Behavioral cardiology --has its time finally arrived?

Abstract

Traditional cardiology has taken a mechanistic approach to heart disease. But the new discipline of behavioral cardiology takes a broader view, concluding that heart disease is not inevitable, but develops largely from unhealthy lifestyles, such as smoking, overeating and physical inactivity, and from psychosocial stress. Physical inactivity and excessive caloric intake are also responsible for the epidemic of obesity, which is associated with a dramatic increase in the prevalence of diabetes. This increase in the incidence of diabetes may, in turn, reverse the recent decline of cardiovascular deaths in the US. A variety of psychosocial stressors have been implicated in the development of cardiovascular disease. These include occupational stress, anxiety, social isolation, hostility, anger, and type A behavior. There is clearly some overlap between these stressors, all of which may affect the heart adversely. Both the lifestyle and psychosocial factors can be altered by behavioral treatment, in which the patient and the practitioner work together. Unfortunately, various barriers can impair the successful implementation of behavioral treatment. These barriers include poor compliance by the patient, lack of skill in providing effective interventions by the health care provider, and lack of incentives within the health care system, particularly reimbursement.