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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.
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NEGATIVE BEHAVIORAL AND PSYCHOSOCIAL RISK FACTORS
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By the late 1990s, considerable evidence had accumulated to identify the role that acute stress can exert in precipitating myocardial ischemia as well as to establish the role of chronic psychosocial factors that are associated with an increased risk for CVD, including depression, hostility, work stress, and social isolation.1 The epidemiologic evidence supporting the clinical importance of behavioral and psychosocial risk factors has since grown and now includes a number of meta-analyses concerning individual psychosocial risk factors. A comprehensive list of behavioral and psychosocial factors that have now been studied for their relationship to clinical heart disease is listed in Table 111–2.
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Various negative health behaviors are strongly associated with an increased risk for CVD, including poor nutrition and or weight control, physical inactivity, and smoking. Each of these behaviors is covered in other chapters ...