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PSYC 2301 (154)
Lecture 9

Lecture 9.docx

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PSYC 2301
Tarry Ahuja

Heart disease, hypertension; stroke, diabetes Overview - Understanding coronary heart disease - What is hypertension? - Understanding stroke - Diabetes 4 major chronic disorders - 4 major chronic disorders include: • Heart disease (CVD) • Stroke (CVD) • Hypertension • Diabetes (type 1/2) - All of the above chronic disorders: • Involve the circulatory and/or metabolic system • May be co-morbid disorders  Overweight may lead to increased rate of heart diseases • Have modifiable risk factors • Non-communicable diseases What is coronary heart disease? - Number two cause of mortality in Canada - Accounts for 1 out of 5 deaths in 2007 - Disease of modernization (diet, activity level) - CHD deaths: • 20% in men • 22% in women - Mostly premature deaths (<75 years old) - Major chronic disease- living with the disease - Caused by atherosclerosis- narrowing of coronary arteries - Lowers oxygen supply to heart - Temporary shortages cause angina pectoris • Sharp shooting pain - Severe deprivation (of oxygen) causes myocardial infarction - CHD is mediated by an inflammatory process - Proinflammatory cytokine IL-6 is involved - IL-6 stimulatesa process that causes atherosclerosis plaques - Levels of C-reactive protein (CRP) in the bloodstream is a strong predictor of CHD - Cause or indicator? - CRP is produced in the liver and released in the bloodstream - Weight gain and low physical activity cause elevated CRP levels - CHD is considered to be a systemic disease due to an inflammatory process - Other risk factors for CHD include: • High blood pressure • Diabetes • Cigarette smoking • Obesity • High serum cholesterol • Low physical activity - Metabolic syndrome is when an individual has 3 or more of the following: • Obesity centered around the waist • High blood pressure • Low levels of HDL • Difficulty metabolizing blood sugar (pre-diabetes) • High levels of triglycerides - CHD has a genetic link (family history) - Worsened by lower socio-economic status - Certain risk factors still remain unidentified Stress and CHD - Cardiovascular reactivity contributes to CHD by: • Damaging endothelial cells • This facilitates the deposit of lipids • Increases inflammation • Development of atherosclerotic lesions - Acute stress can cause angina/heart attack: • Emotional stress • Anger • Extreme excitement • Negative emotions • Sudden bursts of activity - Reactivity or coping to stress with hostility increases risk factors (i.e.: cholesterol) - Daily life stressors, work related stress, modernization, and low levels of control contribute to CHD Prime candidate - CHD is more common with: • Low socio-economic status • Males - Linked with: • Higher rates of physical inactivity • Smoking • Elevated cholesterol • Being overweight Why do we eat too much? - Personal food consumption has increased: • Serving size • Food access • Social context • Stress Women and CHD - CHD is a leading cause of mortality in women - Less is known about CHD in women - Occurs later in life for women but recovery rates are lower - Fewer women are referred to cardiologist - Fewer women return to work after heart attack - Younger women are protected via higher levels of HDL - Estrogen diminishes sympathetic n.s. arousal - After menopause CHD increases because of: • Weight pain • Increased blood pressure • Increased cholesterol, triglycerides - HRT does not reverse effects? - Less media messaging and education for women - Less counseling about lifestyle - Less likely to use pharmacotherapy - More likely to be misdiagnosed - Risk factors for CHD are similar for men/women: • Hostility is linked to poor cardiovascular recovery from stress • Negative attitude (i.e.: pessimism) • Anger and metabolic syndrome atherosclerosis • Depression is a risk factor for metabolic syndrome • Job-related stress - Women tend to display a lower QoL after treatment - Women more likely to go to long-term care facilities Cardiovascular reactivity, hostility - Anger and hostility are risk factors for CHD - May act as: • Potential risk factor for CHD • Predictor for survival • Potential trigger for heart attack/angina - Hostility linked to higher levels of proinflammatory cytokines and to metabolic syndrome - Most dramatic hostility includes: • Cynical hostility (suspiciousness, resentment, antagonism, distrust of others) - Response to stress is heightened and lasts longer in hostile individuals - Reactivity-hostility relationship is biopsychosocial process Cardiovascular reactivity - In some individuals stress causes: • Vasorestriction in peripheral areas of the heart • Simultaneously increases heart rate - Trying to transfer increased blood volume through constricted blood vessels - Eventually produces atherosclerosis lesions and plaque formation - Change in catecholamines may indirectly alter resilience of blood vessels - Stress and anxiety linked to CHD via changes in: • Blood coagulation • Fibrolytic activity (breakdown of blood clots) Depression and CHD - Depression plays an important role in the development and aggravation of CHD - Strong link between depression and metabolic syndrome - Depression just before coronary event is linked to inflammation - Depression is linked to elevated CRP (inflammation) - Treatment of depression may improve long term recovery from coronary events M
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