The synergistic effect of smoking and serum cholesterol on coronary heart disease.

Reviews the evidence of a synergistic interaction effect of smoking and elevated serum cholesterol on coronary heart disease (CHD) morbidity and mortality. Methodological issues involved in assessing smoking status, serum cholesterol, and CHD are discussed, and evidence is presented to support the notion that, in part, serum cholesterol, like smoking, is an index of a behavioral risk factor. Such a synergistic interaction is determined to exist, although improvements in methodology are needed to more clearly identify its magnitude. Studies demonstrating that serum cholesterol can be modified by dietary changes and studies exploring the interaction between smoking and cholesterol are evaluated. Possible mechanisms by which smoking and cholesterol may interact to produce CHD are considered. It is suggested that, if smoking cessation and dietary modification behavioral treatments are focused specifically on young and middle-age Americans who smoke and have elevated serum cholesterol, such treatments may increase their effectiveness in lowering the risk of CHD (benefit) without necessarily increasing their effort (cost). (5 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial influences on the development and course of coronary heart disease: Current status and implications for research and practice.

Psychosocial characteristics predict the development and course of coronary heart disease (CHD). In this review, the authors discussed human and animal research on psychophysiological mechanisms influencing coronary artery disease and its progression to CHD. They then reviewed literature on personality and characteristics of the social environment as risk factors for CHD. Hostility confers increased risk, and a group of risk factors involving depression and anxiety may be especially important following myocardial infarction. Social isolation, interpersonal conflict, and job stress confer increased risk. Psychosocial interventions may have beneficial effects on CHD morbidity and mortality, although inconsistent results and a variety of methodological limitations preclude firm conclusions. Finally, they discussed implications for clinical care and the agenda for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cigarette smokers do more than just smoke cigarettes.

Hypothesized that 199 17–60 yr old light and moderate-to-heavy (MH) cigarette smokers, compared with 675 nonsmokers, would exhibit significantly less healthy attitudes and behaviors on several dimensions of the risk to coronary heart disease (CHD). A factor analysis of survey items measuring knowledge, attitudes, and behaviors in 5 CHD risk areas produced 4 factors: Attitudes, Health Consciousness, Knowledge, and Unhealthy Behaviors. Smokers vs nonsmokers exhibited less positive attitudes toward CHD risk behaviors, whereas MH smokers, as compared with the light smokers and the nonsmokers, exhibited lower levels of health consciousness and enacted unhealthy behaviors at a greater frequency. Results support the hypothesis that smokers exhibit a less healthy lifestyle as shown by cognitive, behavioral, and motivational dimensions related to cardiovascular health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meta-analytic review of research on hostility and physical health.

A new meta-analysis of research on hostility and physical health was conducted that includes 15 studies used in previous meta-analytic reviews and 30 new independent studies. Overall, the results suggest that hostility is an independent risk factor for coronary heart disease (CHD). For structured interview indicators of potential for hostility, the weighted mean r was .18. After controlling for other risk factors for CHD, the widely used Cook-Medley Hostility Scale and other cognitive-experiential measures were most predictive of all-cause mortality (weighted mean r ?=?.16) and, to a lesser extent, CHD (weighted mean r ?=?.08). Similar to other areas of research, the increased use of high-risk studies in recent years produced an increase in null findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of positive psychological well-being and coronary heart disease.

Objective: Research suggests that positive psychological well-being is associated with cardiovascular health. However, much of this research uses elderly samples and has not determined the pathways by which psychological well-being influences cardiovascular disease or whether effects are similar for men and women. This study investigates the association between two aspects of well-being (emotional vitality and optimism) and coronary heart disease (CHD) in a sample of middle-aged men and women, and considers potential mediating factors. Method: Between 1991 and 1994, well-being and coronary risk factors were assessed among 7,942 individuals without a prior cardiovascular event from the Whitehall II cohort. Incident CHD (fatal CHD, first nonfatal myocardial infarction, or first definite angina) was tracked during 5 person-years of follow-up. Results: Positive psychological well-being was associated with reduced risk of CHD with an apparent threshold effect. Relative to people with the lowest levels of well-being, those with the highest levels had minimally adjusted hazard ratios of 0.74, 95% confidence interval [0.55, 0.98] for emotional vitality and 0.73, 95% confidence interval [0.54, 0.99] for optimism. Moreover, the association was strong for both genders and was only weakly attenuated when accounting for ill-being. Neither health-related behaviors nor biological factors explained these associations. Conclusions: Positive psychological well-being was associated with a modest, but consistent reduced risk of incident CHD. The relationship was comparable for men and women, and was maintained after controlling for cardiovascular risk factors and ill-being. Additional research is needed to identify underlying mechanisms and investigate whether interventions to increase well-being may enhance cardiovascular health. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Depressive symptomatology and coronary heart disease in Type I diabetes mellitus: A study of possible mechanisms.

Recent evidence has suggested that depressive symptomatology is a risk factor for the development of coronary heart disease (CHD) in patients with diabetes mellitus, although little is understood about mechanisms that may explain this association. The Pittsburgh Epidemiology of Diabetes Complications (EDC) Study is a natural history study of 658 men and women with childhood-onset Type I diabetes. Participants from the EDC Study who reported the fewest depressive symptoms on the Beck Depression Inventory at baseline examination were least likely to develop CHD over 10 years. Differences in insulin resistance, autonomic dysregulation, inflammation, smoking, and complications associated with Type I diabetes appear to help explain this relationship. Future research should clarify causal pathways between depressive symptomatology, behavioral and physiological processes, and CHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biobehavioral research on cardiovascular disorders.

Discusses several major research issues, needs, and opportunities related to the role of behavior in cardiovascular disorders. Cardiovascular disorders, especially coronary heart disease and essential hypertension, have been among the most well-developed topics in health psychology. There are many physiological, environmental, sociocultural, and behavioral variables that interact in etiology, prevention, and treatment of these disorders. The standard risk factors for coronary disease are all variables with significant behavioral components. A broadened search for mechanisms and influences contributing to heart disorders has led to an examination of psychosocial risk factors. Research issues that are currently under study or that in need of further attention are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interactive effects of behavior and reproductive hormones on sex differences in risk for coronary heart disease.

Examines factors accounting for why women in most industrialized countries are protected from coronary heart disease (CHD) relative to men, focusing on the effects of female reproductive hormones (i.e., estrogens) on lipid and lipoprotein metabolism and blood pressure. Epidemiological studies that statistically adjust for sex differences in lipids, blood pressure, and smoking status cannot explain sex differences in CHD morbidity and mortality. Data also show elevated risk of myocardial infarction and stroke among women who use oral contraceptives. Men who are prescribed estrogens have elevated risk of CHD, and case-control studies show that male CHD patients have elevated estradiol, compared to controls. Simple main-effect models of female protection from CHD are inadequate. Reproductive hormones are important determinants of protection from CHD, and behavioral characteristics can influence the effects of reproductive hormones on CHD risk factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Structure of health risk behavior among high school students.

The authors test the contention of R. Jessor's (1977) problem behavior theory that adolescent health risk behaviors comprise a single behavioral syndrome. Multidimensional scaling (MDS) and cluster analysis are used to analyze data from a statewide survey of high school students' (n?=?5,537) health risk behaviors. A classical MDS analysis was calculated to test the dimensionality of the behaviors. All indicators supported a multidimensional model. An individual-differences MDS (INDSCAL) analysis revealed that a 4-dimensional solution best fit the data, with gender and racial-ethnic differences emerging in the relative salience of the dimensions. The INDSCAL dimensional coordinates for each health risk behavior were then submitted to a hierarchical cluster analysis technique. Five behavioral clusters were identified, 1 of which included many of the traditional "problem behaviors," such as smoking, unprotected sexual intercourse, and alcohol consumption. These findings support a multidimensional structure underlying adolescent health risk behavior. Implications for theory and prevention of health risk behaviors are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intensive cardiovascular risk factor intervention in a rural practice: a glimmer of hope?

BACKGROUND: Large trials of primary care-based health promotion to modify coronary heart disease risks have shown only modest benefits. Could more intensive intervention, with doctors sharing with practice nurses in health promotion, produce better health outcomes in the context of the small family practice? How cost-effective might these interventions be? AIM: To assess the cost-effectiveness of an intensive programme of coronary heart disease (CHD) risk factor modification in a rural general practice in which doctors had a major input. METHOD: A longitudinal study of changes in risk factors in a group of adult patients identified as having one or more major CHD risk factor and monitored for one to seven years. Patients were recruited from and followed up in health promotion clinics, routine practice nurse appointments, or routine doctors' surgeries. All received the practice's routine interventions to modify risk, and changes in risk factors were recorded. Time spent by members of the primary health care team on CHD health promotion was recorded over a two-year period. RESULTS: From a practice list of 2040, 760 patients with one or more CHD risk factors were identified and followed up over a mean of 3.61 years (range six months to seven years). Significant improvements in each of the risk factors occurred, except in body mass index (BMI). Mean Dundee risk scores fell from 7.4 to 5.7 (by 23.3%). The annual cost to the practice (including doctor/nurse/secretarial time plus sundry practice expenses and laboratory costs, but excluding drug costs) was 6000 pounds. Cost per coronary death prevented was calculated as approximately 10,000 pounds. CONCLUSION: The results show an effect on risk factors broadly similar but slightly greater in magnitude than that achieved in the OXCHECK and British Family Heart Studies of nurse-delivered risk factor intervention in primary care. The results suggest that more intensive effort in lifestyle modification and health promotion, with more active involvement of doctors, could produce significant additional benefit. The cost-effectiveness of this approach compares favourably with many other accepted measures in coronary heart disease prevention.     

The connection between clinical health promotion and health status: A critical overview.

Argues that the clinical practice of health promotion is based on at least 4 assumptions: (a) behaviors increase the risk of certain chronic diseases; (b) changes in behaviors can reduce the probability of risk of certain diseases; (c) behavior can be easily changed; and (d) behavioral interventions are cost-effective. Although data support most of these assumptions, the strength of the support is shown to be much weaker than is assumed by many psychologists. Thus, the expected health benefits from behavioral programs may not match the enthusiasm espoused by some health psychologists. A major problem in this field is that outcomes are frequently not conceptualized in relation to health. Health status is therefore suggested as the focal point for conceptualizations of health psychology. (83 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Regional regulation of microtubule dynamics in polarized, motile cells

INTRODUCTION: Tobacco use, diet and physical activity patterns, and alcohol use are the leading causes of death in the United States. To make major improvements in the health status of the population, behavioral risk factors for disease must be addressed. METHODS: We propose a brief survey of behavioral risk factors for enrollees of health care organizations, employer groups, or other adult populations that can be used to profile the health risk behaviors of a population, assess performance of prevention and risk reduction programs, or make comparisons with other populations. The survey contains questions about tobacco, diet, physical activity, alcohol, firearms, motor vehicle safety, sexual behavior, and drugs. RESULTS: Recommendations for survey items, implementation, and calculation of performance measures are given. CONCLUSIONS: Widespread adoption of this type of survey would be a major step forward in acknowledging the impact that behavior has on health and in furthering individual and organizational accountability for improving health risk behaviors.     

Counting the stitches that count: preventive intervention promises and public health

Continued public support for the design, implementation, and dissemination of preventive interventions depends on achievement of four major criteria: (a) Reductions in the incidence or prevalence rates of diagnosable emotional and behavioral disorders, (b) reductions in the need for mental health services through effective primary and secondary interventions, (c) enhancement of the effectiveness of obtained services as screening and early detection efforts are implemented, and (d) reductions in the nation's health care costs associated with emotional and behavioral dysfunctions. Strategies including risk reduction, risk avoidance, health promotion, empowerment, and resource development are preventive insofar as they contribute to achievement of the aforementioned outcomes.     

Health aspects of fish and n-3 polyunsaturated fatty acids from plant and marine origin

An expert workshop reviewed the health effects of n-3 polyunsaturated fatty acids (PUFA), and came to the following conclusions. 1. Consumption of fish may reduce the risk of coronary heart disease (CHD). People at risk for CHD are therefore advised to eat fish once a week. The n-3 PUFA in fish are probably the active agents. People who do not eat fish should consider obtaining 200 mg of very long chain n-3 PUFA daily from other sources. 2. Marine n-3 PUFA somewhat alleviate the symptoms of rheumatoid arthritis. 3. There is incomplete but growing evidence that consumption of the plant n-3 PUFA, alpha-linolenic acid, reduces the risk of CHD. An intake of 2 g/d or 1% of energy of alpha-linolenic acid appears prudent. 4. The ratio of total n-3 over n-6 PUFA (linoleic acid) is not useful for characterising foods or diets because plant and marine n-3 PUFA show different effects, and because a decrease in n-6 PUFA intake does not produce the same effects as an increase in n-3 PUFA intake. Separate recommendations for alpha-linolenic acid, marine n-3 PUFA and linoleic acid are preferred.     

Depression and coronary heart disease in women: Implications for clinical practice and research.

Practicing psychologists who treat depression in women need to consider their depressed clients at heightened risk for heart disease. In this article, the authors review evidence supporting the link between depression in women and their subsequent increased risk for illness and death from coronary heart disease (CHD). Although further research is needed, the evidence to date suggests that women in treatment for depression should, at the very least, be educated about their increased risk for CHD, and, ideally, psychotherapy for depressed women should incorporate interventions designed either to reduce risk factors for CHD, such as obesity, smoking, and alcohol abuse, or to enhance health-maintenance behaviors, such as exercise and adherence to a low-fat diet, which are associated with cardiovascular health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Knowledge and perceived risk of major diseases in middle-aged and older women.

Women's (N?=?200; 41-95 years) knowledge of mortality risks and their perceived general risk, personal risk, control, and preventability of coronary heart disease (CHD) and breast, colon, and lung cancer were examined. Middle-aged (MA) women were more accurate in their mortality knowledge for MA men than for MA women and were more accurate for MA than for older (OA) men and women. OA women, in contrast, were least accurate in their mortality knowledge for OA women compared with all other target groups; only 34% knew that CHD is the leading cause of death in OA women. Participants also overestimated a woman's risk of death from breast cancer and underestimated the risk from lung and colon cancer. Ratings of perceived risk, control, and preventability varied as a function of disease. OA women in particular appear to lack knowledge regarding women's risk of major diseases. Results have implications for women's health behaviors and medical decisions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Economics and psychology practice: What we need to know and why.

Economic contexts and trends relevant to the practice of psychology in mental health and health settings are presented to help practitioners plan better for the future. Professional skills alone are no longer sufficient to thrive and deliver quality services in the current economic climate. A greater focus on understanding the economic indicators for psychology is necessary too. This includes the cost-driven policies, health and behavioral health financing, demands for accountability, losses, and opportunities inherent in the major systemic health care changes occurring in the United States. Practical questions with economic implications about the direction of psychology practices are raised, and the role of psychology initiatives designed to advance practice, which take both professional and economic factors into account, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence for a major gene elevating serum bilirubin concentration in Utah pedigrees

In case-control studies, lower serum bilirubin levels have been associated with increased risk of developing coronary heart disease (CHD). We have also previously shown that serum bilirubin has a significant polygenic component. The purpose of the present investigation was to determine whether there was statistical evidence for a major gene explaining a significant portion of individual variation in serum total bilirubin levels and whether this gene might alter the risk of CHD. Serum bilirubin measurements were obtained from 1240 adults in 84 Utah pedigrees screened twice: from 1980 to 1983 and again from 1983 to 1986. Bivariate maximum-likelihood segregation analysis of serum bilirubin levels obtained from the two clinic visits indicated that a major gene was responsible for elevated levels in 11.5% of the persons in these pedigrees. Phenotypic variations in visit 1 bilirubin arising from polygenes were highly correlated with the phenotypic variation due to polygenes in visit 2 bilirubin, indicating a stable genetic contribution to bilirubin over 2.5 years of follow-up. The major gene explained 27% and 28% of the variance in bilirubin levels at visit 1 and visit 2, respectively. There were no correlations of unmeasured environmental factors influencing bilirubin between the two clinic visits. At both visits, persons with early CHD had lower levels of bilirubin than unaffected persons (P < .01). The odds ratio for the risk of CHD in the high-homozygote group was 0.31, P = .09. We conclude that there is a major gene modestly raising serum bilirubin levels. Since cross-sectional data indicate that low serum bilirubin levels increase the risk of CHD, this major gene may be protective against CHD for about 12% of the persons in this study.     

Introduction to the special series: HIV infection among drug abusers.

Drug users are particularly at risk for contracting the human immunodeficiency virus and serve as a major mechanism for spreading the virus to other sectors of the population. As a result drug abuse treatment and potential behavioral change strategies are primary public health issues. The purpose of this article is to review the contributions included in this special edition, which represent an effort to describe the most current thinking in the field with a blend of theoretical, review, and empirical articles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: Results from a prospective study of bereaved gay men.

Objective: Minority stress is the most frequently hypothesized risk factor for the increased rates of adverse behavioral and mental health outcomes among sexual minorities. However, there is a paucity of longitudinal research addressing this hypothesis. Design: Prospective, community-based cohort of 74 bereaved gay men. Participants were assessed before the partner or close friend died of AIDS and then at 1, 6, 13, and 18 months postloss. Main Outcome Measures: HIV risk behavior (unprotected anal intercourse), substance use and abuse symptoms, and depressive symptoms. Results: Hierarchical Linear Modeling analyses revealed that changes in internalized homophobia, discrimination experiences, and expectations of rejection were differentially associated with HIV risk behavior, substance use, and depressive symptoms, respectively. In contrast to the significant effects of minority stress, bereavement-related stressors (e.g., length of partner illness, quality of relationship with deceased) were largely unrelated to these outcomes. Conclusion: The results provide evidence for the predictive validity of minority stress, even in the context of a major life stressor, and suggest the importance of targeting minority stress experiences in HIV and mental health interventions with gay men. Future studies are needed to assess the mechanisms through which minority stress is associated with adverse health outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)