Psychosocial Stress And Cardiovascular Disease In Women

Not long ago, it was assumed that coronary heart disease mainly--or only--affected men. Now that CHD is recognized as a leading killer of women as well as men, numerous research studies have been made of its diverse presentations in women, causal factors, and possibilities for prevention and treatment. The expert contributions to Psychosocial Stress and Cardiovascular Disease in Women span the results of this cross-disciplinary awareness. This progressive resource takes a three-dimensional approach to its subject, focusing on epidemiology and risk factors for heart disease in women, the psycho- and neurobiology of stress and coronary disease, and promising clinical interventions. Chapters identify and analyze multiple intersections of social, biological, and psychological factors in affecting women's heart health, from the social dimensions of depression to genetic/environmental interactions to the demands of balancing work and family. These wide-ranging findings will assist and motivate professionals in choosing and creating interventions, developing appropriate prevention strategies, and reducing gender-based disparities in health care. Among the topics covered: Enhancing women's heart health: a global perspective. Coronary heart disease in women: evolution of our knowledge. Gender observations on basic physiological stress mechanisms in men and women. Sleep as a means of recovery and restitution in women. LifeSkills training: benefiting both genders, for different reasons. Gender considerations in psychosocial-behavioral interventions for coronary heart disease. In particular this book will be helpful for cardiologists and other clinicians who may ask themselves why patients do not seem to make rational choices. "Why do patients not follow the advice they are offered?" is a common complaint. The role of psychosocial stress for patient compliance and adherence can be traced throughout the volume. It is emphasized in the chapters on psychosocial interventions along with other tangible and conceptual suggestions and experiences with psychosocial stress and life style change. Psychosocial Stress and Cardiovascular Disease in Women offers a deep practical level of understanding of this epidemic to help expand the work of health and clinical psychologists, sociologists, cardiologists, primary care physicians, and epidemiologists.

The main aim of this book is to evaluate the concept of stress and provide tools for physicians to identify patients who might benefit from stress management. This will incorporate a detailed description of the physiological and pathophysiological consequences of acute and chronic stress that might lead to cardiovascular disease. The book will aim to critically evaluate interventional research (behavioural and other therapies) and provide evidence based recommendations on how to manage stress in the cardiovascular patient. Our intentions are to define and highlight stress as an etiological factor for cardiovascular disease, and to describe an evidence based "tool box" that physicians may use to identify and manage patients in whom stress may be an important contributing factor for their disease and their risk of suffering cardiovascular complications.

OBJECTIVE: This dissertation explores the effect of psychosocial stress on risk of coronary heart disease (CHD) and the underlying biobehavioral mechanisms between psychosocial stress and CHD in women. METHODS: Two cohort data were used: 1) Women's Health Initiative Observational Study (WHI-OS) participants aged 50-79 years (N= 80,825); 2) 5,089 adults (2,505 women and 2,584 men) without clinical cardiovascular disease, aged 45-84 years at baseline in Multi-Ethnic Study of Atherosclerosis (MESA). Job strain was constructed based on the Karasek's Job Demand-Control (JDC) model and imputed through linkage of Standard Occupational Classification codes to the Occupational Information Network. Stressful life events and social strain (WHI-OS only) were assessed via validated self-reported questionnaires. Various statistical modeling approaches were used: Cox proportional hazard models, generalized linear models, path analysis with covariance-based structure equation models. RESULTS: For WHI-OS participants with an average of 14.7 years of follow-up, high job strain was associated with 13% increased risk of CHD (HR=1.13, 95% CI:1.03,1.24). Women with the high life event scores had a 20% higher risk of CHD (HR=1.20, 95% CI: 1.09,1.31), and for women with high social strain, the CHD risk increased by 12% (HR=1.12, 95% CI: 1.04,1.22). There was a significant interaction between job strain and social strain (P value= 0.02). High job strain was associated with a 25% increased risk of CHD for women with high social strain (HR=1.25, 95% CI: 1.07,1.46) while no association between high job strain and CHD risk was found in women with low social strain. The results from MESA participants showed that extreme ongoing problems in life were associated with a 7% increase in CHD risk (AMR=1.07, 95% CI: 1.02, 1.13) while job strain was not independently associated with CHD risk. There is no interaction between gender and psychosocial stress in relation to CHD risk. Changes in CHD risks over a 2-year period were not associated with either job strain or ongoing problems in life. The results from path analysis suggested that leisure-time physical activity, alcohol consumption, hypertension, and diabetes explained more than 50% of the associations between each psychosocial stressors and CHD. CONCLUSIONS: In women, psychosocial stress in different domains has a disparate impact on CHD risks, and part of the association between psychosocial stress and CHD risks is explained by biobehavioral factors. Future work for impacting other domains of psychosocial stress and interventions emphasizing specific needs of women are needed.

Annotation This book addresses one major question: Why do men get more heart disease than women? Recent global trends in heart disease show that traditional coronary risk factors, such as elevated blood pressure and cholesterol are poor candidates in explaining the gender gap in heart disease. Changes in these risk factors also cannot explain the recent cardiovascular disease epidemic among middle-aged men in Eastern Europe. This book will focus on environmental, behavioral, and psychosocial variables, as well as new risk factors of a biological nature in an attempt to understand the gender gap in heart disease. It combines perspectives from numerous disciplines, such as demography, epidemiology, medicine, sociology, and psychology. This book features the work of a distinguished group of international researchers appearing in Richard Stone's report on "Stress: the invisible hand in Eastern Europe's death rates" (Science, vol. 288, June 9, 2000, pp. 1732-33). It combines perspectives from numerous disciplines, such as demography, epidemiology, medicine, nutrition, sociology, and psychology to explore the environmental, behavioral, and psychosocial influences on men's greater susceptibility to heart disease

The issue of women's health has long been neglected. This applies to many medical areas, but it has become most evident in the field of cardiology. For a long time, cardiology has been a medical specialty which seemed to be created for men, by men--particularly in research, but also in intensive clinical care units where male patients have been most visible and dominating. Furthermore, the clinical cardiologists--their doctors--have been predominantly male. It is easy to understand that most women think they will die from cancer rather than from heart disease, but this is not true. Heart disease is the leading cause of death for women as it is for men. Female patients are frequently encountered in the cardiology department, but they are older and seem to get less visibility and attention than the male patients. Research on risk factors for heart disease has also been almost entirely focused on men. This is true for psychosocial/behavioral aspects of cardiovascular risk. Aiming to fill this gap, this volume contains contributions from outstanding international and national researchers from different fields such as sociology, psychology, epidemiology, cardiology, clinical medicine, and physiology. These professionals gathered together for an interdisciplinary seminar on women, stress, and heart disease held at the Swedish Society of Medicine. Based on the seminar, this book provides a solid foundation for empirically based scientific conclusions on this important subject.

An opening address should ask the right questions, which we expect to answer during the coming years. A good opening address should formu late hypotheses for falsification during the conference or in the near fu ture. Mter Dr. Groen's excellent lecture yesterday, I feel better about my task, because I feel I am not alone in asking the ten questions in my ab stract. It is an honor for me to give this short paper largely based on my expe riences during 15 years as medical director of a rehabilitation center in Ba varia, as a teacher at two medical schools in Munich and Innsbruck, and as an old-fashioned holistic cardiologist. However, it also is a difficult task for me because the subject of this conference concerning biobehavioral factors in coronary heart disease is controversial, not only in the medical society, but in my own mind as well. When I organized one of the first conferences on stress and coronary heart disease in West Germany in 1976, followed by conferences in 1979 and 1980, the semantic problems between physicians and psychologists were very significant. However, communication has improved in this area during the last decade. The most encouraging event in this field was a sym posium in May 1984 in Rotenburg/Fulda on the topic "Return to Work af ter Bypass Surgery", organized by a cardiac surgeon, Dr. Walter.

The latest volume in the series based on the Annual Stress and Coping Symposia held at the University of Miami, Drs. McCabe, Schneiderman, Field, and Wellens bring together an outstanding group of researchers to examine the relationship between bio-behavioral and social factors and heart disease. Highlights of the book include an in-depth look at the latest research on: * basic physiological processes in cardiovascular reactivity to stress; * pathophysiological mechanisms in cardiovascular disease; * ethnic differences in cardiovascular regulation; * psychosocial influences on cardiovascular function/disease; and * Behavioral interventions designed to treat cardiovascular disorders. The goal of Stress, Coping, and Cardiovascular Disease is to provide a solid empirical foundation on the relationship between stress and cardiovascular disease so as to stimulate further research into the pathophysiology and treatment of the leading cause of death in industrialized countries.

In this groundbreaking work, distinguished contributors explore the myriad relationships between networks of social support and the development, treatment, and rehabilitation of individuals with cardiovascular disease. Chapters span the range from conceptual to methodological issues, and take into account gender, environmental, and cultural differences. The book will provide a wealth of information for clinicians and students in the fields of behavioral medicine, psychophysiology, and cardiovascular disease.