Behavioral Medicine Approaches To Cardiovascular Disease Prevention

Cardiovascular disease (CVD) is the number one killer of men and women in industrialized countries. In older age groups, CVD is also the most important cause for hospitalization, and, in many countries, it is the basis of early retirement from work. Thus, CVD is associated with enormous costs for care and loss of productivity, as well as for disabilities, pensions, etc. All this has motivated clinicians and scientists to develop and implement new methodologies and technologies to better care for patients who are hospitalized for heart disease. Efforts to improve care in the acute phases of coronary heart disease (CHD) have been successful. During the last decade, the immediate mortality risk of a patient admitted to coronary care for a suspected myocardial infarction or other acute coronary syndrome has decreased to less than 10%. Despite these achievements, CVD continues to represent a major threat to the health of middle-aged and elderly men and women. This volume addresses myriad aspects of CHD prevention, including biobehavioral and psychosocial factors, behavioral epidemiology, behavioral intervention models, and policy. The first section of the text provides an introduction to CVD prevention and behavioral medicine. The second section introduces two theoretically different approaches to preventive action, high-risk and population-based strategies. The third section describes and discusses the important questions of how behavioral sciences can be conceptually integrated into traditional, medically based, preventive efforts. The fourth section presents both population and high-risk behavioral intervention approaches. In summary, this volume examines the social environment and its potentials for preventive actions, reviews the psychosocial and biobehavioral mechanisms involved in these effects, and describes concrete and practical implementations of behavioral medicine knowledge as they have been applied to CHD prevention.

Cardiovascular disease continues to be the number ioral medicine" was developed and shaped into the one source of morbidity and mortality in our coun following definition: try. Despite a 35% reduction since 1964, these Behavioral medicine is the interdisciplinary field con diseases, particularly coronary heart disease cerned with the development and integration of behav (CHD), claim nearly 1,000,000 lives each year in ioral and biomedical science knowledge and techniques the United States (Havlik & Feinleib, 1979). relevant to the understanding of health and illness and The Framingham study, among others, has iden the application of this knowledge and these techniques to prevention, diagnosis, treatment and rehabilitation. tified three major risk factors implicated in the de (Schwartz & Weiss, 1978) velopment of CHD: smoking, elevated serum cho lesterol, and high blood pressure (Castelli et at., This concept of "biobehavioral" collaboration 1986). Given that these factors account for less challenged scientists and clinicians of many disci than 50% of the variance associated with CHD plines to consider how they might more effectively (Jenkins, 1976), it has become obvious that addi develop diagnostic, treatment, and prevention tional risk factors must be identified if further pro strategies by merging their perspectives to address gress is to be made in disease prevention and simultaneously, among others, behavioral, psy control.

Cardiovascular disease (CVD), once thought to be confined primarily to industrialized nations, has emerged as a major health threat in developing countries. Cardiovascular disease now accounts for nearly 30 percent of deaths in low and middle income countries each year, and is accompanied by significant economic repercussions. Yet most governments, global health institutions, and development agencies have largely overlooked CVD as they have invested in health in developing countries. Recognizing the gap between the compelling evidence of the global CVD burden and the investment needed to prevent and control CVD, the National Heart, Lung, and Blood Institute (NHLBI) turned to the IOM for advice on how to catalyze change. In this report, the IOM recommends that the NHLBI, development agencies, nongovernmental organizations, and governments work toward two essential goals: creating environments that promote heart healthy lifestyle choices and help reduce the risk of chronic diseases, and building public health infrastructure and health systems with the capacity to implement programs that will effectively detect and reduce risk and manage CVD. To meet these goals, the IOM recommends several steps, including improving cooperation and collaboration; implementing effective and feasible strategies; and informing efforts through research and health surveillance. Without better efforts to promote cardiovascular health, global health as a whole will be undermined.

Smoking, diet, stress, coping, and exercise, among other behaviors and psychological states, are now clearly implicated in the development of cardiovascular diseases. Prevention, based largely on altering behaviors that contribute to this chronic disease, is now as important a goal as is treatment of those already afflicted. This volume, based on a recent meeting of the Academy of Behavioral Medicine Research, addresses several important areas of research in the general area of cardiovascular disease. The topics covered reflect on important aspects of this phenomenon, such as the long-term development of coronary artery disease; central nervous system (CNS) regulation of blood pressure, heart rate, and sympathetic tone playing a pivotal role in sympathetic activity and hypertension; learned blood pressure modulation and baroreceptor activation as a means of reducing the aversiveness of stress or noxious stimulation; and the notion that symptoms of heart disease or infarction may occur in the absence of organic heart disease. Having been impressed by the recent advances in the field, the editors of this book capture the wealth of newly acquired knowledge about behavioral factors in cardiovascular disease and how the body's nervous, endocrine, and cardiovascular systems work together.

Providing a state-of-the-science overview of theory, research, and practice at the interface of psychology and health, this comprehensive volume explores how health and health behaviors are shaped by a wide range of psychological processes and social-environmental factors.

Cardiovascular disease is the leading cause of morbidity and mortality in the United States and most other westernized nations. It is well recognized that traditional risk factors for cardiovascular disease have limited predictive utility in the identification of new cardiovascular disease cases and outcomes. Thus, investigators have argued that application of a biopsychosocial research paradigm in this field may be of particular utility in understanding cardiovascular disease pathogenesis. Accordingly, a subdiscipline within the field of behavioral medicine – cardiovascular behavioral medicine – examines interrelations among biological, behavioral, psychological, and social factors in cardiovascular health and disease. In 1989, Schneiderman and colleagues published a seminal work entitled "Research Methods in Cardiovascular Behavioral Medicine." Since that time, there has been an exponential increase in the amount and scope of work in this topic area, but no similar edited volume has been undertaken. Here we propose to create a compendium of work in the field of cardiovascular behavioral medicine, the purposes of which are to summarize research in this area, promote multidisciplinary research and clinical practice, and encourage researchers and clinicians to consider all relevant facets of the disease process in their evaluation and study of cardiovascular disease pathogenesis and outcomes. In this volume, we propose several sections. Section I will provide an overview of basic cardiovascular anatomy and physiology, cardiovascular disease classification, and application of the biopsychosocial model to the study of cardiovascular disease. Section II will cover sociodemographic, behavioral, psychosocial, biomedical, and psychophysiological risk factors for cardiovascular disease. Each chapter will offer a discussion of construct definition, measurement issues, and epidemiological evidence for relations to cardiovascular disease. Chapters on biomedical and psychophysiological risk factors will also describe sociodemographic, behavioral, and psychosocial correlates of these risk factors. Section III will summarize literature on biopsychosocial investigation of specific cardiovascular disease entities, the evidence base for relevant biopsychosocial interventions, and evaluation of the impact of cardiovascular diseases on behavior. Section IV will cover select special topics in the field of cardiovascular behavioral medicine including common comorbidities, special populations, special issues, and data analytic issues. This volume is unique in several respects. First, there is no similar work available in terms of the scope of topic coverage. Second, the inclusion of relevant measurement issues and construct definitions of a comprehensive set of risk factors will be of great assistance to researchers and clinicians in this area who wish to improve their assessment of these variables yet are not familiar with or trained in the various methodologies. Third, the use of multidisciplinary contributors will greatly enhance the utility of the work. The primary audiences for this work are multidisciplinary researchers, clinicians, and students in cardiovascular behavioral medicine or behavioral medicine more broadly. Representative disciplines include psychology, psychiatry, medicine, nursing, and epidemiology. The prospective authors listed below represent each of these disciplines.

During the past decade, cardiovascular medicine has made significant strides in the diagnosis and treatment of coronary heart disease and related disorders as well as developing a better understanding of potential preventive, risk-reduc ing measures. Highly sophisticated diagnostic instrumentation, surgical pro cedures, and emergency medical care have undoubtedly contributed greatly to the trend of declining mortality from cardiovascular events. In the course of the extensive research efforts associated with this area, it has become increas ingly apparent that the identified coronary risk factors share the common ele ment of lifestyle as a major determiner of health behaviors associated with these factors. Further, it is suspected that behavioral and environmental factors may playa significant contributory role toward the etiology and progression of arteriosclerosis through their effects on the central and peripheral nervous sys tems and associated neurohormonal response. Considerable research effort has been devoted to identifying the risks asso ciated with smoking, elevated blood pressure, and serum cholesterol. Research development and modification is being vigorously pursued. Behavioral research exploring the role of psychological stress factors, social support networks, stressful life events, and the Type AlB behavior patterns has uncovered poten tially meaningful associations between behavioral factors and arteriosclerosis, as discussed in the succeeding chapters of this book.