Psychiatric and Behavioral Aspects of Cardiovascular Disease: Epidemiology, Mechanisms, and Treatment

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA.
Revista Espa de Cardiologia (Impact Factor: 3.79). 08/2011; 64(10):924-33. DOI: 10.1016/j.rec.2011.06.003
Source: PubMed


Psychosocial and behavioral factors, including mood (depression, anxiety, anger, and stress), personality (Type A, Type D, and hostility), and social support, are associated with both the development and progression of cardiovascular disease. "Negative" emotions have been associated with increased rates of cardiovascular death and recurrent cardiac events, although the mechanisms responsible for this association remain unclear. A number of pathophysiological mechanisms have been proposed to explain these relationships, including hypothalamic-pituitary-adrenal axis dysregulation, platelet activation, and inflammation. Behavioral factors also have been implicated, such as nonadherence to prescribed medical therapies and physical inactivity. Several randomized trials of patients with cardiovascular disease have examined the impact of pharmacologic and behavioral treatments on hard cardiovascular disease events as well as on cardiovascular disease biomarkers of risk. Although psychological treatments generally have been shown to improve quality of life and psychological functioning among cardiac patients, the benefit of psychological interventions with respect to improving clinical outcomes has not been conclusively demonstrated.

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    • "Since evidence on the levels of anxiety and SOC is lacking for Roma CHD patients, the aim of the present study was to assess differences in anxiety and SOC between Roma and non-Roma patients. We hypothesised that Roma patients would have higher levels of anxiety and lower levels of SOC when compared with non-Roma CHD patients, crude and adjusted for potentially confounding socio-demographic and medical variables, such as gender, sex, functional status and SES (Skodova et al. 2010; Smith and Blumenthal 2011). "
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    ABSTRACT: Objective: Morbidity and mortality among Roma due to coronary heart disease (CHD) is high, but evidence on potential psychosocial pathways is lacking. This study aimed to assess the differences in the severity of anxiety symptoms and in the sense of coherence (SOC) between Roma and non-Roma CHD patients, crude and adjusted for age, sex, functional status and socio-economic status (SES). Design: We examined 607 CHD patients (mean age 58.0 ± 7.4, 28.7% female) scheduled for coronary angiography, 98 (16.1%) of whom were Roma. Anxiety symptoms were measured using the Hospital Anxiety and Depression Scale and SOC using the 13-item Orientation to Life Questionnaire. Data were analysed using hierarchical regression. Results: Roma ethnicity was associated with more severe anxiety (B = 1.89; [95% confidence interval (CI) = 0.79; 2.98]) adjusted for age, sex, functional status and SES. Roma ethnicity was also associated with lower SOC (B = -4.77; [95% CI = -7.85; -1.68]) adjusted for age, sex and functional status. The latter association lost statistical significance after adjustment for SES. Conclusion: Roma ethnicity is associated with more anxiety symptoms and lower SOC among CHD patients. Our findings indicate that Roma CHD patients have a worse position regarding psychosocial factors that increase mortality and thus require additional attention.
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