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Health Psychology
Lecture 7
Cardiovascular Disease and Cancer
Lecture 7 - Outline
• Part 1
– Cardiovascular disease
– Causes
– Treatment and Prevention
• Part 2
– Cancer
• Part 3
– Practice task for Tutorial Assignment #2
Cardiovascular Disease
• Diseases of the heart and circulatory
systems (arteries and veins)
• Cardiovascular disease (CVD) is the leading
cause of deaths in Western countries
– 45%
Cardiovascular Disease
• Basic cardiac anatomy and function
Types of Cardiovascular Disorder
• Arteriosclerosis
– Narrowing and hardening of arteries (loss of elasticity)
– Most common (all have to some degree)
• Atherosclerosis
– A form of arteriosclerosis
– Deposition of fatty plaques (arthomas) on inner lining
of artery walls
– Plaques consist of cholesterol, lipids, cell debris and
other substances
Types of Cardiovascular Disorder
• Hypertension (high blood pressure)
– Essential hypertension (cause unknown, most common)
– Results from increased peripheral resistance and/or
increased cardiac output (serious risk for CV Disease)
• Coronary Heart Disease (CHD)
– Disease of coronary arteries which feed the heart
muscle itself (often caused by atherosclerosis in the
coronary arteries)
Types of Cardiovascular Disease
Consequences of Arteriosclerosis/Atherosclerosis
• Angina Pectoris
– Severe heart pain arising from reduced blood flow
(ischemia) to the heart muscle
– Relieved by “Anginine” which dilates coronary arteries
– Warning sign vulnerable to heart attack
(Ischemia = restriction of blood flow)
Types of Cardiovascular Disease
Consequences of Arteriosclerosis/Atherosclerosis
• Myocardial Infarction (heart attack)
– Infarct: wedge-shaped area of tissue damage and death
from blocking of an artery
– Loss of 02 to part of the heart, area becomes scarred and
doesn’t repair
Types of Cardiovascular Disease
Consequences of Arteriosclerosis/Atherosclerosis
• Cerebrovascular Accident (stroke)
– Caused by interruption of blood flow through an artery
in the brain
– Can occur because of atherosclerosis, formation of a
blood clot, and embolism (where a piece of a clot or
atheroma breaks off and travels through the blood
stream), rupture of an artery (aneurism).
Measures of Cardiovascular Health
• Blood pressure
– Most common measure
• Electrocardiogram (ECG)
– Electrical activity of heart
– Abnormalities of heart beat but not plaque build up
• Stress test
– EEG during exercise
– Restriction of blood flow results in characteristic pattern
• Cardiac catheterization/angiography
– Most accurate, very uncomfortable procedure.
Risk factors for CVD
• Risk factors can be divided into 2 groups
1. Non-modifiable risk factors
• Eg genetics, gender, age
2. Modifiable risk factors
• Eg hypertension
Risk Factors for CVD
• Standard Risk factors for CVD include
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Genetics / Family History
High serum cholesterol (blood)
High blood pressure
Smoking
Low levels of exercise
Diet
Risk Factors for CVD
• Cholesterol
– Fat-like substance found in animal fats and oils
• Liver produces most of the body’s cholesterol
• The rest comes from dietary intake of animal
products
– Cholesterol is present in blood attached to
proteins (lipoproteins)
Risk Factors for CVD
• Cholesterol transport
– Low density lipoproteins (LDL)
• transport cholesterol which can collect on arterial
walls (bad type!)
– High density lipoproteins (HDL)
• contain more protein and less cholesterol (transport
cholesterol to the liver where it is broken down …
protective type)
Women have more HDL than men -  CVD risk for men
Risk Factors for CVD
• Psychosocial Risk factors for CVD include
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Low SES (workforce status, ethnicity, area of residence)
Hostility (Type A component)
Depression
Low social support
Chronic stress
Psychological risk factors for CVD
• Type A personality (Friedman & Rosenman, 1974)
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Competitive
Impatient
Sense of ‘time urgency’
Achievement orientated
Hostile
• Measured…
– Rosenhan’s Structrured Interview
– Jenkins’ Activity Survey (Jenkins et al 1967)
Acute and Chronic Risk Factors
• Acute risk factors
– Acute stress/anger, exercise, cardiovascular reactivity
• Chronic risk factors
– Standard (age, sex, family history, smoking,
cholesterol, hypertension)
– Psychological (hostility, depression/exhaustion, low
SES, low social support, chronic stress)
Psychological Interventions for CVD
• Possible aims…
– to enhance adherence with diet, weight loss,
exercise, and use of medications
– to reduce BP to mild/moderate levels
• Relaxation training, stress management, biofeedback
• Effective among 75%
– to promote coping, address anxiety/depression
Psychological Interventions for CVD
• Some examples…
– Gould et al. (1992) - Ss with angina
• Stress management / diet and exercise vs. control
• 15 months - 91% reduced angina frequency/duration
– Anderson & Masur (1989) - Cardiac catheterization
• 5 conditions
• Modeling + coping skills reduced anxiety before and during
procedure.
– Psychology involved in prevention, preparation, and
recovery
Psychological Interventions for CVD
• Evaluation
– Meta-analysis of psychosocial interventions (37 since
1974)
• 37% reduction in cardiac mortality
• 29% reduction in recurrence of MI
– Also have positive effects on blood pressure, smoking,
weight, physical exercise, eating habits and cholesterol
The potential role of psychology in CVD
Term Paper #2 - Practice Exercise
Decisions in the management of pain and anxiety in hospitals
• Imagine you are a Health Psychologist working at a large hospital. The
CEO of the hospital asks you if you can reduce patients’ level of pain
and anxiety during their hospital stay.
• There are a number of different approaches that might be taken to
treatment and different goals that might be adopted. Briefly, as the
psychologist, what goals and methods would you consider. What goal
might you ultimately recommend to the CEO and why?
Term Paper #2
Decisions in the treatment of a mildly overweight client.
• Imagine you are a Health Psychologist who is consulted by a 35 yearold client who is mildly overweight. She is 5’6” (167.6cms) tall and
weighs 11 stone 6 lbs (74 kgs)…BMI = 26.34. Since adolescence she
has had an extensive history of repeated, unsuccessful dieting, and has
sought assistance from you to lose weight. She is embarrassed about
her weight and her husband says she is fat, and makes her run up and
down the stairs in their house for 10 minutes each day. She believes
losing weight will improve the quality of her relationship with her
husband and make her happier. She tells you her weight goal is 60 kgs
(132 lbs).
• There are a number of different approaches that might be taken to
treatment and different goals that might be adopted. Briefly, as the
psychologist, what goals and methods would you consider. What goal
might you ultimately recommend to the client and why?
Term Paper #2
Decisions in the treatment of a mildly overweight client.
• Maximum Length:
1000 words
• Due Date:
Monday, March 14, 2005
• References:
– Sarafino, E. P. (2003). Health psychology: Biopsychosocial interactions.
(Chapter 8, pp. 236-265). Wiley: New York.
– Rosen, J. C., Orason, P., & Reiter, J. (1995). Cognitive behavior therapy
for negative body image in women. Behavior Therapy, 26, 25-42.