Hostility and myocardial ischemia in coronary artery disease patients: evaluation by gender and ischemic index.

Helmers, Karin F.; Krantz, David S.; Howell, Robert H.; Klein, Jacob; Bairey, C N; Rozanski, Alan

doi:10.1097/00006842-199301000-00006

Cited by 79 publications

(38 citation statements)

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“…76,80 -82 In addition, studies have reported that CAD patients with high levels of hostility have a greater rate of restenosis after angioplasty, 83 experience more rapid atherosclerosis progression during serial carotid ultrasonography, 84,85 and manifest more ischemia during stress testing than other CAD patients. 86 …”

Section: Personality and Character Traitsmentioning

confidence: 99%

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

1999

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Abstract-Recent studies provide clear and convincing evidence that psychosocial factors contribute significantly to the pathogenesis and expression of coronary artery disease (CAD). This evidence is composed largely of data relating CAD risk to 5 specific psychosocial domains: (1) depression, (2) anxiety, (3) personality factors and character traits, (4) social isolation, and (5) chronic life stress. Pathophysiological mechanisms underlying the relationship between these entities and CAD can be divided into behavioral mechanisms, whereby psychosocial conditions contribute to a higher frequency of adverse health behaviors, such as poor diet and smoking, and direct pathophysiological mechanisms, such as neuroendocrine and platelet activation. An extensive body of evidence from animal models (especially the cynomolgus monkey, Macaca fascicularis) reveals that chronic psychosocial stress can lead, probably via a mechanism involving excessive sympathetic nervous system activation, to exacerbation of coronary artery atherosclerosis as well as to transient endothelial dysfunction and even necrosis. Evidence from monkeys also indicates that psychosocial stress reliably induces ovarian dysfunction, hypercortisolemia, and excessive adrenergic activation in premenopausal females, leading to accelerated atherosclerosis.Also reviewed are data relating CAD to acute stress and individual differences in sympathetic nervous system responsivity. New technologies and research from animal models demonstrate that acute stress triggers myocardial ischemia, promotes arrhythmogenesis, stimulates platelet function, and increases blood viscosity through hemoconcentration. In the presence of underlying atherosclerosis (eg, in CAD patients), acute stress also causes coronary vasoconstriction. Recent data indicate that the foregoing effects result, at least in part, from the endothelial dysfunction and injury induced by acute stress. Hyperresponsivity of the sympathetic nervous system, manifested by exaggerated heart rate and blood pressure responses to psychological stimuli, is an intrinsic characteristic among some individuals. Current data link sympathetic nervous system hyperresponsivity to accelerated development of carotid atherosclerosis in human subjects and to exacerbated coronary and carotid atherosclerosis in monkeys.Thus far, intervention trials designed to reduce psychosocial stress have been limited in size and number. Specific suggestions to improve the assessment of behavioral interventions include more complete delineation of the physiological mechanisms by which such interventions might work; increased use of new, more convenient "alternative" end points for behavioral intervention trials; development of specifically targeted behavioral interventions (based on profiling of patient factors); and evaluation of previously developed models of predicting behavioral change. The importance of maximizing the efficacy of behavioral interventions is underscored by the recognition that psychosocial stresses tend to cluster together. ...

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Section: Personality and Character Traitsmentioning

confidence: 99%

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

1999

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“…35 Parallel ambulatory studies in coronary artery disease patients in daily life show similar results 38 and have been extended to demonstrate that both the intensity of mental effort and the presence of negative mood correlate with myocardial ischemia. In addition, both ambulatory 38 and laboratory studies 39 have demonstrated correlations between hostility and ischemia in humans.…”

Section: Psychosocial Variables and Myocardial Ischemiamentioning

confidence: 99%

Psychosocial Stress and Cardiovascular Disease: Pathophysiological Links

Merz¹,

Dwyer²,

Nordstrom³

et al. 2002

Behavioral Medicine

135

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The remarkable decline in cardiovascular disease (CVD) experienced in developed countries over the last 40 years appears to have abated. Currently, many CVD patients continue to show cardiac events despite optimal treatment of traditional risk factors. This evidence suggests that additional interventions, particularly those aimed at nontraditional factors, might be useful for continuing the decline. Psychosocial stress is a newly recognized (nontraditional) risk factor that appears to contribute to all recognized mechanisms underlying cardiac events, specifically, (a) clustering of traditional cardiovascular risk factors, (b) endothelial dysfunction, (c) myocardial ischemia, (d) plaque rupture, (e) thrombosis, and (f) malignant arrhythmias. A better understanding of the behavioral and physiologic associations between psychosocial stress and CVD will assist researchers in identifying effective approaches for reducing or reversing the damaging effects of stress and may lead to further reductions of CVD morbidity and mortality. Index Termscardiovascular disease; psychosocial interventions; psychosocial stress; review Cardiovascular disease (CVD) remains the largest contributor to morbidity and mortality in developed countries. 1 Advances in prevention and treatment in the last 40 years have resulted in a 40% decline in mortality from this disease. 1 Despite this remarkable success, it is sobering to note that the decline has abated recently,2 paradoxically despite continued reductions in traditional risk factors.3 Up to 50% of patients with established coronary artery disease have recurrent cardiac events, such as myocardial infarction and cardiac death, even with aggressive

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“…This hostility scale was initially developed to differentiate between teachers having good versus bad rapport in their relationships with students, but has become popular among health outcomes researchers as the evidence accumulates suggesting it is an important predictor of future cardiovascular health status (see Smith, 1992 Helmers and Krantz (1996) reported a mean of 21.03 (± 6.9) in their study of 68 healthy men and women. Helmers et al, (1993) reported a mean of 16.9 (± 5.9) in a sample of 63 men with CAD and a mean of 14.6 (± 8.6) in a sample of 17 women with CAD. The questionnaire as provided to the participants is included in the appendix.…”

Section: Hostilitymentioning

confidence: 97%

“…In general, researchers suggest the Ho scale reflects cynical beliefs and mistrust (Barefoot & Lipkus, 1994). Other studies have continued to implement the Composite Hostility score in assessing hostility-health relationships (Suarez & Williams, 1989;Helmers et al, 1993;Helmers et al, 1995).…”

Section: Hostility Assessmentmentioning

confidence: 99%

“…Two studies linking hostility to ischemia were presented (Burg et al, 1993;Helmers et al, 1993), and a study linking acute anger to ischemia was presented . One study noted no relationship between hostility and ischemia, but used a different measure of hostility than did the other ischemia studies (Legault, Langer, Armstrong, & Freeman, 1995).…”

Section: Defensiveness and Myocardial Ischemiamentioning

confidence: 99%

See 1 more Smart Citation

Hostility and anger expression behavioral and cardiovascular responses to mental stress among cardiovascular disease patients

Tucker¹

2002

PsycEXTRA Dataset

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Hostility and myocardial ischemia in coronary artery disease patients: evaluation by gender and ischemic index.

Cited by 79 publications

References 0 publications

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

Psychosocial Stress and Cardiovascular Disease: Pathophysiological Links

Hostility and anger expression behavioral and cardiovascular responses to mental stress among cardiovascular disease patients

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