Psychosocial Issues in Cardiovascular Disease

Clinical Case Download : Download full-size image “Katie” is a 38-year-old married non-Hispanic white woman with a history of spontaneous coronary artery dissection (SCAD), who was referred for psychotherapy by her cardiologist for the treatment of anxiety and stress symptoms; these symptoms were negatively impacting her quality of life (QoL), relationships, and health behaviors. Prior to the SCAD, Katie was otherwise physically healthy and had no history of mental health problems, but she had high stress from her work and family life. Katie owned her own consulting company and worked long hours, leaving her overwhelmed and irritable and taking away time from her relationships with her husband, young daughter, and friends. Following the SCAD, Katie frequently worried about her health. She could not stop thinking about the possibility of having another SCAD and what it would mean for her health, her future, and her family. She reported frequent sadness at the thought of dying young and leaving her husband and young daughter. She was concerned that work stress was contributing to high blood pressure and increased her risk of another SCAD. When she was able to spend time with family and friends, Katie found herself short tempered and easily annoyed. She also began to overeat unhealthy foods when upset and stopped exercising. Katie expressed interest in psychotherapy to learn skills to reduce worries about her health, reduce work stress, and improve her relationship with her partner. Abstract Although cardiovascular disease (CVD) morbidity and mortality rates have decreased over the past 40–50 years, CVD remains the number one cause of death worldwide [1] . Traditional risk factors for CVD include physical health conditions, such as diabetes and hypertension (HTN), and health behaviors such as cigarette smoking and decreased physical activity. A large body of research now demonstrates the significant role that psychosocial factors (i.e., psychological, emotional, and social experiences) play in the development, progression, and prognosis of CVD. The strength of the effect of psychosocial factors on CVD outcomes is often similar to the strength of traditional risk factors. In some cases, the negative effects of psychosocial risk factors are particularly salient and stronger for women as compared to men. In this chapter, we first present an overview of the literature establishing psychosocial factors [anxiety, depression, stress, hostility, socioeconomic status (SES), and social integration] as contributors to CVD outcomes. We then discuss the potential mechanisms linking psychosocial factors to CVD. Lastly, we review the efficacy of pharmacotherapy and behavioral treatments for improving health outcomes in patients with or at risk for CVD. In all instances, we note sex differences when relevant.