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Chapter 13

PSYC 328 Chapter Notes - Chapter 13: Coronary Artery Disease, Coronary Circulation, Cardiopulmonary Rehabilitation

Course Code
PSYC 328
Barbel Knauper

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Chapter 13 Heart Disease, Hypertension, Stroke, and Diabetes
LO1 What is Coronary Heart Disease?
Number two killer in Canada
Not a major cause of illness and death until the 20th century
Disease of modernization alterations in diet and reduction in activity level
Recently began to level off
Most significant aspect: number of the deaths that occur each year are premature deaths (before 75)
Major chronic disease
Great frequency and the toll it takes on relatively young people
Understanding CHD
o Coronary heart disease (CHD): general term for illnesses caused by atherosclerosis, the
narrowing of the coronary arteries (vessels that supply the heart with blood)
When these vessels become narrowed/closed, the flow of oxygen and nourishment to the
heart is partially or completely obstructed
Angina pectoris: temporary shortages of oxygen and nourishment pain, radiates across
the chest and arm.
Heart attack (myocardial infarction): severe deprivation occurs
o Factors involved in the development of coronary artery disease
Inflammatory processes
Proinflammatory cytokine (IL-6) stimulates processes that contribute to the
buildup of atherosclerotic plaque
Low-grade inflammation appears to underlie many, if not most, cases of
cardiovascular disease.
Strong predictor: level of C-reactive protein in the bloodstream (assesses
inflammatory activity)
o Produced in the liver and released in the bloodstream in the presence of
acute or chronic inflammation
o Prognostic sign that this damage may be occurring, may not be related to
other risk factors for heart disease
Increased waist circumference and low levels of physical activity are also
associated with elevated levels of C-reactive protein and other inflammatory
Systemic disease rather than a disease of the coronary arteries because it is responsive
to inflammatory processes.
High blood pressure, diabetes, cigarette smoking, obesity, high serum cholesterol level,
stress, and physical inactivity
Exposure to air pollution
Metabolic syndrome: when a person has three or more of the following problems:
obesity centred around the waist; high blood pressure; low levels of HDL (good
cholesterol); difficulty metabolizing blood sugar, an indicator of risk for diabetes; and
high levels of triglycerides, which are related to bad cholesterol.
High cardiovascular reactivity
Routine screening for metabolic syndrome and inflammation (by assessing C-reactive
protein) increasingly recommended for most middle-aged adults.
Family history
Genetically based predisposition to cardiovascular reactivity may emerge
early in life + exacerbated by low socio-economic + harsh early family
Exposure to stress and difficulties related to early cardiovascular risk
o BUT taking all known risk factors together accounts for less than half of all newly diagnosed
cases of CHD many factors still unidentified
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Role of Stress
o Chronic stress and coronary heart disease are linked
o Cardiovascular reactivity damaging endothelial cells deposit of lipids increase
inflammation development of atherosclerotic lesions development of coronary heart
o The following factors increase risk of CHD
Post-traumatic stress disorder (PTSD) (twin study)
Acute stress involving emotional stress, anger, or extreme excitement, negative
emotions, and sudden bursts of activity may sudden clinical events, such as a heart
attack, angina, sudden death
Reactivity to stress or coping with it via hostility may interact with other risk factors
(e.g. elevated cholesterol level)
CHD more common + symptoms and signs earlier in low SES, esp. males physical
inactivity, smoking, elevated cholesterol
Indirect effects of stress work- related stress & heart disease
Low physical activity and poor diet angina or a heart attack
Balance of control and demand in daily life in general (High demand + low
control) risk for atherosclerosis
Stress due to social instability: urban and industrialized countries, migrants,
acculturation to Western society
Distress associated with cultural change, poor social
Women and CHD
o Coronary heart disease is a leading killer of women in Canada and other developed countries
but studies have all focused primarily on men
o Women: more compromised quality of life inequities in socio-economic status
o More protected at young ages than men against CHD
Premenopausal, higher levels of estrogen higher levels of high-density lipoprotein
(HDL) + diminishes sympathetic nervous system arousal protective effect against
heart disease
Smaller increases in blood pressure, neuroendocrine + some metabolic responses
o BUT higher risk after menopause
Weight gain
Increases in blood pressure, cholesterol, and triglycerides, also risk factors for CHD
Taking estrogen through hormone replacement therapy (HRT) post-menopause DOES
NOT prevent CHD!
Relation of estrogen to heart disease remains unclear
o Women are insufficiently informed about the risks
Less likely to receive counselling
Less likely to learn about the benefits of exercise, nutrition, and weight
Significantly less likely to receive and use drugs for the treatment of heart disease, (e.g.
aspirin, beta blockers, lipid-lowering agents)
More likely to not be diagnosed or to be misdiagnosed
o Reasons for disparities:
Inaccurate commonsense models of illness about gender differences in symptom
Peoples perception of chest pain: medical intervention less important for the female
than male patient
Women report more back pain, palpitations, nausea/vomiting, and loss of appetite
during an acute episode than men
o Social support, esp. in the marriage, is associated with less advanced disease in women
o Hostility, poor prognosis, pessimism poor cardiovascular recovery from
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o Anger, metabolic syndrome progression of atherosclerosis in women
Depression is a risk factor for metabolic syndrome, a precursor of heart
o Job-related factors that predict coronary heart disease in men may also be predictors for women
Employment as a clerical worker as opposed to a white-collar worker higher risk
Can Male and Female Qualities Affect Your Health?
Personality qualities associated with masculine or feminine construals
Agency (focus on the self) vs Communion (focus on others) vs Unmitigated
communion (extreme focus on others to the exclusion of the self)
o Men: higher than women do on agency
Agency good physical and mental health reduced psychological distress.
Communion positive caring orientation to others - higher in women few
relations to mental and physical health outcomes.
Unmitigated communion (self-sacrificing individual who fails to focus on his or
her own needs adverse health outcomes (poorer mental and physical health
outcomes) - higher in women
Little info on differences in men’s and women’s responses to treatment.
Women experience a different quality of life following coronary bypass surgery
o More anxiety after a heart attack (may be unrecognized or untreated)
o Female cardiac patients experience poorer quality of life
Cardiovascular Reactivity, Hostility, and CHD
o Anger and hostility - risk factors for CHD
o Proneness to anger expression potential development of heart disease + predictor of survival
Implicated in hypertension + stroke and diabetes (lesser degree) may be a general risk
factor for CHD + complications.
o Hostility higher levels of proinflammatory cytokines + metabolic syndrome CHD
o Cynical hostility (particularly high risk)
Suspiciousness, resentment, frequent anger, antagonism, and distrust of others, negative
beliefs about others, perception that other people are being antagonistic or threatening,
often highly verbally aggressive and exhibit subtly antagonistic behavior
People high in cynical hostility more conflict with others, more negative affect, more
resulting sleep disturbance higher risk
o Hostility + defensiveness particularly problematic for adverse cardiovascular changes
People do not report socially undesirable aspects of themselves) greatest association
between cardiovascular responses, heart rate, blood pressure under stressful situations
o Who Is Hostile?
Men: higher hostility in general
Hostility was significantly associated with a variety of CHD risk factors cholesterol
levels in white men, BUT unrelated to CHD risk factors in women
Women high in cynical hostility increased risk for developing CHD
o Developmental Antecedents
Hostility reflects an oppositional orientation toward people, developed in childhood,
stemming from feelings of insecurity about oneself + negative feelings toward others
Particular child-rearing practices: parental interference, punitiveness, lack of
acceptance, conflict, or abuse hostility
Hostility runs in families both genetic and environmental
Hyperactivity in childhood is also a predictor for adult hostility
Hostility and Cardiovascular Disease
Cynical hostility = psychological culprit in cardiovascular disease
Expressing versus Harbouring Hostility
o Expression of hostile emotions (e.g. anger and cynicism) more
reliable association with enhanced cardiovascular reactivity
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