Psyc 412 1st Edition Lecture 23Outline of Last Lecture I. CancerII. Psychosocial Factors and the Course of CancerIII. Health Behaviors affecting cancerIV. TreatmentOutline of Current Lecture I. Coronary Heart DiseaseII. HypertensionCurrent Lecture- Coronary Heart diseaseo What is Coronary Heart Disease (CHD)? a general term referring to illnesses caused by atherosclerosis, the narrowing of coronary arteries, the vessels that supply the heart with blood  may be caused by inflammatory processes, high blood pressure, diabetes, cigarette smoking, obesity, high serum cholesterol level and low levels of physical activityo Role of stress: chronic and acute stress have been linked to CHD CHD more common in individuals low in socioeconomic status (SES) job factors linked to CHD balance of demand and control in daily life is associated with CHD social instability tied to higher rates of CHDo Women and CHD: leading killer of women in the U.S.; women seem to be protected at younger ages relative to men higher levels of HDL estrogen diminishes sympathetic nervous system arousal higher risk of cardiovascular disease after menopauseo Type A personality Time urgency Competitiveness Achievement Orientation Rapid pace of work Hostilityo Cardiovascular reactivity, personality and CHD: anger and hostility are risk factors for CHDo Hostile people often have: developmental antecedents difficulty expressing vs. harboring hostility hostility within social relationships reactivity mechanisms linking reactivity and psychological factorso Depression and CHD: depression can lead to development and progression of CHD there is a link between depression and metabolic syndrome depression is tied to elevated C-reactive protein, a marker of inflammationo Other psychological risk factors and CHD: vigilant coping anxiety (implicated in sudden cardiac death) helplessness, pessimism and a tendency to ruminate over problems attempting to dominate social interactions vital exhaustion: a mental state characterized by extreme fatigue, a feeling of being dejected or defeated, and an enhanced irritabilityo Modification of CHD risk-related behavior: dietary intervention programs to stop smoking aerobic exercise in particularo Modifying hostility: relaxation training  speech style interventionso Management of heart disease: role of delay: patients often delay before seeking treatment initial treatment:- cardiac rehabilitation: process by which patients attain their optimal physical, medical, psychological, social, emotional, vocational and economic status o Management of heart disease (cont.): treatment by medication:- Beta-adrenergic blocking agents- Aspirin is commonly prescribed- Statins diet and activity level stress management depression targeting  evaluation of cardiac rehabilitation evaluation of social support- Hypertension: high blood pressure or cardiovascular disease (CVD)o How is hypertension measured? levels of systolic and diastolic pressure are measured by a sphygmomanometero What causes hypertension? 90% is essential (unknown) 5% is caused by failure of the kidneys genetic factors emotional factorso Relationship between stress and hypertension: combination of high demand/low control- chronic social conflict- job strain associated with:- crowded, noisy locales- migration from rural to urban areas- women – extensive family responsibilitieso How do we study stress and hypertension? bring people with hypertension into labs to respond to stressful tasks identify stressful circumstances (such as high pressure jobs) and examine rates of hypertension ambulatory monitoring o Psychosocial factors and hypertension: originally:- thought to be a constellation of personality factors- suppressed anger thought to be dominant currently:- personality insufficient for developing hypertension- expressed anger and the potential for hostility- number of conflict-ridden interactions in daily lifeo Stress and hypertension among African-Americans: tied to stress of racial discrimination stressful locales dark-skinned African Americans have higher rates of hypertension than lighter-skinned African Americans especially prevalent in lower-income groups, including lower income African Americanso Treatment of hypertension: low-sodium diet  reduction of alcohol weight-reduction in overweight patients exercise caffeine restrictiono Drug treatments: diuretics Beta-adrenergic blockers & vasodilators central adrenergic inhibitorso Cognitive-behavioral treatments: relaxation stress management exercise anger managemento Evaluation of cognitive-behavioral interventions: seem to be very successful reduce drug requirements sometimes the combination of cognitive-behavioral techniques and drugs appears to be the best approacho Problems in treating hypertension: “the hidden disease”: often symptomless, so diagnosis occurs during standard medical examinations early detection is important untreated hypertension:- lowers quality of life- compromises cognitive functions- related to fewer social activitiesadherence is