Chapter 9 Behavioral Factors in Cardiovascular Disease
cardiovascular system - The system of the body that includes (1) the heart, (2)
the arteries, and (3) the veins. It carries oxygen to the cells and carries carbon
dioxide and other waste away from the cells.
arteries - Are large vessels (flexible tubes) that carry freshly oxygenated blood
away from the heart to the various parts of the body.
arterioles - are smaller diameter vessels that the arteries branch into.
capillaries - are smaller still vessels that the arterioles branch into. After
traveling through the capillaries, blood passes into the venules and starts its
journey back to the heart.
venules - The smallest of the veins.
veins - Are large vessels that return oxygen depleted blood back to the heart
from the various parts of the body.
myocardium - The muscle of the heart that keeps it contracting and releasing
(pumping).
atrium and aorta - The veins return "used" blood to the "right atrium." The
"aorta" carries oxygenated blood out the various parts of the body "including the
myocardium."
cardiovascular disease (CVD) - Disorders of the circulatory system, including
coronary artery disease and stroke.
atheromatous plaques - Deposits of cholesterol and other lipids (fats),
connective tissue, and muscle tissue that attach to the interior artery walls.
atherosclerosis - The condition involving narrowing and blockage of the arteries
resulting in restricted blood flow. The cause is formation of plaque within the
arteries. A section of plaque can also detach and completely block the narrowed
artery.
arteriosclerosis - (also called "hardening of the arteries") A related condition
marked by loss of elasticity and flexibility of the arteries. Ability of the arteries to
withstand the increased pressure when the heart pumps is reduced. This is also
caused by plaque formation in the arteries.
coronary artery disease (CAD) - Atherosclerosis and/or arteriosclerosis in the
coronary arteries resulting in reduced flow of blood to the heart (myocardium).
Ischemia - is the technical term for artery blockage and restricted blood flow.
coronary heart disease (CHD) - This conditions involves actual damage to the
myocardium due to insufficient blood supply.
myocardial infarction - is the technical term for a "heart attack." The cause is
death of myocardial tissue due to loss of blood supply. Reduced vigor and
stamina may require lifestyle adjustments (assuming one survives).
cardiac rehabilitation - A group of approaches (often involving psychologists)
designed to help heart patients (1) adjust lifestyle, (2) reduce risk factors, and (3)
avoid future attacks.
angina pectoris - A less severe condition involving restricted blood supply to the
myocardium. The symptoms are "crushing" pain in chest and difficulty breathing
which often (but not always) follow exertion or stress.
stroke - is the name for damage to the brain resulting from lack of oxygen (death
of brain cells will occur within "3 to 5 minutes" of oxygen loss). Stroke is typically
the result of cardiovascular disease.
common stroke - is caused by a clot (blockage), most often in a vessel that has
been narrowed by atherosclerosis (plaque formation).
hemorrhagic stroke - is caused by bleeding in the brain due to a rupture of a
weakened vessel. Cells can die (1) because their blood supply is lost OR (2)
from pressure due to the escaping blood.
blood pressure - is the most common measurement of cardiovascular
functioning, probably because of its ease and convenience. The degree to which
the pressure raises a column of mercury in a glass tube indicates the pressure
(just like a barometer with air pressure).
systolic blood pressure - The "first" number, a measure of the blood pressure
generated by the heart’s contraction.
diastolic blood pressure - The "second" lower number, a measure of blood
pressure between contractions of the heart.
hypertension - Abnormally "high blood pressure" (resting). According to our text
(numbers approximate), up to 120 systolic and 80 diastolic are "normal" blood
pressure. Up to 140 / 90 would be Prehypertension, up to 160 / 100 Stage 1
Hypertension, and above that, Stage 2 Hypertension. Hypertension is the "single
best predictor of both heart attack and stroke." The delicate blood vessels of the
"retinas" are at risk from the increased pressure as are other body parts.
essential (primary) hypertension - High blood pressure that has no easily
discernable cause. Genetics and environment likely play important roles.
secondary hypertension - High blood pressure that can be identified as the
result of other diseases (e.g., kidney disease). It is much "less common" than
essential hypertension.
electrocardiogram (ECG) - is a measure of the electrical activity of the heart
during "rest." An abnormal ECG indicates cardiac problems BUT cannot detect
plaque buildup or hardening of the arteries (CAD).
stress test - measures the electrical activity of the heart under increasing levels
of exercise test to diagnose coronary artery disease. Inefficient oxygen supply
due to artery blockage will produce a characteristic pattern. Thus, this is a more
sensitive and useful test than is the ECG.
angiography - The most definitive (but invasive) test for diagnosing CAD. A
catheter is snaked through a blood vessel to the heart. A dye is then injected so
that X-ray pictures can clearly show artery blockage. It is considered the "gold
standard" of diagnosis. Unfortunately, it is uncomfortable or even painful,
frightening, and carries a slight risk of death.
angioplasty - A catheter with an inflatable balloon tip is passed into an
obstructed artery. The tip is then inflated in order to flatten atherosclerotic
deposits of plaque and, at least temporarily, open up blocked arteries. The
procedure is now fairly routine.
stent - a metal tube which can be inserted into the artery after angioplasty to
keep the artery open.
cardiovascular death rates - in the U. S. rose dramatically between 1920 and
the 1960s. It then began a steady decline (when graphed, the pattern forms an
"inverted U function" or bell curve). The decline is due to two factors: (1)
improved emergency treatment, and (2) changes in lifestyle (better diet, more
exercise, etc.).
the Framingham Heart Study - identified a number of now well recognized risk
factors back in the 1960s and, along with the 1964 Surgeon General's Report on
Smoking, likely led to many of the post 1960s lifestyle changes that have helped
reduce heart disease in the U. S.
increasing rates of cardiovascular disease - In contrast to the U. S., rates are
increasing in Russia and other Eastern European areas of the former Soviet
Union. All factors are not understood but higher rates of smoking and increased
alcohol use are two.
inherent risk factors - are things that are not easily changed such as genetics
and the presence of various physical conditions.
advancing age - is the primary risk factor (inherent or otherwise) for
cardiovascular disease. With each 10 years of age, risk of cardiovascular
disease more than doubles.
demographic factors - Risk of CVD for men is about twice that for women.
Native, Asian, and Hispanic Americans are at less risk than European Americans
who are, in turn, at less risk than African Americans. For African Americans,
discrimination leads to hypertension which, in turn, leads to CVD.
cholesterol - fatlike lipoproteins that comes from animal fats and other sources.
They are necessary (in small quantities) to human life.
low-density lipoprotein (LDL) - "Bad cholesterol" is a form of lipoprotein
thought to cause coronary artery disease.
high-density lipoprotein (HDL) - "Good cholesterol" is a form of lipoprotein that
confers some protection against coronary artery disease.
triglycerides - very low density (VLDL) lipoproteins. High levels are thought to
cause coronary artery disease.
total cholesterol to HDL Ratio - yields a number that provides a "snapshot" of
one's cholesterol profile. A lower number is more favorable with a ratio of "4 or
less" being desirable.
behavioral factors - Cigarette smoking is the leading behavioral risk factor for
cardiovascular death in the U. S. Other risks include obesity (esp. with a large
amount of abdominal fat), a diet high in saturated (animal) fats, and sedentary
lifestyle.
psychosocial factors - Lower level of education is a risk factor via association
with other risks such as smoking. Higher income, social support, and (one of my
favorites) having a pet can have beneficial effects.
personality - seems to be less of a factor than intuition would suggest. In the
1970s, cardiologists Friedman and Rosenman identified a CHD prone personality
pattern which they called "Type A." Later research indicated that only hostility
and anger were the relevant personality factors (and even these are NOT major
factors). Neither violent expression of anger nor holding anger in (suppression)
is an effective strategy. Experts suggest calm expression of anger. Anger, badly
handled, can lead to cardiovascular reactivity (CVR).
cardiovascular reactivity (CVR) - An increase in blood pressure and heart rate
as a reaction to frustration or harassment.
cardiologist - A medical doctor who specializes in the diagnosis and treatment
of heart disease.
Dean Ornish - Achieved some degree of fame when his super low fat (less than
10%) vegetarian diet actually resulted in a "decrease" in arterial plaques among
his research patients. Unfortunately, such a program is extraordinarily difficult to
stay with.