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Chapter Summary

This chapter discusses the impact that psychology can have on cardiovascular health (CVH) and cardiovascular disease (CVD); the individual, community, and societal determinants of various psychological factors that impact CVH and CVD risk; and interventions that could be used to reduce/enhance the influence of negative/positive psychological factors. Negative psychological factors such as depression, chronic stress, anxiety, anger/hostility, and pessimism have been shown to affect multiple behaviors and biological factors to result in reduced CVH and increased risk of CVD (see Fuster and Hurst’s Central Illustration). Conversely, positive psychological factors such as positive psychological well-being (including optimism), mindfulness, resilience, and hope are associated with several favorable health behaviors and biological factors to result in improved CVH and reduced risk of CVD. Individual-level interventions that can improve psychological health include stress management, mindfulness, meditation, and other mind-body techniques, as well as other positive psychology approaches. The clinical team, community leaders, and policymakers can also all impact the psychological factors that influence CVH and CVD. While the evidence base on psychological factors in CVH and CVD is still expected to grow, sufficient evidence currently exists to guide the care of patients to promote CVH and prevent CVD.

INTRODUCTION

The role of psychological factors is an important part of our understanding of cardiovascular (CV) health and disease, with respect to both its origins and its potential prevention and treatment. A new CV perspective broadens the long-standing focus on cardiovascular disease (CVD) events and outcomes to include the earlier life course of cardiovascular health (CVH). This concept adds to CVD prevention (primary, secondary, and tertiary) the potential for CVH promotion (primordial prevention), to avert CVD in the first place.

Psychological factors related to CVH and CVD may be negative (eg, depression) or positive (eg, optimism) and include a wide array of factors with varying degrees of research to date. Evidence for their relations to CV conditions is reviewed. Translation of this evidence into practice by cardiologists and others at individual, community, and societal levels has potential to improve both patient and population health. More widespread training and increased resources are required at each level. Implementation research and other studies will be needed to answer several specific questions, including how best to utilize emerging technologies to improve psychological health.

CVH AND DISEASE

Cardiovascular and cerebrovascular diseases (CVD) and CV risk have long been considered consequences of adverse psychological factors, such as depression, stress, or any of several other negative conditions. A substantial body of research addresses links between these factors and CVD events.1–3 Recommendations have been published for intervention with patients to reduce risk of a first CV event, a fatal outcome, or—for survivors—a recurrent event or impaired quality of life. The field of behavioral cardiology has evolved to foster such interventions in clinical practice.4...

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