Rozanski A, Blumenthal JA, Davidson KW, Saab PG, Kubzansky L. The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice. The emerging field of behavioral cardiology

Division of Cardiology, St Luke's-Roosevelt Hospital Center, and the Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Journal of the American College of Cardiology (Impact Factor: 15.34). 04/2005; 45(5):637-51. DOI: 10.1016/j.jacc.2004.12.005
Source: PubMed

ABSTRACT Observational studies indicate that psychologic factors strongly influence the course of coronary artery disease (CAD). In this review, we examine new epidemiologic evidence for the association between psychosocial risk factors and CAD, identify pathologic mechanisms that may be responsible for this association, and describe a paradigm for studying positive psychologic factors that may act as a buffer. Because psychosocial risk factors are highly prevalent and are associated with unhealthy lifestyles, we describe the potential role of cardiologists in managing such factors. Management approaches include routinely screening for psychosocial risk factors, referring patients with severe psychologic distress to behavioral specialists, and directly treating patients with milder forms of psychologic distress with brief targeted interventions. A number of behavioral interventions have been evaluated for their ability to reduce adverse cardiac events among patients presenting with psychosocial risk factors. Although the efficacy of stand-alone psychosocial interventions remains unclear, both exercise and multifactorial cardiac rehabilitation with psychosocial interventions have demonstrated a reduction in cardiac events. Furthermore, recent data suggest that psychopharmacologic interventions may also be effective. Despite these promising findings, clinical practice guidelines for managing psychosocial risk factors in cardiac practice are lacking. Thus, we review new approaches to improve the delivery of behavioral services and patient adherence to behavioral recommendations. These efforts are part of an emerging field of behavioral cardiology, which is based on the understanding that psychosocial and behavioral risk factors for CAD are not only highly interrelated, but also require a sophisticated health care delivery system to optimize their effectiveness.

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Available from: Karina W Davidson, Aug 29, 2015
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    • "For example, self efficacy has a direct impact on individuals' health outcomes [9] [10]. The impact of chronic illnesses such as diabetes mellitus on the bio-psycho-social aspects of individual's health and wellbeing is associated with difficulties of individuals' adjustment to their illnesses and the evolved changes of their lifestyle [11] [12]. Factors such as health locus of control and self-efficacy are considered significant ones for health care professionals, in particular with the nature of treatment plans for patients with diabetes mellitus type-II and the high level of nonadherence [13]. "
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    ABSTRACT: ABSTRACT Background: The comorbidity between chronic physical conditions and psychosocial health became common interest for health professional and researchers. The purpose of this study was to investigate the relationship among health locus of control, self efficacy, and demographic factors in patients with type-II diabetes mellitus. Method: Data were collected using cross-sectional, correaltional design from 793 patients with type-II diabetes in regards to health locus of control (HLOC) self-efficacy, and biomarkers. Results: The mean score for the internal subscale of HLOC was 27.2 (SD = 6.32), for the powerful others subscale of HLOC it was 30.9 (SD = 5.7), and for chance subscale of HLOC it was 18.6 (SD = 6.8). The mean total score of locus of control scale was 76.8 (SD = 13.1) ranging from 19 to 132. The mean score of HbA1C was 7.5 (SD = 2.6). Patients had moderate to high perception of powerful other health locus of control, and self efficacy. Results also showed that locus of control had positive and significant correlation with self efficacy (r = 0.18, p > 0.01) and negative relationship with HbA1C (r = -0.11, p > 0.01). On the other hand, age has no significant correlation with health locus of control. Conclusion: Health care professionals need to enhance patient’s self-efficacy and internal power of their patients for better health outcomes. Nurses and other health professionals need to emphasize the psychosocial health aspects of patients with chronic illnesses, and in particular, those diagnosed with type-II diabetes mellitus.
    Journal of Diabetes Mellitus 08/2015; 5(3):190-197. DOI:10.4236/jdm.2015.53023
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    • "Помимо негативного влияния на качество жизни, депрессия сопряжена с риском развития целого ряда заболеваний и повышенной смертностью. Так, в многочисленных исследованиях продемонстрирована связь между депрессией и высоким риском ишемической болезни сердца и инфаркта миокарда [Carney et al., 2005; Rozanski et al., 2005]. В исследованиях исходов хирургических вмешательств депрессия является независимым неблагоприятным прогностическим фактором в течение послеоперационного периода у хирургических больных, и сопряжена с высоким риском осложнений у таких пациентов [Goyal et al., 2005; Leung et al., 2005]. "
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    DESCRIPTION: Депрессия сопряжена с риском развития целого ряда заболеваний и повышенной смертностью. В настоящее время общепризнанно, что негативные последствия депрессии связаны с перенапряжением физиологических систем стрессорного ответа. В стрессовой ситуации происходит мобилизация всех необходимых ресурсов организма, и одним из важнейших триггеров стрессорного ответа является активация гипоталамо-гипофизарно-надпочечниковой оси. Из всех гормонов данной системы в наибольшей степени изучены эффекты кортизола как в связи с широтой его регуляторных влияний на структуры и функции организма, так и из-за доступности его измерений. В настоящем аналитическом обзоре литературных данных суммированы современные данные о физиологических особенностях функционирования гипоталамо-гипофизарно-надпочечниковой оси, а также о влиянии кортизола на функции и нейротрофические процессы в центральной нервной системе как в физиологических условиях, так и в условиях хронического стресса, и у пациентов с депрессией и/или тревожными расстройствами.
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    • "While there is a large body of evidence linking psychological states to ischemic heart disease [1] [2] [3] [4] [5], little is known about the role of stressors and the human stress response in structural heart disease. "
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    ABSTRACT: Background: Stress is considered a modifiable risk factor for cardiovascular disease. Scalp hair analysis is a tool to assess long-term exposure to the stress hormone cortisol. We aimed to determine the association between hair cortisol concentrations (HCC) and clinical characteristics in patients with structural heart disease. Additionally, we investigated potential predictors for longitudinal change in HCC. Methods: The study consisted of 261 patients with structural heart disease from a randomized controlled trial of mindfulness training. One sample of scalp hair was used to determine HCC both at baseline and at 12-week follow-up. In 151 patients, HCC was available (mean age: 41.3years, range 18-65). We investigated the association between HCC at baseline and several physiological measures (BMI, blood pressure, heart rate, respiratory rate, 6-minute walk test), as well as psychological parameters (physical and mental component summary measures (SF-36), emotional distress (HADS), and perceived stress). Additionally, we used these clinical parameters to predict HCC change over time. Results: The median HCC was 22.3pg/mg of hair (23.5 interquartile range). In multivariable linear regression analyses, an association was observed between log-transformed HCC and BMI (β 0.171, p=0.037), respiratory rate (β 0.194, p=0.016), and the physical summary score (β -0.163, p=0.054). Independent predictors of log-transformed HCC change after 12weeks were mental summary score (β -0.200, p=0.019) and diastolic blood pressure (β -0.171, p=0.049). Conclusions: In patients with structural heart disease a positive association exists between HCC and BMI. Mental health status may predict a change in long-term cortisol over time. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Cardiology 02/2015; 184C:71-78. DOI:10.1016/j.ijcard.2015.02.005 · 6.18 Impact Factor
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