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.
Article: The influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: a systematic review.[show abstract] [hide abstract]
ABSTRACT: There is growing evidence that yoga may offer a safe and cost-effective intervention for Type 2 Diabetes mellitus (DM 2). However, systematic reviews are lacking. This article critically reviews the published literature regarding the effects of yoga-based programs on physiologic and anthropometric risk profiles and related clinical outcomes in adults with DM 2. We performed a comprehensive literature search using four computerized English and Indian scientific databases. The search was restricted to original studies (1970-2006) that evaluated the metabolic and clinical effects of yoga in adults with DM 2. Studies targeting clinical populations with cardiovascular disorders that included adults with comorbid DM were also evaluated. Data were extracted regarding study design, setting, target population, intervention, comparison group or condition, outcome assessment, data analysis and presentation, follow-up, and key results, and the quality of each study was evaluated according to specific predetermined criteria. We identified 25 eligible studies, including 15 uncontrolled trials, 6 non-randomized controlled trials and 4 randomized controlled trials (RCTs). Overall, these studies suggest beneficial changes in several risk indices, including glucose tolerance and insulin sensitivity, lipid profiles, anthropometric characteristics, blood pressure, oxidative stress, coagulation profiles, sympathetic activation and pulmonary function, as well as improvement in specific clinical outcomes. Yoga may improve risk profiles in adults with DM 2, and may have promise for the prevention and management of cardiovascular complications in this population. However, the limitations characterizing most studies preclude drawing firm conclusions. Additional high-quality RCTs are needed to confirm and further elucidate the effects of standardized yoga programs in populations with DM 2.Evidence-based Complementary and Alternative Medicine 01/2008; 4(4):469-86. · 4.77 Impact Factor
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ABSTRACT: The metabolic syndrome, affecting a substantial and increasing percentage of the worldwide population, is comprised of a cluster of symptoms associated with increased risk of type 2 diabetes, cardiovascular disease, and other chronic conditions. Mind-body modalities based on Eastern philosophy, such as yoga, tai chi, qigong, and meditation, have become increasingly popular worldwide. These complementary therapies have many reported benefits for improving symptoms and physiological measures associated with the metabolic syndrome. However, clinical trial data concerning the effectiveness of these practices on the syndrome as a whole have not been evaluated using a systematic and synthesizing approach. A systematic review was conducted to critically evaluate the data from clinical trials examining the efficacy of mind-body therapies as supportive care modalities for management of the metabolic syndrome. Three clinical trials addressing the use of mind-body therapies for management of the metabolic syndrome were identified. Findings from the studies reviewed support the potential clinical effectiveness of mind-body practices in improving indices of the metabolic syndrome.Journal of nutrition and metabolism 01/2011; 2011:276419.
Article: Cardiovascular disease risk factor awareness in American Indian communities: the strong heart study.[show abstract] [hide abstract]
ABSTRACT: To use data from the longitudinal Strong Heart Study (SHS) to determine the level of awareness about risk factors for heart disease among 13 populations of American Indians in Arizona, Oklahoma, and South/ North Dakota. The aim of this study is to assess awareness of nine major risk factors for heart disease among participants in SHS. During July 1993 to December 1995 (phase II of SHS), 3638 participants ages 46 to 80 years (mean age 60) were asked if nine known risk factors for cardiovascular disease affect a person's chances of getting heart disease; 3226 (89%) participants completed the study and met the method reliability criteria for inclusion. Among each of the nine risk factors, the percentage of correct answers provided by study participants ranged from 70% (family history of heart disease) to 90% (being very overweight). Participants with hypertension (90% vs 86%, P<.05) and diabetes mellitus (81% vs 71%, P<.05) were more likely than those without these disorders to know they were heart disease risk factors. For all nine risk factors, the percentage of correct answers was lower (P<.05) among smokers than among nonsmokers. In multivariate logistic regression analyses, female sex, advanced education, and being from Oklahoma were significantly associated with heart disease awareness. Although overall risk factor awareness for heart disease was high, subgroups were identified who could benefit from culturally appropriate health education and other interventions to motivate health prevention actions, especially for smoking.Ethnicity & disease 02/2006; 16(3):647-52. · 0.90 Impact Factor