Chapter 114

Approximately 36% of all deaths that occurred in the United States in 2000, most of which were a result of heart disease, were attributable to behavioral or lifestyle factors, including tobacco use, poor diet, physical inactivity, and alcohol.1 In 2009, it was estimated that high blood pressure accounted for 45% of all cardiovascular deaths, followed by overweight-obesity, physical inactivity, high low-density lipoprotein (LDL) cholesterol, smoking, high dietary salt, high dietary trans-fatty acids, and low dietary omega-3 fatty acids.2 In persons under the age of 70, smoking was the single largest risk factor for cardiovascular death.

Although genetic factors undoubtedly contribute to individual susceptibility to these risk factors, a prime ingredient of this risk is the person's behavior. The costs of treating heart disease are escalating at an increasingly rapid pace due to the widespread use of sophisticated and increasingly expensive treatments such as drug-eluting coronary artery stents, implantable cardioverter-defibrillators, and gene therapy. Most efforts to contain the increase in health care costs have focused on limiting supply (a largely unfulfilled promise of managed care) and imposing some sort of rationing. However, as long ago as 1993, Fries et al3 pointed out that restricting demand could achieve the same objective. They identified six factors, four of which are directly relevant to this chapter. They include the following facts:

1. Much disease is preventable.

2. Risky behavior costs money. Lifetime medical costs, which averaged $225,000 per person, have been clearly related to health behavior. For example, costs are approximately one-third higher in smokers compared with nonsmokers. 3. Self-management can result in savings. Several studies have shown that providing medical consumers with information and guidelines about self-management can lower the use of medical services by 10% or more. 4. The promotion of healthy behavior at work successfully reduces costs. This has also been documented in numerous studies. The resulting tasks for the field of behavioral cardiology in the care of patients with heart disease are as follows: (1) to better identify patients at risk by developing tools that reliably assess behavior that harms and behavior that protects; (2) to educate physicians in the risks associated with lifestyle factors and in managing these risks together with their patients; (3) to develop and test the efficacy and cost-effectiveness of interventions to promote lasting behavior change in patients; and (4) to identify barriers for the implementation of health behavior guidelines in cardiology practice and find ways to overcome these barriers. This chapter focuses on the major lifestyle or behavioral factors that influence the incidence of coronary heart disease (CHD), as well as the progression of existing CHD, and how they can be modified. These factors are smoking, diet, exercise, and adherence to prescribed medication regimens. They all have an impact on a patient's prognosis, and they are linked to long-established biologic risk markers, such as blood pressure, cholesterol, triglycerides, and glucose-insulin homeostasis, and more recently identified risk markers, such as endothelial ... ### MyAccess Sign In Username Password Want remote access to your institution's subscription? Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access. Ok ### About MyAccess If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. ## Subscription Options ### AccessCardiology Full Site: One-Year Subscription Connect to the full suite of AccessCardiology content and resources including textbooks such as Hurst's the Heart and Cardiology Clinical Questions, a unique library of multimedia, including heart imaging, an integrated drug database, and more.$595 USD

24 Hour Subscription $34.95 Buy Now 48 Hour Subscription$54.95