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PSYC 328 (50)
Chapter 13

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McGill University
PSYC 328
Blaine Ditto

PSYC328 Chapter 13 Notes Heart Disease, Hypertension, Stroke, and Diabetes: • Heart disease , hypertension, stroke and diabetes are termed as noncommunicable diseases. What is Coronary Heart Disease? Number two killer in Canada • • Not a major cause of illness and death until the twentieth century Accounts for 20 percent of deaths of men and over 22 percent for women • • CHD is considered a systemic disease because of it’s responsiveness to inflammatory processes. • General term referring to illnesses caused by atherosclerosis (the narrowing of the coronary arteries) • Narrowing causes shortage of oxygen and nourishment flow, causing angina pectoris • Inflammatory processes, for example the increase of cytokine (IL6) stimulates the process contributing to the buildup of plaque • Level of Creactive protein (produced in the liver and released into the bloodstream in the presence of inflammation) indicates damage is occurring as inflammation promotes damage to the walls of blood vessels. • Increased waist circumference and low levels of physical activity are risk factors for CHD, as they are associated with higher levels of Creactive protein • Risk factors include: • High blood pressure • Diabetes • Cigarette smoking • Obesity • High serum cholesterol level • Metabolic syndrome: Person has THREE or more of the following problems; • Obesity around the waist • High blood pressure • Low levels HDL • Difficulty in metabolizing blood sugar • High triglyceride levels • Heart disease has family history component, which includes genetic predispositions to cardiovascular reactivity • Reactivity can be exacerbated by low SES, harsh early family environment and stress Role of Stress: • Chronic stress damages endothelial cells, facilitating deposit of lipids, increasing inflammation, ultimately increasing atherosclerotic lesions • Acute stress involving emotional stress can precipitate heart attack, angina or sudden death • Those with low SES are more common to develop heart disease, especially males. • People with high levels of demand with low levels of control outside of the workplace are at more risk for atherosclerosis • Social instability, migrants, cultural change are all link to increase risk of CHD Women and CHD: CHD is leading killer of women • • Occurs later for women Women are less likely to recover from a cardiac event compared to men • • At young ages, women are protected from higher levels of highdensity lipoprotein (HDL), linked to higher levels of estrogen • Estrogen also diminishes sympathetic nervous system arousal, increasing protective effect against heart disease • After menopause, decreased estrogen and increased weight gain enhance CHD risk • Women are less likely to receive counseling about heart disease, to receive and use drugs, and more likely to be misdiagnosed or not to be diagnosed compared to men with CHD • Women report more symptoms of: • Back pain • Palpitations • Nausea/vomiting • Loss of appetite • Progression of atherosclerosis is predicted by anger and metabolic syndrome in women • Little is known about the differences in men and women’s responses to treatment, however women do not receive the same quality of care • Nurses’ Health Study in 1976 showed that women who adhered to recommended guidelines involving diet, exercise, and abstinence from smoking had low risks of CHD Cardiovascular Reactivity, Hostility, and CHD: • Anger and hostility are implicated as risk factors for CHD • Proneness to expression of anger implicated as a predictor for CHD, survival, and potential trigger for heart attack • Hostility linked to higher levels of proinflammatory cytokines and to metabolic syndrome • Particularly cynical hostility (suspiciousness, resentment, frequent anger, antagonism, and distrust) implicated • Cynical hostility creates more conflict with others, more negative affects, sleep disturbance, and difficulty extracting social support Who is Hostile? • Men show higher hostility • Non-whites are found to be more hostile • Lower SES individuals Developmental Antecedents: • Hostility develops in childhood • Particular child rearing practices such as parental interference, punitiveness, lack of acceptance, conflict or abuse • Create environments of hostility. • Hostility runs in families and both genetic and environmental factors appear to be implicated • Hyperactivity may also predict adult risk for hostility Expressing Versus Harboring Hostility: • Expression of hostile emotions (anger, cynicism, etc..) associated with enhanced cardiovascular reactivity than simply the state of anger or hostility • Those who suppressed hostility interpersonally within a study had higher cardiovascular reactivity than those who expressed hostility interpersonally • This connection between hostile style and increased cardiovascular reactivity is not as reliable for women as it is for men Hostility and Social Relationships: • Hostile individuals have more interpersonal conflicts in their lives and less social support, which can contribute to risk for disease • In a study 60 couples discussed under conditions of high or low threat of evaluation of others either agreeing or disagreeing with each other. Husbands who were high in hostility showed greater blood pressure reactivity in response to stressful marital interaction during threat. The same was not found for wives. Hostility and Reactivity: • Chronically hostile people show more pronounced physiological reactions in response to interpersonal stressors Hostile individuals exhibit a week antagonistic response to sympathetic activity in response to stress, that in turn • lasts longer Hostile individuals have larger and longerlasting blood pressure responses and different patterns of immune • activation in response to sympathetic activation Hostility can predict high levels of creactive protein when paired with anger and depression • • Hostility relationship can be thought of as a biopsychosocial process, developing from the environment, with a genetic predisposition as well as cognitively negative affect response Mechanisms Linking Reactivity and Psychological Factors: • Stress cause vasorestriction in areas of the heart and accelerates the heart rate, producing a wear and tear on the coronary arteries producing atherosclerotic lesions • Catecholamines exert a direct chemical effect on blood vessels: rise and fall of catecholamine levels in the presence of stress prompts changes in blood pressure that undermine the resilience of vessels • Sympathetic activation, which can occur during stress, causes lipids to be shunted into atherosclerosis • Hostility related to increased lipid profiles and increased platelet activation in coronary heart disease patients • Cynical hostility is not related to inflammatory processes Depression and CHD: • Depression has a central and independent role in development of CHD • Depression is environmentally rather than genetically based in this role • Research supports a strong link between depression and metabolic syndrome, cardiovascular disease, likelihood of a heart attack, heart failure among the elderly • Link with depression more consistent in men than women • Depression has strong link to inflammatory processes, like atherosclerosis and elevated creative protein levels. • Depression is treated with serotonin reuptake inhibitors which block receptors, reducing formation of clots by preventing platelet aggregation Other Psychological Risk Factors and CHD: • Anxiety implicated in sudden cardiac death as it reduces vagal control of heart rate • Composite index of anxiety, hostility and anger is a better predictor than any in isolation • Helplessness, pessimism, and a tendency to ruminate also contribute to risk of coronary heart disease • People who ruminate experience sustained blood pressure elevations, placing them at risk for greater damage Social dominance (attempting to dominate social interactions) is related to allcause mortality and morality due to • coronary heart disease Vital exhaustion, feeling dejected or defeated and enhance irritability to risk of coronary disease • Modification of CHD Risk Related Behaviour: • Interventions focus on those at risk for heart disease as well as reducing risk among general population • Interventions target, exercise, healthy eating, stopping smoking, etc… Management of Heart Disease: Role of Delay: • Reason behind high rates of mortality due to patients delaying several hours or days before seeking treatment • Older patients delay longer, or those engaged in self treatment • Experiencing attacking during the day, having a family member present enhances delay as the environment is more distracting Initial Treatment: • CHD managed several ways depending on clinical symptoms • Coronary artery bypass graft treats blockage of major arteries, leading to improvement in angina and psychological distress if delivered timely (note: cognitive dysfunction may result) • Of the patients who had experienced CABG, scores social functioning scores were lower for those who waited more than 3 months for a CAGB, and longer wait times were associated with increased number of C
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