T1 L12: lifestyle factors and cardiovascular disease

• CVD is the leading cause of adult deaths in the UK
• onset and progression of CVD is strongly influenced by lifestyle
• 80% of CVD could be prevented by elimination of modifiable risk factors
• what are the physical (immutable) risk factors for CVD?

  age

  sex

  family history

  genes
• what are the psychosocial risk factors for CVD?

  Health behaviours

  stress

  depression

  social support

  (+other demographics - eg. education)
• what are the 3 pathways by which CVD affects individuals?

  1.health related behaviours (diet, smoking)

  2.causing acute/chronic physiological changes that cause CVD

  3. access to/use of medical care
• least healthy individuals are more likely to develop CVD and more likely to die from it
• interventions can improve diet, smoking habits and increase excercise and lead to lower death rates and lower risk of further cardiac events
• lower socioeconomic groups have greater CVD risk
• lower SES = more likely to die if they develop CVD
• healthy lifestyles have bigger impact among lower SES people
• SES has an effect not accounted for by less healthy lifestyles
• why do people risk their health?

  biased risk perception

  health optimism

  general risk vs personal risk
• general public acknowledge influence of various CVD factors but underestimate impact of diet and excercise 


  motivation to make external rather than internal attributions
• people underestimate the lack of causal factors especially those related to lifestyle
• outcome of MI is strongly assoc. with speed of treatment
• factors linked to shorter times getting to hospital

  male

  married

  attribution of symptoms

  believing MI has serious consequences

  active coping style (problem focused)
• responses to stress

  physical - fight/flight

  behavioural - diet, smoking etc

  emotional - anxiety, depression

  cognitive - poor concentration
• coping responses

  approach - problem solving

  avoidance - distraction
• non-human animal studies show that chronic stress ..

  induces atherosclerosis

  lowers threshold for arrythmia
• observational longitudinal studies show that chronic stress..

  is associated with subclinical atherosclerotic CVD
• epidemiological studies show that acute stress is..

  assoc. with MI and cardiac death

  MI and cardiac death after major events eg. 9/11
• experimental studies show that acute stress..

  triggers ischaemia in patients with CHD

  is assoc with cardiovascular changes
• job strain = chronic stress
• job strain occurs when

  demands are high

  control is low

  support is low
• job strain is assoc. with greater CVD risk
• individual vulnerability factors:

  cardiac reactivity
• emotional impact of CHD

  higher than average prevalence of psychological distress post-MI
• objective severity of disease does not determine psychological distress: what matters more is how people experience, make sense of and respond to CVD
• depression is an independent predictor of premature death in CHD patients and is associated with poorer adherence to medication or lifestyle modification
• anxiety is associated with worse clinical outcomes, more short-term complications, worse long-term prognosis and greater premature death
• what is the goal of screening for psychological distress in cardiac patients?

  targeting those most in need of treatment and support
• effective treatment..

  alleviates psychological distress

  improves long-term survival