Health Psychology
Chapter 9: Cardiovascular Disease
Mansfield University
Dr. Craig, Instructor
1
CVS and its “Circulatory Pipes”
 Cardiovascular System- purpose
• transport system for nutrients (O2, glucose) and
removal system for waste (CO2, immune wastes)
• transports system for hormonal regulatory processes
 Outgoing Pipes (away from the heart)
• Arteries
• Arterioles
• Capillaries (micro)
 Incoming Pipes (back to the heart)
• Venules (micro)
• Veins
The Heart
 Myocardium
heart muscle
 Aorta- largest arteries

feeds the myocardium via the coronary arteries
 Natural wear and tear of heart beating

can lead to scar tissue
 Problems occur when atheromatous plaques bind
to scars


lipids (fats) can calcify
lead to restricted blood flow.
Cardiovascular Disease
 Atherosclerosis “hardening of the arteries”
• excessive buildup of plaques impeding blood flow to
heart or other areas of blood supply
• less volume & greater BP
 Arteriosclerosis- loss of elasticity of the arteries
• less able to handle high volume of blood
• greater BP pressure
 Ischemia- restricted blood flow
• when coronary arteries are impeded-- called Coronary
Artery Disease- if damage to heart--- called CHD
• Effect- Angina Pectoris
Coronary Artery Disease Continued
 Myocardial Infarction- “heart attack”


survival rate about 2/3
tissue suvival rate== 0% at the “epicenter”
 Surgical Treatment

Bypass Surgery- CABG (about 500,000 annually)
• see picture on p239
• graft veins form leg on Aorta, and bypass blocked
areas

Balloon Angioplasty - PTCA
CVD (cont.) & Assessment
 Stroke



arterial blockage
aneurysm
• hemorrhagic stroke
classic effects- localized loss
 Assessment
 Hypertension & Blood Pressure



Systolic and Diastolic Blood Pressure
Essential & Secondary Hypertension
Multifactorial Nature
 ECG- measurement of electrical impulse
• stress test- sensitive to approx 50% blockage
• good for looking at nature of angina pectoris
 Angiography- X-ray of coronary arteries in action
Risk Factors- who is more at risk?
 Framingham Heart Study- identify conditions that
make one group more likely to contract HD in
future than another group

cigarette smoking, cholesterol, hypertension,
sedentary life style, obesity
 Inherent Risk Factors- not changeable

Age (Fig 9.8, p 248) , Family History, Sex (Fig 9.9,
p. 249); Ethnic Background (Afr.-American)
 Physiological Risk Factors


Hypertension
Serum Cholesterol: LDL >200; HDL<35
Risk Factors (continued)
Behavioral Risk Factors

Smoking-


active smoking at least doubles risk
passive smoking increases risk by 20%
Diet-

saturated fat consumption adds to cholesterol levels
antioxidants- (Vitamin C., E, Beta Carotene)



Dietary Fiber- (fruits & vegetables)

break down free oxygen in the system
risk decreased in Nurses Health Study
may protect again coronary heart disease
Fish Consumption (Omega-3 Oils)- may protect
Psychosocial Risk Factors and CVD
 Anxiety-
men and anxiety--- prospective research



2x more likely to develop hypertension
3x more likely to suffer SCD
greater risk for non-fatal MI and Angina
 Education Level & Income (SES variables)
• education level-- at least 2x risk if no HS educ

aggravated if also African-American
• income level

10,000/year 2x risk of survival time from CAD compared
to those making 40,000
Less than 50k/year, 2x risk of those greater than 50k/year
Psychosocial Risk and CVD (continued)
 Marriage/Social Support


2-8 times lower risk for development and progression of CVD
low social support equivalent to taking up smoking according to
James House in Lancet Article.
 The “Nasty 3”: Type A, Hostility and Anger
 Type A Behavior Pattern

general pattern of behaviors related to increased
likelihood of development of CVD
• extreme ambitiousness, competitiveness, time urgency,
impatience as a group unrelated to CVD
• Hostility component appear to be lynch-pin to
relationship with CVD.
Hostility, Anger, Expression and CVD
 HOSTILITY- a generally negative attitude toward others of some
extended duration and scope.

Cynical hostility (“think the worst of people and their
intentions”)- a strong predictor of arterial blockage and
coronary mortality.
• Cook-Medley Scale (MMPI) or Buss-Durkee Scale
• Also related to risk factor profile (behavioral &
psychosocial)



Obesity, alcohol consumption, smoking, blood pressure, negative
life events, social support levels.
When these are controlled statistically relationship betw. HO and
CVD disappears. Therefore it is a “secondary factor”-- not
independently related.
May also affect physiology through “Anger Expression”
 Figure 9.10– Relating Type A, Hostility & Anger to CVD development
Anger, Physiology & Health
 Anger- unpleasant emotion accompanied by physiological
arousal usually of short duration

expressions- Anger-In and Anger-Out
• Anger-Out related to CAD severity-
maybe a matter of type of expression (outburst or controlled)
 CV Reactivity
• angry outbursts---> large rate and BP increase
• controlled expression--> smaller HR and BP response

Provoked response (“buttons pushed”)- men their more
physiologically (key point) reactive than wives
 Suppression Okay then?
• No.. Also related to increase CAD severity
 Key appears to be controlled expression and communication!!
Modifying CVD Risk
 Obviously changing behaviors is KEY!!!
 Major obstacle-- “the optimistic bias”
• the tendency for people to believe that risk factors
increase others potential for health problems but not
their own. No recognition of personal risk
• accurate feedback and information
 Hypertension




medication (side effects and symptom problems)
obesity, exercise, sodium intake, relaxation training (comments on
effectiveness)
Serum Cholesterol
• effects of lowering---> unclear in normal population
anger behavior-- “mood congruent” and controlled speech