total cholesterol and low HDL levels

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Promotes the greatest risk (HDL below 40 mg/dL is considered a risk factor)

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The French Paradox

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Regular consumption of flavonoids in red wine and other foods may offer some protection against an otherwise unhealthy diet *The French eat the most fatty foods, exercise less (less aerobic exercise and gyms) and smoke the most, yet have low cardiovascular disease *French might have lower risk due to lower portions of food, walking and biking used as transportation in cities, etc.)

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Flavonoids

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Lower bad LDL cholesterol and raise good HDL cholesterol levels *Found in red wine (Yet for women, 1-2 cups of alcohol a day puts at risk of alcohol abuse and breast cancer *Found in a lot of other foods (Vegetables in rich color such as carrots, parsley, broccoli etc., citrus fruits, berries, green tea and dark chocolate)

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Metabolic syndrome

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Three or more of following: higher risk of heart disease -Large waist circumference -Elevated serum triglyceride -Low HDL cholesterol -Elevated blood pressure -Glucose intolerance (insulin resistance; insulin decreases glucose levels, unless insulin cannot bind to receptors)

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Psychosocial Factors in CVD

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Involve Type A and Type B

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Type A people

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(Friedman & Rosenman's term) Competitive, hurried hostile people who may be at increased risk for developing CVD

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Type B people

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More relaxed people who are not pressured by time considerations and thus tend to be resistant to coronary disease

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Type A people have:

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-More rapid blood clotting (risk for stroke and heart attack) -Higher cholesterol and triglyceride levels under stress -Greater autonomic arousal, elevated heart rate and higher blood pressure in the face of challenging events -"Combat ready" hyper reactivity (ready to respond in strong, vigilant, quick to react fight or flight response) *Anxiety and depression are also associated with Type A and CVD (more likely to be anxious and depressed)

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Carver & Glass Study (1978)

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Type A students more likely to retaliate (instigation condition than Type B students) -Study involved paired up college students with another "student" (confederate part of study) -Worked on problem solving task -Instigation group (Type A): confederate would antagonize participant -Non-instigation group (Type B): participant and confederate would work together -Next assignment: computer task (if confederate got something wrong then would get shock from participant; participant got to choose shock level)

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Hostility and heart attacks

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(PLEASE SEE GRAPH FROM SLIDESHOW AND NOTES FOR DETAILS)

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Hostility

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-Negative attitude -Often long-lasting *Involves cynical (don't expect good things of people, pessimistic)

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Anger

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-Negative emotion -Accompanied by physiological arousal (sympathetic nervous system; fight or flight response) -Usually shorter in duration *People who get ________ all the time

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Expression of anger-hostility

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Positively correlated to severity of coronary artery blockage *Those with higher anger and hostility have more sever atherosclerosis

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Atherosclerosis Risk in Communities (ARIC) Study

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-Massive study of 13,000 middle-aged men and women -People who scored highest on an anger scale were three times more likely to have a heart attack than those with the lowest score

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Suppressed anger and expressed anger

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Suppressed anger may be as hazardous as expressed anger (Pennebaker)

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Depression

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-Strongly implicated risk factor in CVD and metabolic syndrome; rivals regular expose to secondhand smoke -Not simply an aftereffect of CVD diagnosis; rather, an independent risk factor with likely genetic and environmental causes -Remains underdiagnosed and often untreated in many people with CVD *Prediction of cardiovascular disease *Those diagnosed are prior to heart disease (4x more likely to have a heart attack) *Less likely to take care of themselves *Very undiagnosed, most people not treated for it

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C-reactive protein

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Found in great amounts of people depressed (show inflammation in blood vessels)

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Psychosocial Vulnerability Hypothesis

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Hostile adults lead more stressful lives and have low levels of social support, which, over time, have a toxic effect on cardiovascular health *Face more interpersonal conflicts, problems with work and at home, etc.

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Health Behavior Explanation

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Hostility has an indirect effect through its relationship to other CVD risk factors, including obesity, hypertension, alcohol and tobacco use *More likely not to eat healthy and exercise

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Psychophysiological Reactivity Model

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Hostility and anger act slowly to damage the arteries and heart through unhealthy increases in blood pressure, blood levels of free fatty acids, and outpourings of epinephrine, cortisol and other stress hormones

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The Biopsychosocial Model

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-CVD is triggered by physiological vulnerability in conjunction with a variety of psychosocial factors in the person's life -Stress from work and home environments -Availability of social support -Cognitive-emotional states such as hostility and anger

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Reducing the risk of CVD

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-Controlling hypertension by lowering sodium intake, reducing excess body weight and exercising regularly -Reducing cholesterol by limiting intake of animal fats and hydrogenated oils -Combination of stress management, aerobic exercise, relaxation training, smoking cessation and low fat diet (e.g. the Ornish program) may reverse the development of CVD (yet, can be intensive) *Research tries to find ways for people to change their health lifestyles

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After CVD: Preventing Recurrence

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Stress management following a cardiovascular episode may lower rates of mortality and morbidity

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Controlling Hostility and Anger

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-Hostile people are more likely to encounter stress and less likely to have stress-busting resources such as social support -Interventions focus on identifying triggers of anger, developing strategies for coping with aggravation and helping participants challenge cynical attitudes and modify unrealistic beliefs and expectations *Anger comes into play once cardiac condition comes into effect. (Anger management is then needed) *If you expect too much from other people, you get angry *Obtaining attitudes that things should be done your own way. Yet, the only control we have is on ourselves, not on other people.

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Cynical attitudes

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Contributes toward hostility "People are out to get you, not to help you" can contribute towards anger

PSY 241 Intro to Health Psychology Chapter 10 – Flashcards

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