cvd - Psychotherapy Volume 33/Winter 1996/Number 4 REDUCING...

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Psychotherapy Volume 33/Winter 1996/Number 4 REDUCING RISK FOR CARDIOVASCULAR DISEASE JOHN P. FOREYT WALKER S. CARLOS POSTON II Behavioral Medicine Research Center Baylor College of Medicine, Houston, Texas The focus of this review article is to examine the importance of psychological and social factors in the development and maintenance of cardiovascular diseases, primarily coronary heart and artery disease, and to provide an overview of the effectiveness of psychosocial risk reduction interventions. First we summarize the prevalence and economic burden of cardiovascular disease, as well as the role of psychosocial factors in disease development and progression. We then examine the primary modifiable risk factors and evaluate the role of psychotherapists in the treatment of heart disease. Finally, we assess the effectiveness of risk factor modification and rehabilitation interventions, describe the potential costs and benefits of these programs, and discuss the role of primary prevention programs. Cardiovascular diseases (CVD) comprise a number of disorders affecting the heart and circu- latory system (Mile & Zipes, 1990). CVDs in- clude coronary heart disease (CHD) and it's related complications, for example, angina, myo- cardial infarction (MI), and congestive heart fail- ure, hypertension (HTN), and cerebrovascular disease. The common pathological condition un- Thisresearchwas supported by National Institute of Diabe- tes and Digestive and Kidney Diseases Grant DK43109 and a Minority Scientist Development Award from the American Heart Association and it's Puerto Rican Affiliate. Correspondence regarding this article should be addressed to John P. Foreyt, 6S3S Fannin, MS F700, Houston, TX 77030. deriving these diseases is coronary artery disease (CAD), or coronary atherosclerosis, which is caused by fatty deposits lining arterial walls, lead- ing to the narrowing of medium and large arteries The most common forms of CVD, and the pri- mary focus of this article, are those that affect the heart, including CHD and HTN. According to recent estimates, these two conditions together are the most prevalent chronic diseases in the United States, affecting a total of 192 individuals per 1000, or approximately 19 percent of the U.S. the leading cause of work-related disability among men over 50 and as many as 15% of heart disease patients are functionally disabled and do not return to work (Cooper, 1995; Oldridge, 1991). CVDs are the leading causes of death in the U.S., accounting for 44% of all mortality (Luepker, 1994). Of that, CHD and it's sequelae (e.g., angina, myocardial infarction, and heart failure) account for fully 79% of all cardiovascular- related mortality (Luepker, 1994). CVDs result in enormous economic/health care
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cvd - Psychotherapy Volume 33/Winter 1996/Number 4 REDUCING...

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