Chapter 10

Question 1

Is dying of heart break scientifically possible? If so, what is it called and how does it work?

Answer 1

> It is referred to as “broken-heart syndrome” (or takotsubo syndrome in Japan)

> it is a stress-induced cardiomyopathy (disease of the heart muscle)

> When an individual endures a significant amount of emotional distress, the body is flooded with hormones that directly impact the heart.

> Rapid and immense levels of these hormones can influence the heart to enlarge and pump blood inefficiently

> these effects are typically transient and most individuals fully recover within two months; however, this intense hormonal cascade can lead to heart failure and in rare cases death

Question 2

Diseases of the cardiovascular system include those that occur in what organ, what two sytems?

Answer 2

> those that occur within the heart and the blood transport or circulatory system (i.e., veins and arteries).

Question 3

Is CVD a leading cause of death? If so, for which countries?

Answer 3

> these diseases are among the leading causes of death for North American men and women

Question 4

Are people living with chronic CVD? (What do the mortality rates say…)

Answer 4

> Fortunately, due to advances in treatment, mortality rates from cardio-vascular disease (CVD) have significantly declined in developed nations such as Canada and the United States

> Since mortality rates have de-clined, and onset of disease has not, this means that many people are living with chronic CVD.

Question 5

What factors are associated with the onset of CVD and its progression, as well as the quality and quantity of life of those with CVD?

Answer 5

> psychological factors
such as depression or behavioural changes that come with the diagnosis?

Question 6

The optimal management of heart disease requires what?

Answer 6

> requires multiple behavioural changes, such as abstinence from tobacco, regular physical activity, and adhering to a heart-healthy diet

Question 7

Coping with a heart condition and its treatment can also contribute stress in interpersonal relationships and role functioning (e.g., paid and unpaid work), thus impacting what?

Answer 7

> impacting quality of life.

Question 8

The biopsychosocial model provides a framework describing how behavioural and social factors contribute to the onset of CVD- how does it work?

Answer 8

> Specifically, injury to the endo-thelium is often caused by hypertension (high blood pressure), diabetes (problems regulating blood sugar), and hyperlipidemia (too much cholesterol).

> These injuries are associated with modifiable behavioural and social risk factors such as smoking, abdominal obesity, physical inactivity, unhealthy diet, and psychosocial distress

Question 9

A temporary restriction of blood flow is known as what?

Answer 9

> ischemia (tissue cells remain alive but their functioning is disrupted), in which the heart tissue by the vessel is deprived of oxygen.

Question 10

In the instance of complete blockage, there is no distribution of oxygen and other nutrients to the tissues supplied by that artery- what is this called when it occurs in the arteries?

Answer 10

> When this occurs in the coronary arteries serving the myocardium (heart muscle), this is known as a “heart attack,” or myocardial infarction (mi).

Question 11

The continuum from unstable angina (i.e., ischemia causing chest pain that does not remit with rest) to MI is known as what?

Answer 11

> as acute coronary syndrome

Question 12

What is the end stage of heart disease?

Answer 12

> Heart failure is an end-stage of heart disease, when the heart cannot pump sufficient blood to meet the demands of the body

Question 13

What is the average life span of heart disease?

Answer 13

> the average lifespan of heart-failure patients is approximately five years following hospital discharge

Question 14

What are other forms of heart disease?

Answer 14

> there are other heart diseases related to the function of the valves (ensures directional flow)

> the contraction of the heart (disturbances called arrhythmias,

> some of which can cause sudden cardiac death

> the heart muscle (i.e., cardiomyopathies),

> infections,

> structural defects (i.e., congenital heart disease).

Question 15

What are the warning signs of a heart attack?

Answer 15

> Chest discomfort- uncomfort-able pressure, squeezing, fullness, or pain.

> Discomfort of other areas of the upper body—one or both arms, the back, neck, jaw, or stomach.

> Shortness of breath—with or without chest discomfort.

> Other signs—may include breaking out in a cold sweat, nausea, or light-headedness.

Question 16

What are the symptoms of heart attack for men?

Answer 16

> “experience classic warning signs”

> Uncomfortable pressure, fullness, squeezing or pain in the centre of the chest that goes away and comes back

> Pain that spreads to the shoulders, neck, or arms

> Chest discomfort with lightheadedness, fainting, sweating, nausea, or shortness of breath

Question 17

When are the symptoms of heart attack for women?

Answer 17

> Shortness of breath or difficulty breathing

> Nausea, vomiting or dizziness

> Back or jaw pain

> Unexplained anxiety, weakness, or fatigue

> Palpitations, cold sweats, or paleness

> may experience the classic symptoms, but they are often milder

Question 18

What is the trigger for heart attacks in women?

( What type of stress )

Answer 18

Emotional Stress

Question 19

What is the trigger for heart attacks in men?

Answer 19

> Men most often report physical exertion prior to heart attacks.

Question 20

In Canada, how many individuals experience an MI each year? How many of these result in death?

Answer 20

> over 70,000
14,211 result in death

Question 21

How many in the US experience MI and how many will experience angina?

Answer 21

> In the United States, recent annual estimates suggest that 750,000 adults will have an MI and 3.4 million will experience angina each year

Question 22

There is an associated financial burden; CVD costs the Canadian and American economies what?

Answer 22

> more than $12.1 billion and $316.6 billion, respectively

Question 23

What are the disparities in heart disease? (specifically with relation to ethnicity)

Answer 23

> CD tends to occur in men and women of African ancestry at an earlier age than in Caucasians

> death rates are higher in persons of African ancestry across all age categories

> ethnic minority groups have been shown to have relatively more limited awareness regarding CVD risk factors and less access to health care

Question 24

What do the disparities of CVD highlight in terms of treatment?

Answer 24

> these discrepancies high-light the need for individualized, culturally sensitive methods of CVD prevention, diagnosis, and treatment

Question 25

What are the major signs of heart failure? | C,T, SOB, PE, PLE, SINTA, PAGW, SINAAL

Answer 25

> coughing > Tiredness > Shortness of breath > Pulmonary edema (excess fluid in lungs) > Pleural effusion (excess fluid around lungs) > Swelling in abdomen (ascites) > Pumping action of the heart grows weaker > Swelling in ankles and legs

Question 26

What are the disparities by sex and socio-economic status for CVD?

Answer 26

> women often receive less aggressive treatment and are more likely to die in the early months after a heart attack > CVD risk factors are most common among people in lower income brackets

Question 27

Is heart failure increasing in prevalence? If so, do to what?

Answer 27

> Heart failure is increasing in prevalence, in part due to our aging population demographic

Question 28

Once a patient is diagnosed with acute coronary syndrome, it is important to do what? How is it done?

Answer 28

> it is important to acutely restore blood flow to the heart. > Often, revascularization interventions are performed in hospital to restore sufficient blood flow.

Question 29

What are the two revascularization interventions?

Answer 29

> Revascularization pro-cedures include angioplasty, also known as percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery.

Question 30

What is PCI? How long does it take to complete?

Answer 30

> PCI is a procedure in which a catheter is used to place a mesh tube in the coronary vessels that have nar-rowed. > This mesh tube (“stent”) is then expanded so blood can again flow through the vessel to the heart muscle > a day procedure

Question 31

What is CABG? How long does it take to complete?

Answer 31

> CABG uses arteries or veins from another area of the body to circumvent the blocked flow in the coronary arteries restoring the delivery of the blood supply to heart tissues > CABG requires an approximately week-long hospitalization and extended re-covery period at home.

Question 32

What is the breakdown of the percentage of costs due to cardiovascular disease in Canada?

Answer 32

1) Indirect costs− 65.7% 2) Mortality (as cost of premature death) 41.7% 3) Direct costs − 34.3% 4) Long-term disability 18.7% 5) Hospital care 17.8% 6) Drugs 9.6% 7) Physician care 6.9% 8) Short-term disability 5.3%

Question 33

With respect to CVD, what is secondary prevention?

Answer 33

> Secondary prevention refers to the initiation of treatments to stop or slow the progression of diseases and disabilities once they have already occurred.

Question 34

Secondary prevention of acute coronary syndrome specifically includes what?

Answer 34

> reducing CVD risk factors through behavioural approaches (e.g., exercise, smoking cessation) and pharmacotherapy (e.g., aspirin, cholesterol-lowering drugs).

Question 35

When the pumping function is permanently damaged, as in heart failure, is there a cure? what about treatment?

Answer 35

> no cure. > Heart transplantation is the most enduring treatment approach. *However, there are insufficient organs available to meet need

Question 36

Because there are not enough heart organs, what is a new advancing approach?

Answer 36

> Mechanical circulatory support = the ventricular assist device

Question 37

What is a benefical strategy to reduce psychological distress in those with acute coronary syndrome and CVD? | What type of interview?

Answer 37

> Motivational interviewing

Question 38

Following PCI or CABG, what are patients ideally referred to?

Answer 38

> ideally referred to CR, which is a compre-hensive secondary prevention program that provides risk-factor modification through education, behavioural counselling and structured exercise train-ing. > CR programs provide social support to patients with CVD, and may offer stress-management classes and programs targeting psychological distress > Participation in CR significantly reduces cardiovascular mortality and repeat hospitalization rates, regardless of the setting in which the program is offered

Question 39

Although they are highly effective, CR programs are underused, what is a reason why?

Answer 39

> Barriers to CR are multifactorial and thus efforts to improve access to and participation in CR should target patients, providers, and the broader health-care system

Question 40

Traditional risk factors (e.g., diabetes, hypertension, smoking, dyslipidemia) only explain how many CVD cases?

Answer 40

> only explain about two-thirds of new CVD cases

Question 41

In the international INTERHEART study, over 24,000 people from 52 countries who had MIs were age-and sex-matched to people who had not. Patients who had MIs were more likely to do what?

Answer 41

> were more likely to recall periods of perceived work and home stress, financial stress, and have experienced major life events (i.e., business failure, intra-family conflict), in addition to depression and perceiving lower control over their lives, during the 12 months prior to their car-diac event > overall they exeprienced perceived job and home stress, social isola-tion, depression, anxiety, and even some personality traits.

Question 42

What were the things that the participants in the INTERHEART study recalled considered?

Answer 42

psycholgical risk factors

Question 43

The cardiovascular effects of acute stressors have been demonstrated in stud-ies of people experiencing what?

Answer 43

> people experiencing bereavement, environmental disasters, and terrorist attacks. > For ex-ample, there is heightened risk for cardiovascular events following the death of a spouse for both men and women > During the first month fol-lowing the 1995 Hanshin-Awaji earthquake in Japan, there was a significant increase in MI and stroke among those living near the epicentre. > It appeared that the risk of a fatal outcome following this acute stressor was associated with having underlying CVD prior to the earthquake. In another study, individuals residing in Chicago, New York, Mississippi, and Washington D.C. had significantly greater systolic blood pressure two months following the 11 September 2001 terrorist attacks + data col-lected from 16 New Jersey emergency departments revealed a 49 per cent increase in patients who experienced an MI 60 days following the September 11th attacks

Question 44

This rapid onset of impaired cardiac functioning, followed by an identifiable stressor, is known as what?

Answer 44

> is known as stress-induced cardiomyopathy or “broken-heart syndrome”

Question 45

It has been suggested that acute mental stress can contribute to what cardiac condition?

Answer 45

> can contribute to cardiac ischemia, particularly “silent” ischemia (i.e., no overt chest pain).

Question 46

Rozanski et al. (1988) assessed cardiac functioning in patients with CVD while they completed either exercise or a series of mental tasks that included arithmetic, reading, and public speaking - what mental task was associated with myocardial ischemia

Answer 46

> a majority of the patients, mental stress, particularly public speaking, was accompanied by myocardial ischemia similar to what was ob-served during exercise.

Question 47

The core feature of chronic stress is what?

Answer 47

> is that the person perceives himself or herself as having limited control over the situation in which the chronic stressor(s) occur.

Question 48

Stressors that have been shown to impact CVD onset and prognosis include what?

Answer 48

> job strain, family conflict, and social isolation.

Question 49

What aspect of work is harmful to heart health?

Answer 49

> Low decision-making control > and an im-balance between employees’ efforts at work and the rewards they gain in return

Question 50

A Canadian study established that chronic job strain, as characterized by “high psychological demands” and “low decision control,” is a predictor of what?

Answer 50

> is a predictor of recurrent CVD events following an initial CVD event

Question 51

What occurred in the Canadian study of chronic job strain? What was found?

Answer 51

> survival rates for patients with greater chronic job strain were lower. * these patients had a higher risk for fatal CVD, MI, or angina in the two to six years after their initial MI

Question 52

As per the effort–reward model, there is an increased risk of CVD and poor physical and mental health functioning in employees who perceive what? What does this model emphasize?

Answer 52

> an imbalance between the work they put in for their employer and their rewards > The effect of effort–reward imbalances are particularly evident in employees with limited occupational social support networks

Question 53

Another job strain is shift work that varies from the typical eight-hour workday, disrupts normal biological rhythms- what has it been associated with?

Answer 53

> it has been associated with a higher prevalence of atherosclerosis and MI.

Question 54

Shift workers often have more CVD risk factors, such as:

Answer 54

> smoking and reduced physical activity.

Question 55

The negative CVD outcomes associated with shift work occur in people at what age? Is this age expected (if not - what evidence amounts to it?)

Answer 55

> at a younger age than would be expected in the general population

Question 56

What was found in the Landmark nurses Health study with respect to CVD, MI, and death rates.

Answer 56

> female nurses who worked rotating night shifts had a higher rate of MI and death from CVD > the risk for CVD among women who worked > six years on these shifts was 1.5 times > than it was among the women who were not on these shifts

Question 57

In the Framingham Offspring Study, men and women were assessed on measures of marital status, marital strain, and risk fac-tors for CVD, then followed for 10 years. What was found?

Answer 57

> In this study, the development of a CVD event was primarily related to the reaction to conflict with one’s spouse > Importantly, men and women who had marital conflict tended to have higher blood pressure compared to individuals who engaged in collaborative problem-solving > The impact of marital strain on CVD prognosis appeared to affect both men and women.

Question 58

Approximately what per cent of Americans over the age of 45 have family caregiving responsibilities?

Answer 58

> 12%

Question 59

Providing support to a spouse or other family member who requires assistance increases the risk of CVD onset in the caregiver. Why is this?

Answer 59

> his is often due to chronic stress and the specific strains as-sociated with physically and psychologically demanding tasks, financial difficulty, filling multiple roles, social isolation, and watching the deterioration and suffering of another person.

Question 60

What kind of person is a caregiver?

Answer 60

> Caregivers are often older persons and their own health and emotional adjustment to the situation may de-cline during the process of taking care of another

Question 61

What is a positive benefit from caregiving?

Answer 61

> some recent work suggests that the fulfillment that comes with caregiving can prop up the health of the caregiver

Question 62

What type of social networks have been associated with lower incidences of CVD?

Answer 62

> Social networks, such as family, friends, co-workers, pets and even the patient-centred care network have been associ-ated with a lower incidence of CVD

Question 63

What relationships are particularly protective from risk of CVD? | Not the type of relationship but (quanity not ...)

Answer 63

> Higher-quality relationships

Question 64

With respect to CVD, what has social isolation been related to?

Answer 64

> social isolation has been related to de-creased heart functioning and poor health behaviours.

Question 65

How does social isolation affect CVD?

Answer 65

> those who know fewer than three people well enough to visit their home are at an increased risk for CVD > social isolation and loneliness are associated with a greater risk of inactivity, smoking, multiple health-risk behaviours, and hyperten-sion > People who feel that they have limited social support or who live alone are more likely to die, to have a recurrent cardiovascular event, and to experience decreased quality of life and/or depression

Question 66

Two psychological conditions—have been related to CVD onset and prognosis. What are those two conditions?

Answer 66

> depression and anxiety

Question 67

he difference between clinical depression and psychological distress (“the blues”) relates to what?

Answer 67

> relates to the severity and duration of the symptoms, and the degree of impact on one’s life roles.

Question 68

Adults with CVD have a higher prevalence of what psychological condition? Is it a risk factor for CVD?

Answer 68

> depression > A history of depression is a known psychological risk factor for CVD * BUT the risk for CVD onset remains elevated (albeit lower) for individuals who present with sub-clinical symptoms of depression

Question 69

There is an association between what two factors in patients who have CVD?

Answer 69

> depression and death > Depression in the first two years after MI predicts poor prognosis in terms of cardiac symptoms, quality of life, disability, and death (moreso evident in women) > Specifically, depression in CVD patients is related to two times greater mortality in the two years after CVD diagnosis, when compared to non-depressed

Question 70

The documented prevalence of cardiac patients meeting the criteria for at least one anxiety disorder is approximately what percent?

Answer 70

> 36%

Question 71

CVD populations have a higher risk of anxiety disorders irrespective of what factors? Is there a gender gap in this difference?

Answer 71

> irrespective of socio-economic background, geographic location, and culture > However, the impact of anxiety on CVD appears to be stronger for men than for women

Question 72

Which disorder (Depression or Anxiety) affects CVD more?

Answer 72

> the role of anxiety in the development of CVD is less than that of depression and may be dependent on the specific anxiety-disorder subtype > i.e., the presence of phobic anxiety increases the risk of sudden cardiac death, but not of non-fatal MI

Question 73

Do anxiety levels persist after a cardiac event? What is anxiety related to with respect of CVD?

Answer 73

> anxiety levels tend to be high following a CVD event, and have been shown to persist for longer than six months

Question 74

Post-MI anxiety has been associated with a range of CVD events, including:

Answer 74

> ischemia, recurrent MI, and sudden death > High levels of anxiety are also related to longer hospital stays (which is costly to the health system, and distressing for patients and their families) and reduced quality of life

Question 75

What kind of impact does anxiety have on CVD?

Answer 75

> there is more evidence to suggest a differential impact of anxiety dependent on disorder sub-type > i.e., people with

Question 76

Which type of anxiety may actually help CVD?

Answer 76

> It was suggested that the worrying tendencies among individuals with GAD might actually promote help-seeking behaviour and better CVD self-management

Question 77

Aside from depression and anxiety, what other psychological conditon may affect CVD onset?

Answer 77

> Post-traumatic stress disorder (PTSD) has also emerged as a potential contributor to CVD onset. > It has been linked to poor health behaviours and may be associated with increased risk of atherosclerosis and mortality > Furthermore, PTSD may occur in response to a traumatic cardiovascular event, thus further increasing CVD recurrence and death

Question 78

What studies show support for how anxiety affects CVD? What do the results suggest?

Answer 78

In one study, CVD patients with co-morbid depression and GAD were not at a greater risk for poorer outcomes (cardiac death, cardiac arrest, or revascularization procedures) than those patients who had either major depression or GAD alone > In another study, anxiety alone (not including depression) was an independent risk factor for hospitalization and outpatient clinic visits > this suggests that although depression and anxiety are highly co-morbid, they may relate to CVD in different ways

Question 79

What personality types was the first aspect to be hypothesized to have an independent role in the onset of heart disease.

Answer 79

> Type A personality was the first aspect of personality hypothesized to have an independent role in the onset of heart disease

Question 80

What other personality type has been linked to CVD?

Answer 80

> the focus of personality subtypes has also centered on the Type D personality, referring to people who display both a high level of negative affect and social inhibition > linked to severity - but the results are weak.

Question 81

Notably, there are significant associations between health-related outcomes and positive psychological constructs such as what for those with CVD?

Answer 81

> such as vitality, optimism, hope, positive affect, and happiness

Question 82

DuBois and colleagues (2015) explored this relationship (positive psychology( among cardiac patients and found a significant correlation between what factors?

Answer 82

> found a significant correlation between positive psychological states/ well-being and a reduced risk of mortality and rehospitalization.

Question 83

When people who have survived a CVD trauma such as an MI begin to recognize benefits and take steps towards positive changes in their lives, they may undergo what process of change?

Answer 83

> they may undergo “post-traumatic growth,” defined as the experience of positive consequences arising from the struggle with a traumatic ex-perience. > The resulting transformation is thought to lead not only to a return to previous levels of well-being, but to a higher level of functioning in some aspects of life

Question 84

Psychological risk factors/disorders are commonly assessed via self-administered psychometric-ally validated questionnaires or surveys. For those whose responses suggest a potential mental health problem, what occurs?

Answer 84

> clinical interviews by a trained professional (e.g., psychiatrist or psychologist) are required to “diagnose” a psychological disorder.

Question 85

Notably, most medical care for cardiac patients focuses on their physical health, despite the large burden of psychological distress in those with heart disease. Some experts recommend as a result?

Answer 85

> Some experts recommend screening for psychological distress (i.e., brief surveys of depression) within the context of rou-tine cardiac care for patients > Unfortunately, however, psychological disorders are under-recognized and undertreated in people with CVD

Question 86

What is the gold standard for diagnosis of a cardiac patient with a mood or anxiety disorder?

Answer 86

> Diagnosis of a cardiac patient with a mood or anxiety disorder can be complicated by the fact that many symptoms of depression or anxiety, are similar to that of CVD > For these reasons, structured diagnostic interviews are considered the gold standard

Question 87

What scales are used to diagnose mood/anxiety disorders in CVD patients?

Answer 87

> Patient Health Questionnaire (PHQ) (Kroenke, Spitzer, & Williams, 2003) and the Hospital Anxiety Depression Scale (HADS)

Question 88

Many scales are available to assess social support, but these are typically administered within the research setting- which ones are used?

Answer 88

> One recommended measure in the CVD literature is the ENRICHD (Enhancing Recovery in Coronary Heart Disease) Social Support Inventory (ESSI)

Question 89

In the laboratory setting, hostility, arguably the most hazardous trait of the Type A personality, can be measured via what scale?

Answer 89

> can be measured via the Cook-Medley Hostility (Ho) Scale

Question 90

What traits (measured via the HO scale) are most predictive of mortality?

Answer 90

> High scores on cynicism, hostile affect, and aggressive responding

Question 91

What class of anit-depressants are used for CVD patients with depression? Which aren't?

Answer 91

> selective serotonergic reuptake inhibitors (SSRIs) is recommended = given their efficacy and safety in this population > some antidepressants such as monoamine oxi-dase inhibitors and tricyclic antidepressants have cardiotoxic effects and are rarely prescribed to patients with cardiac disease

Question 92

An initial study to evaluate antidepressant medication in CVD patients was what study?

Answer 92

> was the Sertraline Antidepressant and Heart Attack Randomized Trial (SADHART)

Question 93

What were the results of the SADHART study?

Answer 93

> In this study, sertraline was not associated with negative changes in any cardio-vascular indicators, suggesting that it is safe for use in CVD populations > sertraline was more effective than a placebo in reducing depressive symptoms.

Question 94

More recently, Glassman, Bigger, and Gaffney (2009) conducted a seven-year follow-up study of the SADHART participants. They found what?

Answer 94

> they found that baseline depression severity and a lack of improvement of depressive symptoms, regardless of being in the sertraline or placebo group, were the two strongest predictors of mortality. > These results highlight the importance of long-term follow-up of depressed cardiac patients to ensure treatment is sufficient to achieve remission and that patients do not relapse.

Question 95

What was found in the MIND-IT study? Was it similar to SADHART?

Answer 95

> Mir-tazapine is part of a newer class of antidepressants, activating serotonin and other receptors in the brain involved in mood. > In MIND-IT, MI patients who received mirtazapine had lower depressive symptoms at follow-up. > Similar to SADHART, those who responded best to the antidepressant treatment tended to be those with a history of depressive episodes.

Question 96

What is the difference of CBT and IPT (interpersonal psychotherapy)

Answer 96

> As indicated in previous chapters, the goal of CBT is to identify cognitive patterns and behaviours that generate these psychological manifestations, while IPT is focused more on the patient’s relationships and social environment.

Question 97

What was the ENRICHD trial designed to do?

Answer 97

> the ENRICHD trial was designed to address whether treating depression and increasing social support would reduce recurrent CVD events and death

Question 98

What were the results of the ENRICHD trial?

Answer 98

> Results were disappointing; > Treatment allocation had no effect on recurrent MI or death during the four-year follow-up period. > Depression symptoms were reduced and social support was significantly increased in the intervention group vs patients in usual care; however, benefits were not sustained over the long term > findings showed that improvements in mood and social support were found to be related to the adherence of the patient to the CBT-related homework assignments as well as exercise instead

Question 99

What was the CREATE trial? What did it test?

Answer 99

> Another trial tested combination therapy: an SSRI antidepressant, citalopram, alongside IPT. > The Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) study Cognitive behavioural therapy is used to identify maladaptive thoughts and behaviours that contribute to anxiety and mood dis-orders. > Results showed that citalopram was significantly better than the placebo in the reduction of depression scores 12 weeks after initiation of the antidepressant treatment. There was no effect of IPT. > Therefore, the investigators recommended that citalopram be considered as a first-line treatment for co-morbid depression in CVD patients

Question 100

Is stress management training (SMT) an effective psychological intervention? (What study points to yes?)

Answer 100

> In one randomized trial, patients who received either comprehensive CR, or comprehensive CR plus stress management training (SMT), had significant improvements in cardiac biomarkers, physical activ-ity, and perceived level of stress.

Question 101

In the Secondary Prevention in Uppsala Primary Health Care Project (SUPRIM) trial, what occured?

Answer 101

> CVD patients who were randomized into the CBT/stress management intervention demonstrated a significant decrease in recurrent cardiovascular events compared to controls. > Moreover, higher attendance rates across the 20 CBT stress management sessions was associated with the lowest recurrent CVD risk

Question 102

At what point of intervention for CVD is physical activity involved in?

Answer 102

> Physical activity, a core component of CR, is effective in the primary and secondary preven-tion of CVD