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The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice
Open accessAbstract
Observational studies indicate that psychologic factors strongly influence the course of coronary artery disease (CAD). In this review, we examine new epidemiologic evidence for the association between psychosocial risk factors and CAD, identify pathologic mechanisms that may be responsible for this association, and describe a paradigm for studying positive psychologic factors that may act as a buffer. Because psychosocial risk factors are highly prevalent and are associated with unhealthy lifestyles, we describe the potential role of cardiologists in managing such factors. Management approaches include routinely screening for psychosocial risk factors, referring patients with severe psychologic distress to behavioral specialists, and directly treating patients with milder forms of psychologic distress with brief targeted interventions. A number of behavioral interventions have been evaluated for their ability to reduce adverse cardiac events among patients presenting with psychosocial risk factors. Although the efficacy of stand-alone psychosocial interventions remains unclear, both exercise and multifactorial cardiac rehabilitation with psychosocial interventions have demonstrated a reduction in cardiac events. Furthermore, recent data suggest that psychopharmacologic interventions may also be effective. Despite these promising findings, clinical practice guidelines for managing psychosocial risk factors in cardiac practice are lacking. Thus, we review new approaches to improve the delivery of behavioral services and patient adherence to behavioral recommendations. These efforts are part of an emerging field of behavioral cardiology, which is based on the understanding that psychosocial and behavioral risk factors for CAD are not only highly interrelated, but also require a sophisticated health care delivery system to optimize their effectiveness.
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“Mechanisms that link psychosocial factors to increased CVD risk include unhealthy lifestyle (more frequent smoking, unhealthy food choice, and less physical exercise), increased healthcare utilization, and low adherence to behaviour-change recommendations or cardiac medications.88,90,116 -119”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [118]
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“In addition, persons and patients with depression and/or chronic stress show alterations in autonomic function (including reduced heart rate variability) in the hypothalamic-pituitary axis and in other endocrine markers, which affect haemostatic and inflammatory processes, endothelial function, and myocardial perfusion.117,118,120”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [118]
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Basics of Related Medical Disciplines
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Brouillette, J. (2019) · Biomedical Journal of Scientific & Technical Research · doi:10.26717/bjstr.2019.23.003844
“Moreover, although several hypotheses linking anxiety to cardiovascular diseases have been proposed [7-10], the physiopathological mechanisms responsible for linking these two pathologies remain to be specified.”
BackgroundMedical Conditions Affecting Women’s Mental Health
Rückl, S., Couto, T. C. E., Parada, J. M. S., & Rosa, C. E. (2020) · Springer eBooks · doi:10.1007/978-3-030-29081-8_18 · Cited by 1
PTSD and Cardiovascular Disease
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“001 Alanine aminotransferase (U/L)b 26 (19-38) 30 (22-41) 0.”
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Pushkarev, G. S., Мацкеплишвили, С. Т., & Анатольевич, К. В. (2021) · Almanac of Clinical Medicine · doi:10.18786/2072-0505-2021-49-033 · Cited by 1
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Stress als Risikofaktor für körperliche und psychische Gesundheitsbeeinträchtigungen
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Natural Disasters and the Risk of Cardiovascular Disease
Zarifeh, J., & Mulder, R. (2016) · Springer eBooks · doi:10.1007/978-981-287-206-7_19 · Cited by 1
von Känel, R. (2010) · Springer eBooks · doi:10.1007/978-3-642-16964-9_14 · Cited by 1
Psychosomatic Problem Areas and Comorbidities Using the Example of Coronary Heart Disease
Albus, C., Herrmann‐Lingen, C., Köllner, V., von Känel, R., & Titscher, G. (2022) · Springer eBooks · doi:10.1007/978-3-662-65322-7_5 · Cited by 1
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“However, serum aldosterone levels differed among subjects depending on their age and sex, irrespective of tVNS. Worldwide, psychosocial stress is an important risk factor for the development of cardiovascular diseases 1,2 .”
An Updated Review on the Complex Association of Cardiovascular Disease (CVD) and Depression
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Una psicologia clinica per la malattia cardiaca
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Puesta en marcha y desarrollo de un programa de enlace de salud mental con el área del corazón.
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Stress e malattie cardiovascolari
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Psychosocial risk factors and personality disorders in outpatient cardiology setting
Suárez-Bagnasco, M., Brandani, M., Lobo, M., Masson, W. M., Peressotti, B., Jorge, N., Gagliardi, J., Higa, C. C., & Zylbersztejn, H. M. (2015) · International Cardiovascular Forum Journal · doi:10.17987/icfj.v3i0.91 · Cited by 1
Metadata
- Authors
- Rozanski, A., Blumenthal, J. A., Davidson, K. W., Saab, P. G., & Kubzansky, L.
- Affiliations
- St. Luke's-Roosevelt Hospital Center (US)
- Duke Medical Center (US)
- Columbia University (US)
- University of Miami (US)
- Harvard University (US)
- Corresponding author
- Rozanski, Alan
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2005-03
- Volume
- 45
- Issue
- 5
- Pages
- 637-651
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2144716474
- Cited by
- 1,238
- References
- 113
- Citations by year
- 2026: 27 · 2025: 16 · 2024: 19 · 2023: 28 · 2022: 30 · 2021: 48 · 2020: 42 · 2019: 46 · 2018: 48 · 2017: 48 · 2016: 72 · 2015: 72 · 2014: 72 · 2013: 82 · 2012: 84
- FWCI
- 12.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc25197-0-0-0)
- National Heart, Lung, and Blood Institute (R24HL076857, N01 HC025197)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- psychosocial risk factors, coronary artery disease, psychological distress, behavioral interventions, cardiac rehabilitation, physical activity, screening, patient adherence, lifestyle risk factors
- MeSH terms
- Affective Symptoms, Arousal, Behavior Therapy, Combined Modality Therapy, Coronary Artery Disease, Heart, Humans, Hypothalamo-Hypophyseal System, Life Style, Myocardial Infarction, Patient Care Team, Pituitary-Adrenal System, Psychotherapy, Brief, Psychotropic Drugs, Risk Factors, Social Support, Stress, Psychological, Sympathetic Nervous System, Comorbidity
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