Abstract This essay examines the psychological characteristics and psychosocial factors associated with, or causative of, cardiovascular disease. The essay also addresses some models like the cardio reactivity model, psychoneuroimmunology, the role of the sympathetic nervous system in cardiovascular disease, and the HPA axis. The association of certain psychosocial risk factors such as depression leading to medical non-compliance is also dealt with.
Outline:
Introduction
Psychological Factors Associated With or Causative of Cardiovascular Disease
Psychosocial Factors
Cardio Reactivity Model
Psychoneuroimmunology
The Involvement of the Sympathetic Nervous System
The HPA Axis
Association of Psychosocial Risk Factors with Certain Health Behaviors
Conclusion
References
From the Paper "Psychological risk factors for coronary syndromes belong to three categories. These include: chronic, episodic, and acute psychological risk factors (Kop, 1999). Chronic psychological risk factors (like hostility) lead to a gradual progression of coronary artery disease. The temporal relation to coronary syndrome is 10 years and the associated cardiovascular risks include hyperlipidemia, hypertension, and increased sympathetic activation. The pathophysiology involves sympathetic activity and elevated lipids. The primary pathological result is atherosclerosis (Kop, 1999).
"Psychological risk factors, which occur episodically (like exhaustion) have a duration, which lasts from few months to two years and can occur again. The temporal relation to coronary syndrome is 2 years and the associated cardiovascular risks include increased blood clotting and inflammation, and a shift of sympatho-vagal balance. The pathophysiology involves sympatho-vagal imbalance, neurohormonal changes, and a procoagulant state. The primary pathological result is altered homeostasis (Kop, 1999)."
Abstract This paper describes the causes, diagnosis and medications used to treat cardiovascular accidents (CVAs), also known as strokes. The paper also gives an outline of the responsibilities of nurses caring for such patients and what is expected of them.
From the Paper "A stroke or cardiovascular accident causes damage to the brain when the blood supply is reduced or stopped completely usually by the bursting of a blood vessel or the occlusion of a vessel by a blood clot . A thrombotic stroke occurs when a blood clot forms in an artery and blocks the blood supply to part of the brain. An embolic stroke occurs when a blood clot or piece of plaque breaks away in another part of the body and blocks an artery in..."
Abstract This paper answers a number of specific questions about the cardiovascular system, some of them structural, but many of them tracing blood flow paths through the body. A discussion of the systemic, pulmonary, and fetal circulations is included as well.
From the Paper "The pulmonary circulation takes de-oxygenated blood from the right ventricle to the lungs where it is re-oxygenated and returned to the left atrium. From here it passes into the left ventricle. The systemic circulation pumps blood from the left ventricle out to the rest of the body where it delivers oxygen to the tissues and picks up carbon dioxide for discharge from the body by the lungs. It returns the de- oxygenated blood to the right atrium. From here the blood passes into the right ventricle and into the..."
Abstract This paper explains that research has demonstrated that the psychosocial status of the individual is likely to correlate to their cardiovascular fitness. The author points out that positive social roles correlate to a positive status, while negative social roles lead to a lower level of status. The paper uses the Kolcaba Comfort Care Model to identify and promote positive psychosocial development in patients.
From the Paper "A growing body of data suggests that the emergence and severity of cardiovascular disease is contributed to by the psychosocial status of the body (Barry, 1996). The psychosocial status of the body refers to the correlation of social and psychological factors, and the impact that these factors have - both combined and separately - on the individual's physical status (Barry, 1996; Catherall, 2004). Data suggests that the psychosocial status of the individual has active correlates to the onset and development of heart disease, particularly cardiovascular failure (Drench, 2002; Catherall, 2004). "
Abstract "The paper discusses cardiovascular health, highlighting in brief the five basic cardiac systems: coronary arteries, peridardium, myocardium, endocardium and cardiac conductive system. The paper further examines the associated pathologies and NYHA classifications, and the psychological and vocational counseling implications for each of the cardiac categories presented.
From the Paper "Much can be said about cardiovascular health. As one of the leading causes of death and disability in both men and women, cardiovascular disease must be understood by those at risk, current patients and those in the health profession or allied helping professions seeking to offer assistance. Cardiovascular disease is often a silent killer that can strike without warning. It is often cited as the number one cause of death in men and women in the US. Reyes (2005) states that "at any given time, there are about 6 million Americans with symptoms of cardiovascular disease." "
Abstract This paper examines the race-associated differences in health outcomes among African-American women with CVD (Cardiovascular Disease). The paper explains that African Americans suffer greater incidence of cardiovascular disease, and women women suffer cardiovascular and peripheral vascular disease in greater numbers than men. The combination of the two: African-American women, suffer greater cardiovascular disease than the general population in the United States. The paper demonstrates that the above statements are true, and analyzes the causes for this discrepancy in cardiovascular diagnosis and care. The paper then looks at both the demographic as well as the socioeconomic and ethnological reasons for the difference in cardiovascular care. The paper also points out that women experience a greater amount of heart disease, and a lower level of treatment than men. This paper examines the reasons for that discrepancy as well.
Table of Contents:
Introduction
Underlying Causes of Heart Disease
African-American Women and Heart Disease
Lifestyle, Heredity and Demographics
Differences in Medical Care
Differences in Demographics
Women's Lower Rate of CHD Treatment
African American Distrust of Physicians and the Medical System
Conclusion
Bibliography
From the Paper "Although death from coronary heart disease (CHD) is declining for both African Americans and white Americans, the rates are declining faster for white Americans than their Black counterparts. According to the AHA, the incidence of deaths by whites from CHD has declined 46% and 40% for white men and women, respectively, while it has declined 33% and 27% for African American men and women respectively from 1979 to 2002 (AORN, 2002). The AHA posited that the lower decline in the death rate from CHD for African Americans was due primarily to heredity and life style habits."
Abstract Cardiovascular disease is one of the leading causes of mortality in the industrialized world. At the same time, high blood cholesterol is known to be a risk factor for heart disease. Decreasing total blood cholesterol can have a profound effect, reducing the incidence of coronary heart disease by close to 30%. Further, there is a wide variety of research that links blood cholesterol levels to heart disease and mortality. This paper presents a design for a study that aims to add to this body of evidence by investigating the impact of decreased cholesterol consumption on mortality from cardiovascular disease.
From the Paper "In each facility, 1,000 research subjects will be recruited using voluntary recruitment procedures. Advertisements for volunteers will be placed in local newspapers, community message boards, and clinic and emergency waiting rooms. Subjects will range in age upwards from 21 years of age. Subjects will not be excluded from the study on any medical or other grounds. This wide range of subjects and large sample size will allow researchers to correlate cholesterol intake with a number of other factors, including age, sex, race, place of residence, and other medical conditions."
Abstract This paper discusses the impoverished communities in the United States in terms of their vulnerability as a population in relation to cardiovascular care. The paper explains that this population generally does not have health care and for those individuals that cannot be covered by either Medicare or Medicaid, their vulnerability is increased significantly. Major health concerns such as cardiovascular disease often lead to patients that do not receive care because of the cost and availability of services.
Abstract This paper explains that cardiovascular diseases can be prevented by eating healthfully, participating regularly in aerobic activity, and by not smoking. The paper describes a diet that is heart healthy and stresses the importance of physical aerobic activity and the avoidance of cigarettes.
From the Paper "Nearly twenty percent of the American population has a form of Cardiovascular Disease. In 2002, thirty-five percent of the deaths in the United States were related to heart and blood vessel diseases according to the Center for Disease Control (CDC). Cardiovascular Disease includes Coronary Heart Disease, atherosclerosis, high blood pressure, and stroke. Some causes for Cardiovascular Disease can be attributed to physical inactivity, unhealthy nutritional planning, smoking, and age."
A review of the limitations of "Prevalence and Cardiovascular Disease Correlates of Low Cardiorespiratory Fitness in Adolescents and Adults," written by Mercedes R. Carnethon, Martha Gulati and Philip Greenland.
Abstract This paper discusses and reviews the article, "Prevalence and Cardiovascular Disease Correlates of Low Cardiorespiratory Fitness in Adolescents and Adults," written by Mercedes R. Carnethon, Martha Gulati and Philip Greenland. It discusses the purpose of the study, the results and conclusions and the limitations of the study's methods.
From the Paper "The age selection was quite broad, so the study could control for other fitness factors relating to age impinging upon the results. But there is an obvious weakness in using such a large sampling. The population size is so diluted and generalized in its composition that the conclusions drawn from the study may be too vague to be of prescriptive use. To conduct the study, the authors submitted the test subjects to submaximal treadmill testing so they reached at least 75% to 90% of their age-predicted maximum heart rate. Maximal oxygen consumption, or VO2 max, was estimated by measuring their heart rate response to their effort. Low levels of fitness were defined by using percentile cut-off points of estimated VO2 max from existing external referent populations. In other words, the VO2 max definitions of fitness were derived purely from preexisting literature and studies. Similarly, the other physical and laboratory CVD risk factors measured according to standard methods were derived from preexisting literature."
Abstract The paper describes the case of an American-Indian, morbidly obese, male patient who practiced unhealthy eating habits, did little or no exercise, had no health insurance and was employed as a cook. The paper further relates that the patient had a brother who was also obese, he smoked, had poor coping strategies when dealing with stress and was easily depressed and withdrawn. The paper therefore shows how this patient presented with risk factors that made cardiovascular (CV) disease inevitable even at his early age.
From the Paper "This is a case of C. V., a 28 year old, American Indian, and morbidly obese male patient at weighing at 292 lbs. He was admitted on April 10, 2008 due to abdominal pain, and subsequently succumbed to respiratory failure. His family history reveals that he has one brother who is also obese, a smoker, and is unemployed. The patient had observed unhealthy eating habits, and did little or no exercise. He had no health insurance, and was employed as a cook. He smoked 2 packs per day. He had poor coping strategies when dealing with stress, and was easily depressed and withdrawn. He was bedridden throughout his stay in the hospital."
Abstract The leading cause of death in America is cardiovascular disease. This particular disease was responsible for 960,000 deaths in this country last year, accounting for 41.5 percent of all deaths. Studies have shown that exercise reduces the risk of heart disease. Indeed, people who are less fit have between a thirty and fifty percent greater risk for the development of high blood pressure. The paper provides a breakdown of the different types of heart rates and why they are important to fitness and cardiovascular health.
From the Paper "The person who has been inactive for years should always consult a doctor before the beginning of a new exercise regimen, especially those who are middle-aged or older. Beyond this, those people who would like to start an exercise program but find facts and figures about the heart rate confusing should acquire the help and expertise of a professional trainer. These people are trained to understand the goals of their clients and to help them to achieve them in an appropriate fashion."
This paper discusses the crisis communication strategies used by Merck, Pfizer and Johnson & Johnson in problems marketing their specific controversial products.
Abstract This paper explains that Merck's culpability lies in the fact that fully six years before the drug VIOXX was withdrawn from the market, they continued to attempt to dodge and deny rather than holding detailed studies on the cardiovascular risks of the drugs, which has made Merck so vulnerable to court action today. The author points out that when Pfizer Pharmaceuticals found itself in similar trouble with Celebrex, it should have re-submitted Celebrex for safety trial specific to cardiovascular events to the FDA; instead Pfizer, like Merck, bet that marketing the risk versus benefit profile of the drug would be sufficient. The paper relates that Johnson and Johnson plans to make direct to consumer (DTC) advertisements for drugs, such as Levitra and Viagra, more informative; however, the paper stresses that the best decision about whether or not a drug is right for a patient should be left to the physician and his or her patient, not a 30 second television advertisement.
Table of Contents
Merck and VIOXX
Pfizer and Celebrex
Johnson & Johnson and DTC (Direct to Consumer) Marketing
From the Paper "In this case, it is difficult to asses whether Pfizer was being coy surrounding the potential risks of Celebrex or was simply under the impression that the drugs, while sharing the same class and mechanism of action, did not hold the same cardiovascular risks. This assumption could be held up when one thinks of the release of the non-sedating antihistamine Seldane in the 1990s. This drug, originally containing a black box warning (the highest warning made by the FDA) against concurrent use with certain antifungal and antibiotic drugs, was later removed from the market due to a propensity to cause a fatal heart rhythm. A popular drug, it was soon reformulated and is now widely available even as an over-the-counter preparation without these side effects. It could be possible that Pfizer truly felt the initial studies were flawed, but the manner in which they chose to disseminate the data from the first study would seem somewhat underhanded in nature."
Abstract The number of existing cases of high blood pressure is nearly 40% higher in blacks than in whites and its effects are more frequent and severe in this population. Recent emphasis on racial/ethnic health disparities in the field of public health has led to a call for the development of socio-ecological approaches toward the elimination of cardiovascular disease disparities, however solutions to the problem are typically directed at health behavior change. This paper examines policies addressing hypertension disparities enacted at the federal level during the last five years, provides an overview of the problem definitions and solutions framed to set the agenda for these policies, explores the role of key policy actors in setting the policy agenda for the reduction of hypertension disparities, and makes recommendations for a different problem definition (less individualistic) with plausible solutions.
From the Paper "African Americans are disproportionately burdened with disease morbidity and mortality associated with hypertension.1 The existence of these racial disparities warrants public health policy attention for two reasons: first, the constitution delegates the "responsibility to protect and promote the welfare of the public" to the government (Scutchfield & Keck, 1997) and the existence of these disparities suggests that the welfare of some citizens is not being protected; second, the ethical framework for public policy development, which includes the egalitarian perspective of justice, holds that "everyone should have equal access to both the benefits and burdens arising from the pursuit of health" (Longest 1998); however, current research on disparities highlights inequalities in access to employment, education, housing, and healthcare as underlying reasons for gaps in health status (Office of Disease Prevention and Health Promotion, 2000; Ren & Amick, 1996; Kawachi, Kennedy & Wilkinson, 1999)."
Abstract This paper analyzes an experiment of physiological reactivity in relation to different temperatures of the cold pressor. Three groups of subjects are compared using 15 people in each group. Each group experienced a different temperature of the cold pressor, specifically 0, 10 or 20 degrees Celsius. Physiological measurements taken were systolic and diastolic blood pressure, heart period and pre-ejection period. The data was analyzed and compared between groups to determine differences in nervous system reactivity. The results showed a clearer understanding of cardiovascular reactivity in relation to the use of the cold pressor.
From the Paper "Cold pressor techniques are used in psychophysiological research to induce pain and stimulate the sympathetic nervous system. The cold pressor as an experimental tool can be applied to the subject's forehead or the subject's foot or arm can be immersed in ice water, with each variation resulting in differing degrees of physiological response (Durel, et. al., 1993). The limb applications are considered the most reliable because the facial application may involve the dive reflex (Durel, et. al., 1993). For the purpose of this study, the arm immersion will be used."
