PSYC 3170 Chapter Notes - Chapter 13: Coronary Artery Disease, Coronary Circulation, Blood Sugar

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24 Apr 2012
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Chapter 13: Heart Disease, Hypertension, Stroke, and Diabetes
What is coronary heart disease?
Coronary heart disease (CHD) is the number one killer in Canada
Past: people died of infectious disease
Caused by alterations in diet and decreased physical activity
Account for 35% of death for men and 37% of death in women
Is a major chronic disease
Identified as: biological, social determinates and cures have been high priority in
health research in Canada
Understanding CHD
Coronary heart disease (CHD): is general term that refers to illnesses caused by
atherosclerosis, narrowing of coronary arteries (vessels supply heart with blood)
o Temporary shortages of oxygen and nourishment cause pain = angina
Inflammatory process in development of disease = buildup of atherosclerotic
plaque (IL6)
Strong predictor of heart disease = level of c-reactive protein in bloodstream
o C-reactive protein = produced in liver and released in bloodstream in
chronic or acute inflammation
o Heart disease a systemic disease rather than coronary arteries; because
responsive to inflammatory process
Risk factors:
o High blood pressure
o Diabetes
o Cigarette smoking
o Obesity
o High serum cholesterol level
o Low levels of physical activity
o Exposure to air pollution
Metabolic syndrome: is diagnosed when a person has three or more of the
following problems:
o Obesity centered around waist
o High blood pressure
o Low levels of HDL (good cholesterol)
o Difficult metabolizing sugar
o High triglycerides-bad cholestoral
Also a family history component which includes:
o Predisposition to cardiovascular reactivity (early in life)
o Low-socio economic status
o Harsh early family environment
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Role of stress
Chronic stress leads to CHD
Damaging endothelia cells and deposits of lipids, increasing inflammation, and to
heath disease
Acute stress: anger, emotional stress, extreme excitement, sudden burst of
activity = can produce sudden heart attack
Heart disease more common in:
o Low socio-economic status
o Males
o Symptoms of cardiovascular disease develop early
Research in CHD in workplace reveals several job factors increase risk:
o Job strain
o High work demands and low control
o Discrepancy between education and job level
o Low job security
o Little social support at work
o High work pressure
o Vigilant coping strategy
Stress due to social instability may be tied to higher rates of CHD
Higher incidence of CHD in industrialized countries than in developing
Western countries more at risk for high blood pressure
Distress is due to cultural change (immigrants)
And those people who are more occupationally, residentially or socially mobile =
at risk for CHD
Women and CHD
Is the leading killer in women in Canada and most developed countries
37% of all female deaths
Studies in rehabilitation, risk, diagnosis has been focused on men
Occurs later in women but is more dangerous
o Women less likely to recover than men do
More women admitted to hospital for heart problems than men
34% women unable to work; compared to 28% of men
Women more protected at young age because of higher levels of high-density
lipoprotein which linked to premenopausal higher levels of estrogen
Women experience higher risk of CHD after menopause
o Gain weight
o Increased blood pressure
o Cholesterol
o Triglycerides
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Brief estrogen replacement therapy following menopause would keep rates of
CHD down
Women who are more physically active, low cholesterol, and triglycerides = same
as men (low change of CHD)
Hostility = poor cardiovascular recovery from stress, poor prognosis and is
pessimism
Depression = risk for metabolic syndrome (precursor of heart disease)
Women experience more anxiety after heart attack
Women more likely referred to long-term care facilities rather than sent home or
to rehabilitation
Poorer quality of life than men
More older women have stopped smoking and have changed diets in healthy
direction
Cardiovascular Reactivity, Hostility, and CHD
Anger and hostility are risk factors for CHD
o Both risk factor and development of heart disease
Anger linked to hypertension, stroke, and diabetes
o Risk for CHD, cardiovascular disease and complications
Hostility = higher levels of proinflammatory cytokines and metabolic syndrome
Cynical hostility =suspiciousness, resentment, frequent anger, antagonism,
distrust of others
o More conflict with others
o Negative affect
o Sleep disturbance
Hostility combined with defensiveness = adverse cardiovascular changes
Both hostility and defensive greater association between cardiovascular response
and coronary heart disease
Who’s Hostile?
Men = higher hostility (heightened risk CHD)
Higher hostility = non-Whites and lower socio-economic status
Developmental Antecedents
Insecurity and negative feelings towards others developed in childhood
Children rearing practices that foster hostility
o Parental interference
o Punitiveness
o Lack of acceptance
o Conflict
o Abuse
Family environments for hostility in sons :
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