Cited by 1,238Cardiac Health and Mental HealthCardiovascular Health and Risk FactorsCardiac Imaging and Diagnostics

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The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice

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Rozanski, Alan, Blumenthal, James A., Davidson, Karina W., Saab, Patrice G., Kubzansky, Laura·2005·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2004.12.005

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Abstract

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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“Furthermore, there is evidence that reductions in these negative emotions can improve CVD risk factor profile and disease end points.(152) More general measures of stress and resources have shown less consistent evidence with cardiovascular risk.”
Background

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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
ORCID: Rozanski, Alan
Blumenthal, James A.
Davidson, Karina W.
Kubzansky, Laura
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)
DOI: 10.1016/j.jacc.2004.12.005
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: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 3096 d)
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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The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice

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