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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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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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