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Review Article
Volume 2 Issue 1 - November 2016
DOI: 10.19080/JOCCT.2016.02.555577
J Cardiol & Cardiovasc Ther
Copyright © All rights are reserved by Giuseppe Gullace
Behavioral Cardiovascular Risk Factors: Changing
Perspective to Approach the Problem
Giuseppe Gullace *
Consultant Cardiologist, Multimedica Hospital Group, Italy
Submission: October 25, 2016; Published: November 09, 2016
*Corresponding author: Giuseppe Gullace, Consultant Cardiologist, Multimedica Hospital Group, Via San Leonardo 11 23864 Malgrate (Lecco),
Italy, Tel: ; Email:
Abstract
Keywords:
Introduction
Atherosclerosis is a multi factorial disease of polygenic
inheritance and the interrelation with environmental and
social factors adds to complexity of the disease; in addition
cardiovascular and cerebrovascular diseases has been widely
as obesity, hypertension, physical inactivity, dyslipidemia,
diabetes) and psychosocial (such as stress, depression, anxiety,
type A personality, hostility and anger) [1-7]. The use of
term follow-up of the Framingham Offspring cohort [8] allowed
and overall cardiovascular event. However, depending on this
The European action on secondary prevention through
out in eight European countries [9] reports that despite
obesity and diabetes were seen in patients with established
factors for the development of atherosclerotic disease, which
present in 50 % of those who develop atherosclerotic problems
[10]. These individuals appear to have other genetic disorders or
Moreover, epidemiological research suggests that
psychological factors, stress and undesirable social
circumstances play an important role in the occurrence of
various cardiovascular diseases [11,12] and are considered
prone behavior pattern, called type A, that was originally
described by Friedman & Rosenman [13] in the late 1950’s,
has been considered a clinically derived behavioral syndrome
strong job involvement. Characteristics as anger or aggression
of a group of patients have been demonstrated to be important
J Cardiol & Cardiovasc Ther 2(1): JOCCT.MS.ID.555577 (2016) 001
Journal of
Cardiology & Cardiovascular Therapy
ISSN: 2474-7580
How to cite this article: Giuseppe G. Behavioral Cardiovascular Risk Factors: Changing Perspective to Approach the Problem. J Cardiol & Cardiovasc
Ther. 2016; 2(1): 555577. DOI: 10.19080/JOCCT.2016.02.555577
002
Journal of Cardiology & Cardiovascular erapy
factors for cardiovascular and cerebrovascular disease [14] and
to be related to carotid atherosclerosis, while depression was
associated with endothelial dysfunction in diabetic patients
[15], predicts incident coronary artery disease and worsens its
prognosis [16-19], and anxiety is considered an independent
mortality following acute myocardial infarction and cardiac
events [20,21]. In addition, there are different lifestyle behaviors
promote atherosclerosis and cardiac events, including unhealthy
are related to emotional status and experience of chronic stress
[22].
Purpose
As reported above, the relationship among cardiovascular
occurrence appears a complex and intriguing issue not yet
completely and fully disentangled. The relationship between
psychological (stress, anxiety, depression, etc.) and behavioral
hypertension, diabetes and dyslipidemia) factors is one of the
interesting issues that we try to deal with in the present paper
at them from a different point of view.
The Current Way
We are convinced, from a wide literature and daily practice,
that the four pillars of good health, related to the individual’s
lifestyle and depending on his behavior, are:
ii. Eating little
iv. Sex a lot
obesity is highly present in general population, only less than
50% of adult people practice regular physical activity and sexual
psychological, social, economic, political, cultural, ethical, legal,
historical, religious, and spiritual factors; but also by violence
For the latter, the report concludes: “Sexual and reproductive
health is fundamental to the social and economic development of
[23]. All of them are related to person’s psychological factors,
behavior and life style.
Within this context, we note that although cardiologists are
accustomed to managing lifestyle behaviors such as overeating,
their limited time, interest or familiarity with effective strategies
and recommendations [24] or because a systematic review,
counseling, is associated with favorable but modest changes
For instance, regarding physical activity, only 47% of primary
care physicians include an exercise history as part of their initial
examination, whereas13% of patients report physicians giving
advice about exercise and physically active physicians are more
main issue of this situation is that the four pillars of good healthy
the relationship with either the inside self emotions and feelings
or the outside, people and events included. More attention
should be paid to study all these aspects.
The structure of the individual
mechanisms are strictly related to social behaviors whose main
means that neuro hormonal structure of individual is related to
[29]. There exisists a wide literature reported in an interesting
review [30] that lists the numerous examples of reciprocal
psychological components that may be central to developing
of energy and enthusiasm and a sense of aliveness [31]; it is
fueled by both a sense of purpose and a sense of self-worth and
connotes a sense of positive excitement [24] and attitude.
Vitality promotes two adaptive responses (which may in turn
positive response mechanisms (such as patience, discipline,
optimism) and emotional competence, that represents the ability
to regulate emotions across a range of situations [32], important
terms of a greater sense of vitality; this provides energy needed
to develop and mantain greater emotional competence and
How to cite this article: Giuseppe G. Behavioral Cardiovascular Risk Factors: Changing Perspective to Approach the Problem. J Cardiol & Cardiovasc
Ther. 2016; 2(1): 555577. DOI: 10.19080/JOCCT.2016.02.555577
003
Journal of Cardiology & Cardiovascular erapy
force for maintaining a sense of vitality [24].
All this process well represents the individual’s relationship
(balance) between inner and outer and between neuro
hormonal and psycho behavioral structures. When several
factors negatively affect the structures the relationship is
unbalanced and anxiety, depression, stress, affective disorders
responses that cause multiple peripheral adverse effects such as
endothelial dysfunction, insulin resistance, obesity, hypertension,
is evident that stress as a complex of several psychological
situations, is the effect of multiple long acting factors that
progressively determine unbalancing of neuro hormonal and
psycho behavioral structures reducing the sense of purpose
and the sense of self-worth negatively modifying vitality,
emotional competence and positive response mechanisms and
Changing perspective to approach the problem
psychologist and philosopher [34]. This is very useful to do
and complex and the solutions to problems are confused and
solutions or the best one or when a new way to cope situations
and problems is needed to give suitable answers and acceptable
reported above it is important to experiment a new point of view
orienting the attention towards person’s perception of them
persons have, either with themselves (inner) or with the others
process: (Figure 1) where several factors disturb along the time
stress; this induces multiple adverse peripheral effects related to
Figure 1: Process as a ow chart.
more attention to the persons (subjects or preclinical patients),
striving to understand what there is behind them that pushes to
unsuitable and deleterious lifestyle. Hippocrates wrote that “it
Investigators and clinical practitioners pay great attention to the
factors and their potential effect on disease onset [35]. However,
at the same time, literature is stingy in considering, for example,
the cause of something but rather the effect of an incorrect and
inappropriate interpretation and management of relationships
that persons establish with those.
experimented orienting the attention towards what there
is behind their onset. A statement from the World Health
social values and health behavior without creating the
and coronary artery disease suggests that cardiologists and
physicians in general need to be proactive in addressing this
important aspect of patient care [25]. Querying patients about
How to cite this article: Giuseppe G. Behavioral Cardiovascular Risk Factors: Changing Perspective to Approach the Problem. J Cardiol & Cardiovasc
Ther. 2016; 2(1): 555577. DOI: 10.19080/JOCCT.2016.02.555577
004
Journal of Cardiology & Cardiovascular erapy
are important and relevant to providing optimal care. Screening
has been suggested using structured interviews or validated
history and assessment of the patient additional information
emotional factors, such as depression, anxiety, and anger;
somatic complaints that maybe stress-related, such as fatigue
and disrupted sleep [25].
distress; more attention should be paid to the patient’s neuro
the level of factor stressors, what is disturbing the patient
infarction or post heart surgery patients usually come daily to
they can change their deleterious lifestyle; we cannot dismiss
psyco behavioral problems trying to identify and understand
the distress stressor factors and helping him to remove them.
The role of the cardiologist is important by exploring various
ways for effective clinical involvement and also by managing
involvement of other specialists is recommended [37-39].
In our daily experience with patients’ problems we use,
with positive results in the majority of them, an approach in
is disturbing or not and help him in his decision to remove them;
cardiovascular diseases, relationship among neuro hormonal
structure and function, behavior and cardiovascular apparatus
are given.
of view, to give him the necessary information to better manage
his disturbing factors and to help him to recover the emotional
energy and the positive sense of purpose and self worth: in few
at the future in a better way.
The Way Forward
perception of themselves regarding their internal world and
wishing to be themselves balanced against the external world
are the main topics to be stressed in the incoming future, and
cardiologists and all the specialists involved, should play a
preminent role in promoting more attention, more time to
spend and more research for a better comprehension of stress
time to dedicate to treatment. Behavioral Cardiology could be
manage and treat stressing factors that produce adverse
lifestyle behaviors, emotional distress, and chronic life stress
contributing to promote atherosclerosis and adverse cardiac
distress and , recovering the old way of medical profession’s
the disease.
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