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Stress and Cardiovascular Disease.

HSBH 1003 group presentation.
by

Heidi Chan

on 29 May 2013

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Transcript of Stress and Cardiovascular Disease.

Stress and Cardiovascular
Disease:







Is there a link? Responses to Stressors Cardiovascular Disease Types of CVD Theories Theories Fight or Flight Phase #1 -
Alarm Reaction Pituitary Gland Stressors Life Hassles ‘recurring day-to-day stressors that confront most
people' 1) Thyrotropic hormone (TTH)
More energy is readily available to the body.

2) Adrenocorticotropic hormone (ACTH)
Stimulates adrenal cortex to release hormones that control metabolism. Blood pressure remains high
Sympathetic Nervous System releases fatty acids
Hormones released increase risk of blood clot formation
High levels of hormones may elicit erratic heart activity Indirect Links Acute Chronic General
Adaptation
Syndrome Alarm reactions are brief periods of bodily arousal that prepare the body for vigorous activity. Phase #2
- Resistance The prolonged stressor causes the organism to resist. Phase #3
- Exhaustion Depleted body’s resources due to long lasting or extremely intense stress. Stress. A pattern of responses an organism has to stimulus events that disturb its equilibrium and its ability to cope. Stimuli events placing demand on an organism for some adaptive response. physiological
behavioral
emotional
cognitive www.simplypsychology.org Require significant adjustment in life Life Events www.attymangano.com www.funeraldirectoryusa.com Gerrig, R et. al, 2012, p.462 www.guardian.co.uk Traumatic
Events ' uncontrollable, unpredictable or ambiguous' www.trauma-and-alcoholism.com Gerrig, R et. al, 2012, p.455 Coronary Heart Disease www.bhf.org.uk Myocardial Infarction bert-firebert.blogspot.com Hypertension High blood pressure for several weeks http://nandanursing.com Angina Chest pain www.tumblr.com Direct Links Smoking
Obesity
Excess alcohol www.acneeinstein.com eatsimplylivehealthy.blogspot.com www.projectknow.com Study #2: (Low, Salomon, & Matthews, 2009) Study
#4: (Holman, Silver, Poulin, Andersen, Gil-Rivas, & Mcintosh, 2007) The INTERHEART study (Rosengren et al., 2004) To maintain integrity and equilibrium for normal functioning (Selye, 1967) Adrenal Glands Catecholamines:
Adrenaline
Noradrenaline Medulla Cortex Cortisol Autonomic Nervous System breathing faster and deeper
heart rate rises
blood vessels constrict
blood pressure rises syossetdentalnews.com www.kulfoto.com www.123rf.com Studies Method: www.heartdiseasenet.com Do high levels of stress increase a person’s risk of having a heart attack ? Case group : 11,000

Control group : 13,000
(no heart attack/CVD)


4 types of stress:
work stress
stress at home
financial stress
major life events Results: Case group had higher prevalence for all 4 types of stress.

"Permanent WORK stress was experienced by TWICE as many cases as controls"

"TWICE as many cases reported permanent stress at HOME compared with controls" Points to consider: 52 countries
25,000 participants

Smoking, physical activity, diabetes, family history

stress = subjective
heart attack = bias Chronic Life Stress, Cardiovascular
Reactivity and Sub-clinical Cardiovascular
Disease in Adolescents Method: 158 adolescents
14 -16 years old

Trial 1 - measured HR and BP

after 3 years...

Trial 2 - measured HR, BP and IMT Results: INCREASED CHRONIC STRESS

- life events INCREASED
CARDIOVASCULAR
RE-ACTIVITY

- blood pressure INCREASED IMT

- increased risk of atherosclerosis Limitations: Study was too short - atherosclerosis takes a while to develop.

IMT was only measured in the second trial.

Study population consisted of adolescents and was too small. Study #3 : Impact of Chronic Psychosocial Stress on CV Auto-regulation (Lucini, Di Fedi, Parati, Pagani, 2005) Method: 294 participants
Control group = no chronic stress
Blood pressure and ECG Results: Study
#5: Work stress: Method: 25 years
812 industrial workers

Heavy/precision engineering to clerical/administration work

Stress questionnaire

Death register for CVD death (Rosengren et al., 2004) http://alternityhealthcare.com/ultrasound-view-of-carotid-artery-and-imt-2/ http://creatingabetterlife.net/2011/04/10-tips-for-stress-management-at-workplace.html http://rochrealestate.blogspot.com.au/2012/10/showing-stress.html Increased BP
-> hypertension

Reduced Baroreflex sensitivity
-> reduced auto-regulation
-> coronary heart disease Strengths: Stress questionnaire and clinical psychologist assessment

Study population reduced by 162 due to other CVD risk factors (smoking, drugs, medical history) Terrorism, Acute Stress and CV Health Method: Pre 9/11:
- National health survey

Post 9/11: (3 weeks)
- 2592 participants
- acute stress reaction questionnaire
-> direct exposure
-> live media exposure
-> no exposure
- modified health survey Results: "Acute stress responses were associated with 53% increased incidence of cardiovascular ailments." http://www.telegraph.co.uk/news/worldnews/september-11-attacks/8750870/September-11-anniversary-extracts-of-audio-recordings-of-attacks.html Strengths: Limitations: > Cardiac risk factors
> Unrelated stress
> Opportunistic - pre and post 9/11 health cardiovascular
ailments ? Work
stress
and risk of cardiovascular mortality JOB STRAIN =
high work demand +
low job control

EFFORT-REWARD IMBALANCE =
high effort + low reward http://www.lawyerswithdepression.com/articles/dans-top-10-stress-and-anxiety-book-picks/ (Kivimaki, Leino-Arjas, Luukkonen, Riihimaki, Vahtera & Kirjonen, 2002) Results: HIGH JOB STRAIN
- 2.2 fold risk of CVD death
- increased cholesterol

HIGH EFFORT-REWARD IMBALANCE
- 2.4 fold risk of CVD death
- increased BMI Strengths: 2 types of work stress

25 years

indirect link Limitations: Stress was subjective

one work place http://www.123rf.com/photo_11293307_group-of-professional-industrial-workers.html http://www.123rf.com/photo_11752517_manager-eating-unhealthy-food-at-work-place.html Study #1: STRESS + CVD? STRESS is the trigger that accelerates the onset of
CVD YES! Gerrig, R et. al, 2012, p.455 Gerrig, R et. al, 2012, p.460 (Holman, Silver, Poulin, Andersen, Gil-Rivas, & Mcintosh, 2007, p1) "state of arousal with clear onset and offset patterns” Gerrig, R et. al, 2012, p.455 "is a continuous state of arousal in which an individual perceives demands as greater than the inner and outer resources available for dealing with them" Gerrig, R et. al, 2012, p.455 Reference List Gerrig, R; Zimbardo, P. G; Campbell; Cumming; Wilkes (2012) Psychology and Life, Frenchs Forest NSW: Pearson Australia

Holman, E. A., Silver, R. C., Poulin, M., Andersen, J., Gil-Rivas, V., & McIntosh, D. N. (2008). Terrorism, acute stress, and cardiovascular health: A 3-year national study following the september 11th attacks. Archives of General Psychiatry, 65(1), 73-80. doi: 10.1001/archgenpsychiatry.2007.6

Holmes, T. H., & Rahe, R. H. (1967a). Holmes-Rahe life changes scale. Journal of Psychosomatic Research, 11(2), 213-218.

Holmes, T. H., & Rahe, R. H. (1967b). The social readjustment rating scale. Journal of Psychosomatic Research, 11(2), 213-218.

Joeym928 (Producer). (2007, 30/05/2013). Stress at Work [Video] Retrieved from http://www.youtube.com/watchv=vdv63kqa8U4

Kivimäki, M., Leino-Arjas, P., Luukkonen, R., Riihimäki, H., Vahtera, J., & Kirjonen, J. (2002). Work stress and risk of cardiovascular mortality: Prospective cohort study of industrial employees. BMJ, 325(7369), 857–860. doi: doi: 10.1136/bmj.325.7369.857

Low, C. A., Salomon, K., & Matthews, K. A. (2009). Chronic life stress, cardiovascular reactivity, and subclinical cardiovascular disease in adolescents. Psychosomatic Medicine, 71(9), 927-931. doi: 10.1097/PSY.0b013e3181ba18ed

Lucini, D., Di Fede, G., Parati, G., & Pagani, M. (2005). Impact of chronic psychosocial stress on autonomic cardiovascular regulation in otherwise healthy subjects. Hypertension, 46(5), 1201-1206. doi: 10.1161/01.HYP.0000185147.32385.4b

Morrison, V; Bennett, P; Butow, P; Mullan, B; White, K (2012) Introduction to Health Psychology in Australia, Frenchs Forest NSW: Pearson Australia

Rosengren, A., Hawken, S., Ôunpuu, S., Sliwa, K., Zubaid, M., Almahmeed, W. A., . . . Yusuf, S. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): Case-control study. The Lancet, 364(9438), 953-962. doi: 10.1016/S0140-6736(04)17019-0

Sarafino, E. P. (2006) Health Psychology Biopsychosocial Interactions (5th Ed.) United States of America, John Wiley & Sons, Inc.

Selye, H. (1976). Stress in health and disease. Reading, MA: Butterworth.
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