Effects of Psychological and Social Factors on Organic Disease: A Critical Assessment of Research on Coronary Heart Disease

Abstract

An extensive research literature in the behavioral sciences and medicine suggests that psychological and social factors may play a direct role in organic coronary artery disease (CAD) pathology. However, many in the medical and scientific community regard this evidence with skepticism. This chapter critically examines research on the impact of psychological and psychosocial factors on the development and outcome of coronary heart disease, with particular emphasis on studies employing verifiable outcomes of CAD morbidity or mortality. Five key variables identified as possible psychosocial risk factors for CAD are addressed: acute and chronic stress, hostility, depression, social support, and socioeconomic status. Evidence regarding the efficacy of psychosocial interventions is also presented. It is suggested that, taken as a whole, evidence for a psychological and social impact on CAD morbidity and mortality is convincing. However, continued progress in this area requires multidisciplinary research integrating expertise in cardiology and the behavioral sciences, and more effective efforts to communicate research findings to a biomedical audience.

Health benefits: Meta-analytically determining the impact of well-being on objective health outcomes

“…An increase in cortisol is an adaptive response to a stressor, but when prolonged over time, it can negatively impact immune system functioning (Cohen & Williamson, 1991;Dickerson & Kemeny, 2004;Herbert & Cohen, 1993;Segerstrom & Miller, 2004). Further, multiple studies and reviews indicate that stress can negatively affect the cardiovascular system (e.g., BoothKewley & Friedman, 1987;Krantz & McCeney, 2002;Kubzansky & Kawachi, 2000), neuroendocrine activity, and negative disease outcomes (Carver, 2007).…”

Heart Rate Variability, Catecholamine and Hemodynamic Responses During Rest and Stress in Coronary Artery Disease Patients: The PIMI Study

“…However, psychological stress is different. It is not tied to an increased metabolic demand, and it does not have clear beginning or end (Krantz & McCeney, 2002;McEwen, 2004). Frequent activation of the HPA axis with associated increases in cortisol and sympathetic activation in response to psychological stressors has been linked to visceral obesity, hypertension, hyperlipidemia, and insulin resistance (Hautanen & Adlercreutz, 1993;Rosmond, Dallman, & Bjorntorp, 1998) and to an increased risk for chronic conditions such as cardiovascular disease, diabetes, and atherosclerosis (Bjorntorp, 1997;Karasek et al, 1988;McEwen, 2004).…”

“…It is believed that individuals with chronic or episodic stress are at higher risk for subsequent coronary events in the face of the acute challenge (acute stress) (Krantz & McCeney, 2002;J. E. Muller & Tofler, 1992;Suchday, Krantz, & Gottdiener, 2005).…”

“…E. Muller & Tofler, 1992). Examples of chronic stress are occupational stress (low control and high demand environment) (Karasek et al, 1988) and marital strain (Gjerdingen, McGovern, Bekker, Lundberg, & Willemsen, 2000).Acute mental stress results from exposure to short-term stressors such as terrorist attack, anger, public speaking, etc (Krantz & McCeney, 2002;Krantz et al, 1999;McEwen, 2004). Finally, episodic mental stress is neither long term nor short term and ranges in duration from several months to a year (e.g.…”

RL-14: Desarrollo, consistencia interna, fiabilidad y validez de una escala de riesgos laborales en lengua española.

“…Tercero, las que atañen al sistema respiratorio como el asma (Quirce, 2011), la apnea (Ruberto, 2011) y el enfisema (Santo-Tomás, 2011). Y finalmente, las patologías cardiovasculares (Chaparro, 2011;Krantz y McCeney, 2002) como la arteriosclerosis (Rosenström, 2011) y la hipertensión (Brison, 2000). Así-mismo, también hemos tenido en cuenta la importancia de la información / formación siguiendo los preceptos del ENGE (2009) dado que es un aspecto relevante de la prevención de los riesgos laborales tal como ha quedado demostrado en investigaciones precedentes (Boada-Grau, De Diego y Agulló, 2004;Boada-Grau, De Diego y Macip, 2001).…”