CAS PS 332 Lecture Notes - Lecture 15: Angina Pectoris, Coronary Artery Disease, Motivational Interviewing
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6 Apr 2020
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March 31st, 2020
Lecture 15
Cardiovascular disease interventions and motivational interviewing
Objectives:
- Identify the goals, timing and specific targets of preventing CVD onset and progression
- Distinguish primary, secondary and tertiary prevention
- Explain the goals, strategies, adherence, and outcomes/effectiveness of cardiac rehab
programs
- Describe the main goals and tenets of motivational interviewing (MI)
o Spirit of MI
o Principles of MI
o Ways to elicit change talk
CV System: review of key concepts
- CVD pathophysiology
o Hypertension
o Coronary artery disease
▪ Atherosclerosis
▪ Arteriosclerosis
o Ischemia
o Angina pectoris
o Myocardial infarction
o Stroke
- Mechanisms through which chronic stress → cardiovascular disease
CVD: epidemiology and risk factors:
- Leading cause of death in the US and worldwide
o Accounts for about 25% of US mortality (31% of deaths globally)
o Age, sex, race/ethnicity, region (within US and globally)
- Risk factors: characteristics that occur more frequently in someone with a disease than
someone without it
o Inherent
o Physiological
o Behavioral
o Psychosocial
Reducing risk
Types of prevention:
- Primary prevention: stop spread of disease
- Secondary prevention: detect it early and prevent it from getting worse or recurring
- Tertiary prevention: improve QoL and functioning and reduce symptoms of a disease
you already have
Preventing CVD ONSET: (primary prevention)
- Goal: address modifiable risk mechanisms to decrease the likelihood of future CVD onset
- Timing: promote health habits starting in childhood (diet, physical activity) and
adolescence (smoking)
- Barrier: reinforcing power of avoiding heart disease in 40+ years?
Prevention – Specific targets:
- Reducing hypertension (pre-hypertension)
o BP “set point” regulated to be chronically high
o Antihypertensive medication
▪ Side effects in meds but not high BP… implication for adherence?
o Weight loss and exercise
o Lower sodium intake
o Stress management/relaxation
- Lowering cholesterol
o Diet and exercise
▪ Increase fruits, veggies, grains
▪ Decrease saturated fats
▪ Increase physical activity
▪ More effective for prevention than treatment
o Medications (e.g., statins)
▪ These medications (statins) Block enzyme necessary to manufacture LDL
▪ Effective but potential for serious side effects
- Reducing psychosocial risk factors
o Decrease anxiety and depression
o Manage stress, anger, and hostility
o Promote better sleep
o CBT (or other empirically-supported treatment)
o Mindfulness
o Relaxation training
o Biofeedback
Cardiac rehabilitation:
Goals: avoid relapse/increase survival
- Cope with diagnosis
o Depression→ increase risk of death by 3.5x
o Anxiety about future attacks
- Adopt healthier lifestyle
o Behavioral modification programs
o Smoking, eating, exercise, etc.
o Stress management
- Return to normal physical activities
- Medically-supervised, multi-disciplinary programs