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Chapter 13

Chapter 13.docx

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York University
PSYC 3170
Gerry Goldberg

1 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 2 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 3 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 Whos 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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