3.4.4. Psychosocial Issues

Question 1

What are risk factors?

Answer 1

Risk Factors: factor in the individual or population that increases the person’s likelihood of presentation the disease, a characteristic that is associated with increased disease frequency

Question 2

What is the Framingham study and what does it provide?

Answer 2

Framingham Heart study: longest continuing epidemiologic study
can determine your 10 year risk for general CVD using a set of predictors

Question 3

Set of predictors for the Framingham Study

Answer 3

sex
age
diabetes
smoking
treated and untreated systolic BP
total and HDL cholesterol
BMI (replacing lipids in a simpler model)

Question 4

as many as ___% of CHD deaths can be attributed to smoking

Answer 4

as many as 30% of CHD deaths can be attributed to smoking

Question 5

Relationship between smoking and CVD

Answer 5

dose response relationship

Question 6

Does CHD increase in women?

Answer 6

CHD rates increase 2-3x postmenopausal

Question 7

studies show that women are more likely to get _____ vessel disease

Answer 7

studies show that women are more likely to get small vessel disease

Question 8

Relationship between socioeconomic status and CHD

Answer 8

inverse linear relationship: the richer you are, higher socioeconomic status, the better you will do with a variety of diseases

Question 9

Study about effects of 9/11 on defibrillator discharges in patients vulnerable to sudden cardiac death.

What did it show?

Answer 9

there was a substantial increase in event rate in the 30-day period after 9/11

Question 10

Angry outbursts: raises blood pressure→ heart has trouble pumping, increase stroke risk.

What type of analysis is this?

Answer 10

Angry outbursts: raises blood pressure→ heart has trouble pumping, increase stroke risk (meta-analysis)

Question 11

___ ___ is associated with increased incidence of coronary heart disease (type I anger). Bottom line, being a type A personality isn’t bad, being hostile and angry is bad.

Answer 11

High hostility is associated with increased incidence of coronary heart disease (type I anger). Bottom line, being a type A personality isn’t bad, being hostile and angry is bad.

Question 12

What is type 1 anger

Answer 12

High hostility is associated with increased incidence of coronary heart disease (type I anger). Bottom line, being a type A personality isn’t bad, being hostile and angry is bad.

Question 13

Discuss the lcinical case involving acute mental stress and myocardial ischemia

Answer 13

Acute mental stress triggers myocardial ischemia

clinical case study: normal and ischemic LV wall motion
war veteran asked to think about stressful memories

during his recall/stressful imagery, the veteran experienced pronounced ischemia

Question 14

____________ is an index of myocardial ischemia

Answer 14

Abnormal left ventricular wall motion

Question 15

Acute psychological/mental stress can _____ diseased coronary arteries

Answer 15

Acute psychological/mental stress can constrict diseased coronary arteries

Question 16

What is job strain?

Answer 16

high job demand when individual has little control (job strain)

Question 17

What does job strain result in?

Answer 17

high job demand when individual has little control (job strain) results in increased hypertension and CHD

Question 18

unemployment associated with distress, mental illness and suicide in both workers and spouses. Increased mortality and increased ___ rates

Answer 18

unemployment associated with distress, mental illness and suicide in both workers and spouses. Increased mortality and increased CHD rates

Question 19

hypertension is _____ as likely among vets with mental health issues vs vets with no mental health diagnoses

Answer 19

hypertension is 2x as likely among vets with mental health issues vs vets with no mental health diagnoses

Question 20

Why is the following believed to be true?

hypertension is 2x as likely among vets with mental health issues vs vets with no mental health diagnoses

Answer 20

theory: fight or flight response that includes a variety of biological responses (catecholamine release, etc)

Question 21

___ ____ is a protective factor in CHF

Answer 21

social support is a protective factor in CHF

Question 22

Depression as a serious risk factor for ___

Answer 22

Depression as a serious risk factor for CHD

Question 23

prevalence of depression or depressive symptoms is about _____ in CAD patients

Answer 23

prevalence of depression or depressive symptoms is about 20% in CAD patients

Question 24

Effects of depression

Answer 24

changes autonomic nervous system function

changes platelet function (platelet serotonin is more activated in depressed people)

reduces compliance (medications, diet, etc)

Question 25

Studies so far have not shown that either ___ or ___l treatment for depression reduces risk for disease progression in CHD patients (currently an area of intensive study)

Answer 25

Studies so far have not shown that either psychological or pharmacological treatment for depression reduces risk for disease progression in CHD patients (currently an area of intensive study)

Question 26

What are protective factors?

Answer 26

Things like joining a gym, being active in church, improving diet, etc that reduce stress or medical illness and engage you in a community to help fend off things like CHD

Question 27

Recommendations to manage modifiable risk factors

Answer 27

acquire relaxation/stress management skills and supportive environment establish regular physical activity to improve physical conditioning and maintain weight avoid/stop cigarette smoking reduce saturated fat; increase omega-3 fatty acids; a diet high in fruits, vegetables, nuts and whole grains adhere to medical regimens to control hypertension and hyperlipidemia