3.4.4. Psychosocial Issues Flashcards
What are risk factors?
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
What is the Framingham study and what does it provide?
Framingham Heart study: longest continuing epidemiologic study
can determine your 10 year risk for general CVD using a set of predictors
Set of predictors for the Framingham Study
sex age diabetes smoking treated and untreated systolic BP total and HDL cholesterol BMI (replacing lipids in a simpler model)
as many as ___% of CHD deaths can be attributed to smoking
as many as 30% of CHD deaths can be attributed to smoking
Relationship between smoking and CVD
dose response relationship
Does CHD increase in women?
CHD rates increase 2-3x postmenopausal
studies show that women are more likely to get _____ vessel disease
studies show that women are more likely to get small vessel disease
Relationship between socioeconomic status and CHD
inverse linear relationship: the richer you are, higher socioeconomic status, the better you will do with a variety of diseases
Study about effects of 9/11 on defibrillator discharges in patients vulnerable to sudden cardiac death.
What did it show?
there was a substantial increase in event rate in the 30-day period after 9/11
Angry outbursts: raises blood pressure→ heart has trouble pumping, increase stroke risk.
What type of analysis is this?
Angry outbursts: raises blood pressure→ heart has trouble pumping, increase stroke risk (meta-analysis)
___ ___ 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.
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.
What is type 1 anger
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.
Discuss the lcinical case involving acute mental stress and myocardial ischemia
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
____________ is an index of myocardial ischemia
Abnormal left ventricular wall motion
Acute psychological/mental stress can _____ diseased coronary arteries
Acute psychological/mental stress can constrict diseased coronary arteries
What is job strain?
high job demand when individual has little control (job strain)
What does job strain result in?
high job demand when individual has little control (job strain) results in increased hypertension and CHD
unemployment associated with distress, mental illness and suicide in both workers and spouses. Increased mortality and increased ___ rates
unemployment associated with distress, mental illness and suicide in both workers and spouses. Increased mortality and increased CHD rates
hypertension is _____ as likely among vets with mental health issues vs vets with no mental health diagnoses
hypertension is 2x as likely among vets with mental health issues vs vets with no mental health diagnoses
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
theory: fight or flight response that includes a variety of biological responses (catecholamine release, etc)
___ ____ is a protective factor in CHF
social support is a protective factor in CHF
Depression as a serious risk factor for ___
Depression as a serious risk factor for CHD
prevalence of depression or depressive symptoms is about _____ in CAD patients
prevalence of depression or depressive symptoms is about 20% in CAD patients
Effects of depression
changes autonomic nervous system function
changes platelet function (platelet serotonin is more activated in depressed people)
reduces compliance (medications, diet, etc)
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)
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)
What are protective factors?
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
Recommendations to manage modifiable risk factors
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
