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This chapter discusses the psychological, social, and behavioral factors that contribute to health and cardiovascular disease (CVD), and the management of these factors. Various physical health behaviors are known to be associated with increased risk for CVD (see accompanying Hurst’s Central Illustration). Increased CVD risk has also associated with negative emotions and mental mindsets, and with chronic stress, including perceived stress, the level of which can vary greatly in response to a given life situation, depending on personality, resilient resources, and other factors. In the absence of challenge or purpose in life, boredom and dissatisfaction may develop and result in negative health effects, leading to CVD. Social factors such as social isolation and low socioeconomic status are also associated with increased CVD risk. A dose-response relationship has been noted between most of these factors and the occurrence of cardiovascular events. Moreover, in real life, these factors tend to cluster. Behavioral cardiology targets both the management of behavioral risk factors for CVD and the management of psychosocial risk factors that contribute to the pathogenesis of CVD, promote adverse health behaviors, and impede adherence to behavioral recommendations. Notably, a reciprocal relationship exists between management of health behaviors and psychosocial risk factors; the management of health behaviors (for example, exercise) can promote psychosocial well-being and psychosocial interventions also improve health behaviors.

eFig 111-01

Behavioral and psychological factors associated with increased risk of cardiovascular discusses.


Behavioral cardiology is a dynamic new field that studies the role of psychological, social, and behavioral factors that contribute to health and cardiac disease. The field includes various components, as summarized in Table 111–1. These include the epidemiologic study of psychosocial factors that serve as risk factors for cardiovascular disease (CVD) and the pathophysiologic basis for this risk. In addition, the field has become increasingly focused on examining positive psychosocial factors that promote health and longevity and the physiologic basis for such buffering. In the clinical realm, the field seeks to examine psychological approaches for modifying adverse health behaviors that promote disease, such as poor diet and physical inactivity, and for developing approaches that help manage psychosocial risk factors, such as chronic stress, which can contribute to adverse health behaviors and promote disease. Due to the large breadth of this growing field, each of these areas will be reviewed in a general rather than in-depth manner, with references limited to examples of representative studies.

TABLE 111–1.The Clinical Scope of Behavioral Cardiology

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