Psychosocial Factors and CHD June 2009

Psychosocial Factors and CHD June 2009 - Psychosocial Risk...

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Psychosocial Risk Factors for Cardiovascular Disease Nathan D. Wong, PhD
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“ For every affection of the mind that is attended with either pain or pleasure, hope or fear, is the cause of an agitation whose influence extends to the heart, and there induces change from the natural constitution,in the temperature, the pulse and the rest” - Dr William Harvey, 1962
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Proposed Mechanisms Relating Chronic Stress to Atherosclerosis Rozanski et al., JACC 2005
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Six Reasons that Promote Interest in Evaluation and Management of Psychosocial Stress in Heart Disease Rozanski et al., JACC 2005
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INTERHEART Study: Psychosocial Index and Risk of Acute MI Psychosocial index based on individual items of depression, locus of control, work or home stress, financial stress, and adverse life events.
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Adverse Childhood Experiences Study (Dong et al. Circulation 2004) Prevalence and adjusted odds ratio of ischemic heart disease Childhood experience Prevalence of heart disease (%) Adjusted odds ratio 95% CI Emotional abuse (n=1829) 13.5 1.7 1.5-1.9 Physical abuse (n=4912) 12.7 1.5 1.4-1.9 Sexual abuse (n=3586) 12.7 1.4 1.3-1.6 Domestic violence (n=2201) 12.8 1.4 1.2-1.6 Parental marital discord (n=4031) 10.2 1.0 0.9-1.2 Emotional neglect (n=1256) 12.3 1.3 1.1-1.6 Physical neglect (n=836) 14.7 1.4 1.2-1.8 To download table as a slide, click on slide logo below
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The term “Psychosocial” broadly categorizes factors which are: Psychologic – e.g, anxiety, depression Psychosocial – e.g., work stress, discrimination, emotional support Social-structural – e.g., socioeconomic status, social integration, neighborhood effects
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Depression Estimated prevalence of major depression in the US is 14%, but up to 30% in cardiac patients Characterized by a depressed mood and combination of other symptoms such as weight change, sleep disturbance, insomnia, fatigue, feelings of guilt, worthlessness, and/or hopelessness. Of all psychosocial factors, evidence of association with CVD is strongest for depression.
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Depression and CVD (cont) Frasure-Smith et al (JAMA 1993) reported a 4-fold increase in mortality during 6 months following acute MI from depression in cardiac patients. Meta-analysis examining depression as a factor in development of CHD in healthy individuals showed a risk factor-adjusted RR=2.69 for CHD incidence ( Rugulies, Am J Prev Med 2002).
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Depressive Symptoms and Cardiac Free Survival in Post-MI Patients
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Depression and CHD
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Anxiety and CHD Anxiety is characterized by heightened levels of perceived fear and nervousness– may include panic disorder, social phobia, obsessive-compulsive disorder, acute stress disorder, posttraumatic stress disorder. Clear relation to sudden cardiac death in a dose-
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This note was uploaded on 12/21/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Psychosocial Factors and CHD June 2009 - Psychosocial Risk...

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