Handbook of Cardiovascular Behavioral Medicine

Preface
References
Acknowledgments
Contents
About the Editors
Contributors
Section I: Cardiovascular Disease: Background and Biopsychosocial Model
1 Cardiovascular Behavioral Medicine: Past, Present, and Future
Introduction
Risk Factors
Pathophysiology of Cardiovascular Disease
Biobehavioral Interventions in Cardiovascular Disease
Comment
Present Context and Future Prospects
References
2 Introduction to Cardiac Anatomy, Physiology, and Pathophysiology
Cardiovascular Anatomy
Cardiac Physiology
Atherosclerotic Cardiovascular Disease Processes
Cardiac Pathophysiology
Clinical Syndromes
Stable and Unstable Angina
Acute Coronary Syndromes
Diagnostic Tools in Clinical Cardiology
Electrocardiogram
Holter Monitor
Exercise-ECG Stress Testing
Echocardiogram Stress Testing
Nuclear Stress Testing
Mental Stress Testing
Calcium Score
CT Angiogram
Coronary Catheterization
Electrophysiology
Congestive Heart Failure
Types of Cardiomyopathy
Conclusions
References
3 Classification of Cardiovascular Diseases: Epidemiology, Diagnosis, and Treatment
Risk Factors for Cardiovascular Disease
Hypertension
Epidemiology
Diagnosis
Mechanisms and Risk Factors
Treatment
Ischemic Heart Disease
Myocardial Infarction
Epidemiology
Diagnosis
Diagnostic Tests
Mechanisms and Risk Factors
Treatment
Cardiomyopathies and Left Ventricular Hypertrophy
Epidemiology
Diagnosis
Mechanisms and Risk Factors
Treatment
Heart Failure
Epidemiology
Diagnosis
Mechanisms and Risk Factors
Treatment
Cardiac Arrhythmias and Sudden Cardiac Death
Epidemiology
Diagnosis
Mechanisms and Risk Factors
Treatment
Stroke and Cerebrovascular Disease
Epidemiology
Diagnosis
Mechanisms and Risk Factors
Treatment
Conclusions
References
4 The Biopsychosocial Perspective on Cardiovascular Disease
Introduction
Origins and Challenges of the Biopsychosocial Perspective
Animal Research in Cardiovascular Behavioral Medicine
Laboratory and Clinical Mental Stress Testing
Ambulatory Monitoring in Cardiovascular Behavioral Medicine
Observational Epidemiological and Clinical Studies
Synthesis
References
Section II: Relations of Cardiovascular Risk Factors to Cardiovascular Disease
5 Childhood Factors in Adult Risk for Cardiovascular Disease
Early Emergence of ``Adult´´ Risk Factors
Sex
Race and Ethnicity
Discrimination
Hostility and Anger
Depression
Cardiovascular Stress Responses
Risk Factors Specific to Childhood
Childhood Adversity
Socioeconomic Status
Adverse Childhood Experiences
Moderators and Mediators of Childhood Adversity
Low Birth Weight
Conclusion
References
6 Aging Changes in Cardiovascular Structure and Function
Demographics of Aging and Impact of Age on Cardiovascular Disease
Aging Changes in the Vasculature
Morphology of Aging Vasculature
Physiological and Clinical Effects of Vascular Aging
Aging Changes in Cardiac Structure and Resting Function
Cardiovascular Response to Exercise and Other Stressors
Orthostatic Stress
Pressor Stress
Aerobic Exercise Capacity and Aging
Mechanisms of Impaired LV Ejection During Maximal Aerobic Exercise in Healthy Older Adults
Sympathetic Modulation
Deficits in Cardiac Beta-Adrenergic Receptor Signaling
Electrocardiography
Sinus Node Function
P-Waves
P-R Interval
QRS Complex
Repolarization
Arrhythmias
Atrial Arrhythmias
Isolated Atrial Ectopic Beats
Atrial Fibrillation
Paroxysmal Supraventricular Tachycardia
Ventricular Arrhythmias
References
7 Risk Factors for Ischemic Heart Disease in Women
Introduction
Overview of IHD and Women
Sex Differences in Symptoms, Diagnosis, and Treatment
Microvascular Coronary Dysfunction and Cardiac Syndrome X
Sex Hormones and IHD
Limitations of Using the Framingham Risk Score in Women
Differential Risk Factors Between Men and Women
Unique Risk Factors in Women
Psychosocial Factors and Risk for Incident IHD
Type A, Hostility, and Anger
Depression
Anxiety
Social Support
Stress
Psychosocial Factors in Women with IHD
Depression
Anxiety
Hostility, Anger, and Type A Behavior
Social Support
Psychosocial Intervention for Women with IHD
Sex Differences in Major Psychosocial Clinical Trials for IHD Patients
The Montreal Heart Attack Readjustment Trial (M-HART)
The Enhancing Recovery in Coronary Heart Disease (ENRICHD) Trial
Meta-analyses of Psychosocial Interventional Studies in IHD Patients
Cardiac Rehabilitation Program Services
Recent Developments
Conclusions
References
8 Stress and Heart Disease in Women: The Stockholm Women´s Intervention Trial in Coronary Heart Disease Study
Clinical Picture
Why Are Women Under-Represented in the Coronary Care Units (CCUs)?
Age Characteristics
Sex Hormones
The Stockholm Female Coronary Risk Study
The Stockholm Women´s Intervention Trial in Coronary Heart Disease (SWITCHD)
Topics Discussed at the Group Sessions
Results from the SWITCHD Intervention Trial
Subjective Experiences of Women´s (Group) Interactive Patterns
Conclusions
References
9 From Race to Racism in the Study of Cardiovascular Diseases: Concepts and Measures
Race and Disease
Human Races Revisited
Conceptual Distinctions
Empirical Findings
Family Trees, Venns, and Trellises
Human Variation, Genetics, and Cardiovascular Disease
``Race´´ and Hypertension
Race and Genetic Markers of Health
Whither the Study of Race and Cardiovascular Disease
Racism and Cardiovascular Disease
Racism Conceptualized
The Study of Racism and Disease
Methodological Advances
The Promise of the Empirical Studies
Future Directions
Conclusion
References
10 Socioeconomic Status and Cardiovascular Disease
Conceptualization and Measurement of SES
Traditional Indicators
Childhood Indicators
Life Course Approaches
Area-Based Measures
Subjective Social Status
Conclusions
Socioeconomic Gradients in CVD
Indicators of Adult SES and CVD
Indicators of Childhood SES and CVD Later in Life
Life Course Approaches to Evaluating the SES and CVD Association
Variability in the Pattern of the Gradient
Conclusions
What Are the Pathways Connecting SES with CVD and What Possibilities Exist for Intervention?
Upstream/Structural Determinants
Environmental Influences
Healthcare Access and Quality
Biobehavioral Risk Factors
Psychosocial Risk and Resilience Factors
Summary
Concluding Comments
References
11 Health Disparities and Cardiovascular Diseases
A Conceptual Approach to Studying Health Disparities
Racial/Ethnic Disparities in Cardiovascular Diseases
Coronary Heart Disease
Hypertension
Heart Failure
Stroke
Recent Progress
CVD Risk Factors and Racial Disparities
Genetics
Socioeconomic Status
Traditional Risk Factors
Psychosocial Factors
Racism
Multiple CVD Risk Factors
Does Where You Live Matter? Geographic Disparities in CVD Risk
Unequal Treatment
Summary
Future Directions: Closing the Gap
Improving Socioeconomic Determinants and Policies
Cultural Competency Among Healthcare Providers
Increased Awareness of Health Disparities
Diversity in Practice
More Research, Better Research
Conclusion
References
12 Nicotine Dependence and Cardiovascular Diseases: Biobehavioral and Psychosocial Correlates
Measurement Issues
Acute Effects of Smoking on Cardiovascular System
Interactive Effects of Nicotine and Acute Stress
Smoking and Cardiovascular Diseases
Coronary Artery Disease
Stroke and Cerebrovascular Diseases
Peripheral Vascular Diseases
Mechanisms of Tobacco Effects on Cardiovascular Risk
Psychosocial Correlates/Determinant of Smoking Effects
Ethnic and Racial Factors
Socioeconomic Status (SES) and Smoking
Weight Concern After Smoking Cessation
Treatment Option for Smoking Cessation
Behavioral Intervention
Pharmacologic Therapy
Nicotine Replacement Therapy (NRT)
Non-Nicotine Pharmacologic Therapy
Effects of Cessation on Reversing Cardiovascular Diseases
Discussion
Conclusions
References
13 Alcohol and the Cardiovascular System: Implications for Behavioral Medicine
Facts About Alcohol Consumption
Measurement of Alcohol Consumption
Alcohol Consumption and Health
Alcohol and the Cardiovascular System
Hypertension
Stroke
Coronary Artery Disease
Arrhythmia
Cardiomyopathy
Drinking Patterns and Cardiovascular Disease Risk
Biopsychosocial Factors Contributing to Alcohol Use and Cardiovascular Disease
Conclusions
References
14 Impact of Specific Diets and Nutritional Supplements on Cardiovascular Diseases
Specific Diets
Mediterranean Diet
DASH-Style Diet
Low-Carbohydrate/High-Protein Diet
Safety
Fish Oil-Based Therapies: Omega-3 Fatty Acids
Potential Mechanisms of Action
Omega-6 Fatty Acids
Dietary Recommendations Related to Omega-6 Fatty Acids
Potentially Important Vitamin Supplements
Vitamin D
Vitamins E and Vitamin C
Vitamin B and Folic Acid
Co-enzyme Q10
Cardiovascular Benefits of CoQ10
Hypertension
Myocardial Infarction
Angina Pectoris
CV Surgery
Heart Failure
Cardiac Arrest
Adverse Effects of CoQ10 and Interactions
L-Carnitine
Chronic Stable Angina
Myocardial Infarction
Heart Failure
Peripheral Arterial Disease
L-Arginine
Arginine and Vascular Effects
Hypertension
Diabetes Mellitus
Obesity/Insulin Resistance
Smoking
Heart Failure
Peripheral Arterial Disease
Conclusions
References
15 Understanding Obesity and Cardiometabolic Risk
Obesity: Definition
Obesity: Measurement
Anthropomorphic Measures
Body Mass Index (BMI)
Waist-to-Hip Ratio and Waist Circumference
Skinfold Calipers
DEXA Scans
Bioelectrical Impedance Analysis (BIA)
Underwater Weighing
Doubly Labeled Water (DLW)
Bod Pod
Obesity: Prevalence
Adipose Tissue and Body Fat Distribution
Adipose Tissue
Body Fat Distribution
Fat Distribution and Cardiometabolic Risk: Mechanisms
PIMA Indians: A Case Example of Racial/Ethnic Differences in CVD and Obesity
Understanding Ethnic Differences in Health Risks Associated with Obesity: Theories
Obesity Treatment/Prevention: What to Do?
Concluding Remarks
References
16 Physical Activity/Exercise and Cardiovascular Disease
Introduction
Assessment of Physical Activity/Exercise
Epidemiological Studies Evaluating the Association of Physical Activity/Exercise with CVD
Stroke
Hypertension
Heart Failure
Mediators in the Relationship Between PA and CVD
Moderators in the Relationship Between PA and CVD
Summary
Exercise Interventions Among Patients with CVD
Stroke
Hypertension
Heart Failure
Peripheral Arterial Disease
Mediating Factors in the Relationship Between Exercise Activity and CHD Outcomes
Moderators in the Relationship Between Exercise and CVD
Summary
Discussion
References
17 Sleep as a Bio-behavioral Risk Factor for Cardiovascular Disease
Dimensions of Sleep Important to Health and Functioning
Sleep Duration
Sleep Duration: Definitions and Measurement
Sleep Duration and Health: Evidence
Sleep Continuity
Sleep Continuity: Definitions and Measurement
Sleep Continuity and Health: Evidence
Sleep Architecture
Sleep Architecture: Definitions and Measurement
Sleep Architecture and Health: Evidence
Sleep Quality
Sleep Quality: Definitions and Measurement
Sleep Quality and Health: Evidence
Behavioral Medicine and Sleep: Future Directions
Biological Mechanisms Linking Poor Sleep to Increased CVD Risk
Potential Pathways Between Sleep and Cardiovascular Disease
Interaction of Sleep and Psychosocial Factors in Disease
Sleep as a Mediator of Psychosocial Factors and Disease
Synergistic Effect of Sleep and Psychosocial Factors in Disease
Clinical Interventions to Enhance Sleep and Reduce CVD Risk: The Role of Mindfulness
Background
References
18 Methodological Challenges Associated with the Measurement of Medication Adherence in Patients with Cardiovascular Disease
Accuracy of Methods to Assess Medication Adherence
Challenges in Adherence Measurement
Methods to Assess Medication Adherence
Direct Methods
Biological Assays
Direct Patient Observation
Indirect Methods: Objective Measures
Electronic Monitoring Devices
Pill Counts
Pharmacy Refill Records
Indirect Methods: Self-Report Measures
Patient Interviews
Questionnaires
Patient Diaries
Agreement Among Adherence Measures
Special Considerations when Selecting Self-Report Measures
Conclusion
Recent Developments
References
19 Personality Factors in Cardiovascular Disease: The Big Five and Type D Personality
Big Five Personality Traits
Background
Big Five Personality Traits and Health Outcomes
Neuroticism
Extraversion
Openness to Experience
Agreeableness
Conscientiousness
Type D Personality
The Nature of Type D Personality
Type D Personality and Patient-Reported Outcomes in CVD
Type D Personality and Adverse Clinical Outcomes in CVD
Coronary Heart Disease
Congestive Heart Failure and Heart Transplantation
Implantable Cardioverter Defibrillator
Peripheral Artery Disease
Mechanisms Linking Personality to Health Outcomes
Physiological Mechanisms
Arousability
Cellular Processes
Inflammatory Activation
Neurobiological System
Genetic Factors
Behavioral Mechanisms
Behavioral Interventions
Conclusions
References
20 Hostility and Health
Components and Definitions
Origins of Hostile Predispositions
Developmental Influences
Effects of Adult Adversity
Genetic and Physiological Influences
Social Environment
Hostility and Health Outcomes
Coronary Disease Development
Prognosis of Those with Established Coronary Disease
Total Mortality and Other Diseases
Potential Demographic Moderators
Mechanisms Linking Hostility and Health
Social Stressors
Physiological Links Between Social Stress and Disease
Health Behaviors
Interventions
Conclusions
References
21 Negative Emotions: Depression, Exhaustion, and Anxiety
Pathways from Negative Affect to CVD
Mechanisms
Depression
Definition
Measurement
Epidemiology
Treatment
Exhaustion
Definition
Measurement
Epidemiology
Treatment
Anxiety
Definition
Measurement
Epidemiology of Anxiety and Chronic Stress
Treatment
Implications for Research
Conclusions
References
22 Positive Psychological Well-Being and Cardiovascular Disease
Indicators of Positive Psychological Well-Being
Methods
Studies in Healthy Populations
Optimism
Ikigai
Other Indicators of Positive Psychological Well-Being
Summary
Studies in Patient Populations
Optimism
Other Indicators of Positive Psychological Well-Being
Summary
Discussion
Future Questions
What Features of Positive Psychological Well-Being Are Critical?
What Effect Modifiers Are Pertinent?
What Are the Pathways by Which Positive Psychological Well-Being Influences CVD?
Concluding Remarks
References
23 Stress and the Development of Atherosclerotic Cardiovascular Disease
Stress Definition
Measurement Issues
Global Perceived Stress
Work Stress
Marital Stress
Major Life Events
Other Sources of Stress: Caregiving and Discrimination
Stress Reduction and CVD Risk
Have We Over-Adjusted Our Models?
Mediators for Stress-CVD Association
Health Behaviors
Heightened Cardiovascular Responses to Acute Stress
Platelet Activation, Coagulation, and Fibrinolysis
Oxidative Stress
Hypothalamic-Pituitary-Adrenal (HPA) Axis Activity
Inflammation
Moderators for Stress-CVD Association
Conclusion
References
24 Work and Cardiovascular Diseases
Work and Cardiovascular Disease: Theoretical Background
Empirical Evidence 1: Epidemiological Studies
Empirical Evidence 2: Experimental and Quasi-experimental Studies
Implications for Behavioural Medicine Interventions
References
25 Social Support and Cardiovascular Disease
Definitions of Social Support
Structural Social Support: Social Integration and Social Networks
Functional Social Support: Provision of Social Resources
Perceived vs. Received Support
Commonly Used Measures of Social Support
Social Network Measures
Role-Based Measures of Social Networks
Social Participation Measures of Social Network
Complex Social Network Measure
Measures of Received Support
Measures of Perceived Social Support
The ENRICHD Social Support Instrument (ESSI)
Interpersonal Support Evaluation List (ISEL)
Epidemiologic Evidence of an Association between Social Support and CVD
Social Support and CVD Incidence in Initially Healthy Populations
Social Support and CVD-Specific and Total Mortality in Initially Healthy Populations
Potential Gender Effects in Epidemiologic Research on Social Support and CVD
Social Support and Adverse Outcomes in CVD Patients
Prognostic Studies in CHD Patients
Prognostic Studies in CHF and Stroke Patients
Mechanisms through which Social Support May Affect CVD
Social Support and CVD Risk Factor Behaviors
Social Support and CVD-Related Physiological Mechanisms
Evidence of Effects of Social Support Interventions on CVD Outcomes
Summary and Recommendations for Future Research
References
26 Racism, Ethnic Discrimination, and Cardiovascular Health: Conceptual and Measurement Issues
Constructs and Definitions
The Levels and Types of Racism and Ethnic Discrimination
Cultural Racism
Measurement Strategies and Limitations
Health Effects
Future Directions
Institutional Racism
Measurement
Health Effects
Future Directions
Individual-Level and Interpersonal Racism
Measurement Strategies and Limitations
Health Effects
Future Directions
Internalized Racism
Measurement
Health Effects
Future Directions
Summary and Conclusions
References
27 Religion, Spirituality, and Cardiovascular Disease
Construct and Measurement Issues
Construct Definition
Measurement Concerns
Conclusions
Empirical Studies
Studies of Denomination Effects
Religion, Spirituality, and CV Mortality
R/S and Coronary Artery Disease
Non-surgical Studies
Surgical Studies
Possible Mechanisms
Concluding Statements
References
28 Aggregation of Psychosocial Risk Factors: Models and Methods
Conceptual Models of Aggregation
Models of Emotion, Personality, and Psychological Disorders
Structure of Negative Affects and Related Traits and Diagnoses
Taxonomies of Personality
Models of Social Behavior
Models of Associations Between Individual Differences and Social Relations
Ecological Models of the Embedded Nature of Psychosocial Risk
Aggregation over Time: Life Course Models
Methodological Implications of Aggregated Risks
The Guiding Role of Theory
Approaches to Analysis
Conclusions
References
29 Contexts and Cardiovascular Health
Research on Contexts and Cardiovascular Disease
Social Contexts
Social Economic Position
Social Networks
Social Stressors
Social Marketing on Online Social Networking Sites
Proximal Spatial Contexts
Residential Housing
Neighborhood Contexts and the Built Environment
Choice Architecture for Prevention
Organizational Contexts and Connectivity to Services
Workplace, Schools, and Other Institutional Settings
Coupling of Communities and Health Systems
Methodological Issues and Advances
A Potential Outcomes Approach to Casual Inference
Exchangeability and Modern Tools for Inference
Causal Inference and Multilevel Modeling for Contextual Factors
Composition Versus Context
Measuring Context
Timing and Temporality
Scale of Measurement
Perception and Meaning
Conclusions
References
30 Environmental Toxicants and Cardiovascular Behavioral Medicine
Neurotoxicology
Toxins vs. Toxicants
Detecting Toxicants
Risk Assessment in Neurotoxicology
Practical Considerations for the Researcher
Toxicant Forms
Chemical Mixtures
Measurement Precision and Compartment Decisions
Toxicants and Cardiovascular Health
Lead (Pb)
Mercury (Hg)
Particulate Matter (PM)
Persistent Organic Pollutants (POPs)
Arsenic
The Potential Importance to Cardiovascular Behavioral Medicine
Model 1: Toxicant Exposure as a Distal Cause
Model 2: Toxicant Exposure as a Mediator of Psychosocial-CVD Association
Model 3: Toxicant Exposure as a Covariate
Model 4: Toxicant Exposure as an Effect Modifier
Conclusion
References
31 Genetics in Cardiovascular Behavioral Medicine
A Brief Introduction to Genetics
Genome-Wide Association Studies in Cardiovascular Behavioral Medicine
Cigarette Smoking and Nicotine Dependence
Obesity and Diet
Limitations of GWAS
Gene-Environment Interaction
Gene-Environment Interaction in Cardiovascular Behavioral Medicine
Gene Expression
Epigenetics
Precision Medicine
Summary
References
32 Hypertension
Historical Perspective on Blood Pressure Measurement
Diagnosis of Hypertension
Blood Pressure Goals
Psychosocial Factors and Elevated Blood Pressure
The Concept of ``True´´ Blood Pressure
Office Blood Pressure, Ambulatory Blood Pressure, and the Circumstantial Misclassification of Hypertension Status
White Coat Hypertension
Masked Hypertension
Selected Psychosocial and Behavioral Factors that Contribute to Differences Between Office and Ambulatory Blood Pressure
Psychological Stress
Hypertension Labeling and Stress
Home Blood Pressure Monitoring as an Alternative to Ambulatory Blood Pressure Monitoring
Conclusions
References
33 The Measurement of Lipids and Lipoproteins in Behavioral Medicine Research
Epidemiological Associations of Lipids and Lipoproteins to Cardiovascular Disease
Measurement
Decisions Regarding Which Lipids to Sample
Collecting the Samples
Hemoconcentration
Processing the Samples
Analysis
Lipids, Lipoproteins, and Psychological Factors
Stress
Chronic and Episodic Stressors
Acute Stressors
Mood and Depression
Cognition
Variation in Lipids and Lipoproteins
Potential Clinical Significance of Psychologically Associated Lipid Elevations
Interventions
Future Directions
References
34 Insulin, Glucose, and the Metabolic Syndrome in Cardiovascular Behavioral Medicine
Evolution of the Concept of the Metabolic Syndrome
Definition of the Metabolic Syndrome
Criteria Proposed for Clinical Diagnosis of the Metabolic Syndrome in Adults
Criteria Proposed for Clinical Diagnosis of the Metabolic Syndrome in Children
How to Measure Components of the Metabolic Syndrome
Factors Underlying the Metabolic Syndrome
Genetic Factors
Neuroendocrine Factors
Hypothalamic-Pituitary-Adrenal Axis
Autonomic Nervous System
Psychosocial Factors
Prenatal Factors
Conclusions
References
35 Inflammation, Atherosclerosis, and Psychological Factors
The Inflammatory Response
Components of the Inflammatory Response: Proinflammatory and Anti-inflammatory Cytokines
Triggers of Chronic Inflammation
Atherosclerosis as an Inflammatory Disease: The Development of Hypotheses
The Atherosclerosis and Lipid Hypothesis
Atherosclerosis and the Response to Injury Hypothesis
Atherosclerosis and the Inflammation Hypothesis
Measures of Inflammation in Clinical and Research Settings: Relevance to Cardiovascular Behavioral Medicine
Inflammation in Cardiovascular Behavioral Medicine: Shared Genetic Influences
Inflammation and Psychological Factors: A Biopsychosocial Model of ACVD
Personality Traits and Inflammation
Personality Factors and Markers of Inflammation
Trait Hostility and Anger
Type D Personality
Life Orientation, Optimism, and Pessimism
Negative Affective States, Anxiety, Mood Disorders, and Inflammation
Clustering of Psychosocial Factors and Inflammation
Psychological Factors and Inflammation: Potential Bidirectional Pathways
Conclusions
Limitations
References
36 Hemostasis and Endothelial Function
Hemostasis Pathways
Measurements of Hemostasis and Endothelial Factors
Acute Psychosocial Stress
Healthy Individuals
Modulating Factors of the Acute Stress Response
Sociodemographic Factors
Cardiovascular Disease
Medication
Negative and Positive Affect
Social Support
Chronic Psychosocial Stress
Physiologic Mechanisms with Acute Stress
Chronic Psychosocial Stress
Socioeconomic Status
Job Stress
Stress of Caregiving
Traumatic Stress
Social Support
Psychological Distress
Depression
Anxiety
Vital Exhaustion
Physiological Mechanisms with Chronic Stress
Summary and Conclusions
References
37 Catecholamines and Catecholamine Receptors in Cardiovascular Behavioral Medicine
Cardiovascular Epidemiology
Stress Studies in Behavioral Medicine
Issues Pertaining to Catecholamines in Plasma, Urine, and Gut Samples
Catecholamine Assay Techniques
Radioenzymatic Assays
High-Performance Liquid Chromatography (HPLC)
Immunoassays
Assay Summary and Other Relevant Methodological Considerations
Catecholamine Kinetics and Adrenergic Receptor Assays
Catecholamine Kinetics
Adrenergic Receptors
Acute Stress Studies and Catecholamine Sampling
The SNS and Genomics
Summary
References
38 The Assessment of Autonomic Influences on the Heart Using Impedance Cardiography and Heart Rate Variability
Autonomic Balance and Health
Aspects of Cardiac Function: Chronotropy, Inotropy, and Dromotropy
The Baroreflex
Impedance Cardiography
The Genetics of Impedance-Derived Measures
Summary
Heart Rate Variability
Physiological Regulation
Emotional Regulation
Cognitive Regulation
Models of Neural Control of HRV
The Polyvagal Theory
The Model of Neurovisceral Integration
Measures of HRV
Time-Domain Indices of HRV
Frequency Domain Indices of HRV
Commonly Asked Questions on the Use of HRV
The Genetics of HRV
Summary
Conclusion
References
39 Hypothalamic-Pituitary-Adrenal Axis
Hypothalamic-Pituitary-Adrenal Axis and Its Measures
Hormones of the HPA Axis: CRH, ACTH, and Cortisol
HPA Axis Functioning
HPA Axis Activity
HPA Axis Feedback Sensitivity
Glucocorticoid Sensitivity of Target Tissues in the Periphery
HPA Reactivity to Acute Psychosocial Stress
HPA Axis and Allostatic Load
The HPA Axis in Cardiovascular Disease (CVD)
Altered HPA Axis Functioning and Stress Reactivity in Essential Hypertension
HPA Axis Activity and Feedback Sensitivity
Glucocorticoid Sensitivity of Target Tissues in the Periphery
Stress Reactivity
HPA Axis in Patients with CVD
HPA Axis in Cardiovascular Patients: Cross-Sectional Findings
HPA Axis and New Onset of CVD
Exogenous Glucocorticoid Administration
Endogenous Cortisol
HPA Axis and Progression of Cardiovascular Disease
Urinary Cortisol
Salivary Circadian Cortisol Measures
HPA Axis Feedback Sensitivity
Stress Reactivity
Potential Impact of Psychological Risk Factors for CVD on HPA Axis Measures in CVD Patients
Type D Personality
Depression
Hostility
Exhaustion
Potential Mechanisms Underlying Associations Between Heightened CVD Risk with HPA Axis Alterations
Direct Influences: Potential Modulation of the Disease Process by the HPA Axis
Indirect Influences: Cortisol Excess Elevates Biological Risk Factors for CVD
Conclusions
References
40 Ambulatory Monitoring and Ecological Momentary Assessment
Ambulatory Blood Pressure (ABP)
Epidemiological Evidence
Sociodemographic, Psychological, and Behavioral Correlates of Ambulatory Blood Pressure
Measurement Issues
Oscillometric Vs. Auscultatory Devices
Cuff Sizing
Validation Procedures
Ambulatory Cortisol Assessment
Epidemiological Evidence
Sociodemographic, Psychological, and Behavioral Correlates
Measurement Issues
Sampling
Compliance
Moderators and Confounds
Analysis and Reporting
Interpretation
Ambulatory Self-Report Assessment
Epidemiological Evidence
Sociodemographic, Psychological, and Behavioral Correlates
Measurement Issues
Sampling
Psychometric Characteristics
Measurement Reactivity
Compliance
Future Directions
New Environmental Sampling Techniques
Global Positioning System Monitoring
Monitoring of Circadian-Related Light Exposures
New Developments in Ambulatory Biological Measures
Interstitial Fluid Assessment
Wearable Computer Systems
New Bioassay Approaches
New Developments in Ambulatory Self-Report Assessment
Computer Adaptive Testing
Context-Sensitive Assessment
References
41 Cardiovascular Reactivity and Risk for Cardiovascular Disease
Definitions and Methodological Issues
The First Published Reactivity Study
A Trait Conceptualization of Cardiovascular Reactivity
Cardiovascular Responses to Mental Stress
Active Coping and Passive Coping Stressors
Stability of Cardiovascular Reactivity Within Persons Over Time
Do Cardiovascular Stress Responses Generalize to the Natural Environment?
Evidence for CVR as a Predictor of Future HTN and Cardiovascular Disease: Cross-Sectional Studies of CVR and HTN in Adults
Prospective Studies
CVR and Future HTN in Adults
Prospective Studies of CVR and Future Elevated BP in Children
Prospective Studies of CVR and the Prediction of Subclinical and Clinical Endpoints
Prediction of Left Ventricular Mass (LVM)
Prediction of Carotid Atherosclerosis/Coronary Calcification
Prediction of Clinical CVD or Its Progression
Predictors/Determinants of CVR
Genetic, Constitutional, Personality, and Situational Effects on CVR
Effects of Family History of HTN
Twin Studies
Effects of Age
Effects of Sex
Menopause
Menstrual Cycle
Race
Hostility
Social Support
New Developments
Limitations of the Reactivity Hypothesis
Summary
Future Studies
Measurement Studies
Generalizability Studies
Relations Among Predictors
Cross-Sectional Relationships Between Risk Factor and Disease
Prospective Studies
Conceptual Studies
Summary
Procedural Framework for the Conduct of CVR Studies
The Laboratory Setting May Have Powerful, Unintended Effects
Experimenter Characteristics
Experimenter Behavior
Demand Characteristics
Experimenter Expectancies
Between-Subject and Within-Subject Designs
Use of Multiple Stressors Within a Single Session
Inter-task Baseline
Sampling Framework
Presession Instructions and Controls
The Experimental Session
Adaptation
Baseline
Reactive Measures
Exposure to Stress
Selection of the Stressor
Validity
Feasibility
Psychometric Properties
Usage
Stressor/Task Domains and Specific Tasks
Active and Passive Coping
Emotional Arousal
Social Interaction Tasks: Speech Tasks
The Trier Social Stress Test (TSST)
The Cold Pressor
Duration of Stressor Exposure
Manipulation Checks/Probe Measures
Statistical/Measurement Issues
Measurement Reliability
Type I Error
Assessment of Post-stress Recovery
Summary
References
42 Neuroimaging and the Study of Cardiovascular Stress Reactivity
Stress Reactivity in Behavioral Medicine Research
Cardiovascular Stress Reactivity: A Brief Background
Example Applications of Neuroimaging Methods in Stress Reactivity Research
Neuroimaging Methods Commonly Used in Stress Reactivity Research
Laboratory Tasks and Cardiovascular Measurements Used in Neuroimaging Studies of Stress Reactivity
Functional Neuroimaging of Stressor-Evoked Cardiovascular Reactivity
The Brain as a Target of Peripheral Physiology
Studies of Stressor-Evoked Neuroendocrine Reactivity
Studies of Stressor-Evoked Inflammatory Reactivity
Neuroimaging, Stress Reactivity, and Health-Relevant Outcomes
Summary and Future Directions
References
43 Asymmetric Innervation of the Heart
Psychological and Social Factors in Stress-Induced Arrhythmia
Asymmetric Autonomic Innervation of the Heart
Brain Effects on the Heart
Evidence for Brainstem and Subcortical Influences on Arrhythmogenesis
Cortical Influences on Arrhythmogenesis
Role of the Amygdala
Lateralized Feedback from an Abnormal Heart
Discussion
References
Section III: Biopsychosocial Factors in Cardiovascular Disease, Its Treatments, and Comorbidities
44 Biopsychosocial Factors in Coronary Artery Disease
Psychosocial Epidemiology of Coronary Artery Disease
Pathophysiology of CAD
Atherosclerosis and CAD
Hyperlipidemia and Endothelial Dysfunction in ATH
Oxidative Stress and Inflammation in ATH
Behavioral and Psychosocial Factors in ATH and CAD
Social Environment, ATH, and CAD in Animal Models
Psychosocial Stress and Endothelial Dysfunction in Humans and Animals
Biopsychosocial Factors That May Attenuate ATH and CAD
Role of Oxytocin in Disease Attenuation
Human Psychosocial-Behavioral Interventions After Major Adverse Coronary Events
Summary
References
45 Chest Pain: Cardiac and Non-Cardiac
Angina Pectoris
History
Psychological Influences
Ischemic Silence/``Noisiness´´ and Putative Causes
Risk of Coronary Heart Disease and the ``Open Artery´´ Hypothesis
Anxiety, Depression, and Anger
Noncardiac Chest Pain (NCCP)
History
Alternative Theories
Emotional Distress
Biopsychosocial Mechanisms
References
46 Mental Stress-Induced Myocardial Ischemia: Prevalence, Clinical Significance, and Treatment Implications
Transient Myocardial Ischemia During Daily Life
Mental Stress-Induced Myocardial Ischemia in the Laboratory
Tasks to Assess Mental Stress Ischemia
Clinical Characteristics of Patients with Mental Stress-Induced Ischemia
Mechanisms of Mental Stress-Induced Myocardial Ischemia
Clinical Significance of Mental Stress-Induced Myocardial Ischemia
Biobehavioral Interventions in the Treatment of Mental Stress-Induced Myocardial Ischemia
Conclusions
References
47 Acute Behavioral and Psychosocial Triggers of Myocardial Infarction
Pathophysiology of MI
The Role of External Triggers in the Pathophysiology of MI
Methodological Issues in Studying Triggers
Acute Versus Chronic Events
Behavioral Triggers of Acute MI
Physical Exertion
Sexual Activity
Alcohol Consumption
Cigarette Smoking
Marijuana and Cocaine Use
Disturbed Sleep
Summary of Behavioral Triggers
Psychosocial and Emotional Triggers of Acute Myocardial Infarction
Environmental Stress
Natural Disasters
Sporting Events
War
Summary of Environmental Stressors
Psychosocial Stress
Emotional Distress
Bereavement
Work Stress
Anger
Summary
Discussion
Methodological Considerations
Use of Case-Crossover and Case-Control Design Methodology
Other Issues
Summary
References
48 Cardiac Arrhythmias and Sudden Cardiac Death
Pathophysiology of Ventricular Arrhythmia and Sudden Cardiac Death
Epidemiology
Diseases with Possible Applicability to Psychosocial Predictors/Triggers
Research Methods Applied to Arrhythmia and Psychosocial Factors
Ambulatory ECG Monitoring
Laboratory Analogue Studies
Other Arrhythmia Syndromes Associated with Psychosocial Risk Factors
Stress Cardiomyopathy
Long QT Syndrome (LQTS)
Atrial Fibrillation (AF)
Psychosocial Predictors of Arrhythmia: Clinical Studies
Studies of Ventricular Arrhythmia: Anxiety and Depression
Studies in ICD Cohorts
Behavioral Interventions
Conclusions
References
49 Behavioral Medicine Treatments for Heart Failure
Pathophysiology and Classification of Heart Failure
Etiology of Heart Failure
Coronary Artery Disease and Myocardial Infarction
Hypertension
Damaged Heart Valves
Cardiomyopathy
Heart Arrhythmias
Tests for Diagnosing HF
Echocardiogram
Chest X-Ray
Electrocardiogram (ECG)
Other Imaging Modalities
Blood Tests
Natriuretic Peptides
Diagnostic, Risk Assessment, and Prognostic Value of BNP
Natriuretic Peptides for Screening and Early Intervention
Markers of Cardiac Damage, Remodeling, and Inflammation
Troponins
Markers of Extracellular Matrix Remodeling
Markers of Inflammation
Drug Treatment of Heart Failure
Angiotensin-Converting Enzyme (ACE) Inhibitors
Beta-blockers
Angiotensin Receptor-Neprilysin Inhibitor (ARNI)
Digoxin
Diuretics
Medical Devices and Transplant Surgery
Implantable Cardioverter-Defibrillator (ICD)
Cardiac Resynchronization Therapy (CRT) or Biventricular Pacing
Heart Transplant
Behavioral and Psychosocial Risk Factors for Heart Failure
Medical Risk Factors with Behavioral Components
Diabetes
Sleep Apnea
Hypertension
Behavioral Risk Factors for HF
Alcohol Abuse
Amphetamine and Cocaine Abuse
Obesity
Lifestyle Factors: Exercise, Diet, and Smoking
Psychosocial Factors Associated with HF
Social Support
Depression
Positive Psychological Factors
Underlying Biological Mechanisms of Depression and HF
Relationship Between Cell Mobilization Factors and BDI Depression Ratings over Time
PBMC Chemotaxis to a Bacterial Peptide and Chemokine in HF with Depression
PBMC Chemotaxis to a ß-Adrenergic Agonist in HF with Depression
Psychosocial and Behavioral Interventions
Lifestyle Interventions
Adherence Management Interventions for HF and Telehealth
Meditation/Gratitude Journaling/Stress Reduction
Standard Exercise in HF
Tai Chi and HF
Summary and Conclusions
References
50 Stroke and Carotid Artery Disease
Disease Pathophysiology
Pathophysiology of Stroke
Pathophysiology of Carotid Artery Disease
Epidemiologic Data
Epidemiology of Stroke
Epidemiology of Carotid Artery Disease
Traditional Risk Factors for Stroke and Carotid Artery Disease
Biopsychosocial and Socioecological Approaches to Understanding Stroke Risk
Psychosocial Factors Related to Stroke and Carotid Artery Disease
Depression, Stroke Risk, and Carotid Artery Disease
Stress, Risk for Stroke, and Carotid IMT
Anger/Hostility, Stroke Risk, and Carotid IMT
Psychosocial Factors and Racial Disparities in Stroke
Biologic Mechanisms Linking Psychosocial Factors, Stroke, and Atherosclerotic Vascular Disease
Future Directions
Investigating Interrelationships Among Multiple Risk Factors
Investigate the Influences of Upstream Factors
Examine Factors That Contribute to Race/Ethnicity and Gender Differences in Stroke Risk and Carotid Artery Disease
Develop Behavioral Medicine Interventions That are Culturally Sensitive and Community-Based
Summary
References
51 Congenital Heart Disease
Children and Adolescents with Congenital Heart Disease
Neurodevelopmental Issues
Psychological Functioning
Social Functioning
Transition from Pediatric to Adult Cardiac Care
Issues Related to Transfer of Pediatric to Adult HealthCare for CHD
Patient Education
Parent Education
Adults with Congenital Heart Disease
Neurocognitive Considerations
Psychological Functioning of Adults with CHD
Social Functioning
Psychological Interventions in Adults with Congenital Heart Disease
Conclusion
References
52 Coronary Artery Bypass Grafting: Psychosocial Dimensions of a Surgical Procedure
CABG: Indications, Procedures, and Referral
CABG as a Crisis: Psychological and Physical Stress Effects
The CABG Patient Experience and Outcomes
The Presurgical Period
Psychological Preparation for CABG
The Postsurgical Hospital Stay
Psychological Aspects of Recovery
The Post-discharge Period
Psychological Influences Following Hospitalization
Long-Term Disease Management
Post-discharge Status and Secondary Prevention
Psychological Interventions for CABG Patients
Presurgical Intervention
In-Hospital Intervention
Post-discharge Intervention
Home-Based Nursing
Telehealth
Cardiac Rehabilitation
Treatments for Depression
Conclusions
References
53 Heart Transplantation
Natural History of the Heart Transplant Experience
Psychiatric Issues in Transplant Patients
Depression
Depression in Pre-Transplant Patients
Depression in Post-Transplant Patients
Anxiety
Anxiety Symptoms in Pre-Transplant Patients
Anxiety in Post-Transplant Patients
Other Psychiatric Issues
Ventricular Assist Devices
Psychiatric Effects of Post-Transplant Immunosuppressants
Calcineurin Inhibitors
Corticosteroids
Psychological Implications of Internalizing a New Organ
Psychiatric Assessment in Transplant
Pre-Transplant: Psychiatric Assessment of Transplant Candidates
Treatment Adherence and Non-adherence
Assessment of Adherence
Predictors of Non-adherence
Interventions
References
54 Measuring Behavioral Outcomes in Cardiac Rehabilitation
AACVPR Outcomes Matrix
Medication Adherence
Supplemental Oxygen Usage
Tobacco Use and Smoking Cessation
Nutritional Assessment
Individual Participant
Group of Participants
Attendance Rate
Individual Participant
Group of Participants
Cardiac Disease Knowledge Score
Individual Participant
Group of Participants
Exercise Compliance
Individual Patient
Group of Participants
Conclusion
References
55 The Psychological Treatment of Cardiac Patients
The Nature of the Problem
Cardiac Rehabilitation: Targets for Psychological Intervention
Depression
Anxiety
Personality Factors
Stress
Social Support
The Nature of Psychological Interventions for Cardiac Patients
Research on the Efficacy of Psychological Interventions
How Well Do Psychological Interventions Work?
Factors Influencing Participation in Cardiac Rehabilitation
Sex Differences in Participation and Outcomes of Cardiac Rehabilitation
Conclusions and Recommendations for Clinical Practice
Conclusion
References
56 Quality of Life and Subjective Health: Strengthening the Subjective Perspective in Cardiology
Historical Background
Concepts of Quality of Life
Assessment of Quality of Life
General Principles, Psychometric and Cultural Considerations
Generic Instruments
Generic Scales Developed in Non-English Languages and Cultural Aspects
Disease-Specific Instruments
Utility Indices/Quality-Adjusted Life Years
Quality of Life in Cardiac Patients
Quality of Life in Different Cardiac Disease Entities and Functional States
Effects of Cardiac Interventions on Quality of Life
Association of Psychosocial Factors with Quality of Life in Heart Disease
Quality of Life as Prognostic Indicator
Summary and Implications for Patient Care and Research
References
57 Cardiovascular Disease and Cognitive Function
Cardiovascular Risk Factors and Neurocognitive Function
Blood Pressure and Hypertension
Lipids
Body Mass Index and Obesity
Glucose Parameters and Diabetes
Inflammation
Behavioral, Psychosocial, and Psychophysiological Risk Factors
Summary
Cardiovascular Diseases and Neurocognitive Function
Cardiac Arrhythmias and Cardiac Arrest
Subclinical Cardiovascular Disease
Atherosclerosis
Arterial Stiffness
Endothelial Dysfunction
Left Ventricular Hypertrophy
Subclinical Vascular Disease Mechanisms
Coronary Heart Disease (CHD)
Peripheral Arterial Disease
Heart Failure
Summary
Discussion
References
58 Diabetes and Cardiovascular Disease
Overview of Diabetes Mellitus
Classification of Diabetes
Prevalence
Incidence
Behavioral Risk Factors and Prevention of Type 2 Diabetes
Cardiovascular Disease in Persons with Diabetes
Epidemiology
Pathophysiology
Insulin Resistance and the Prediabetic State
Dyslipidemia
Hypertension
Hyperglycemia
Other Effects of Diabetes on the Cardiovascular System
Management of Diabetes and Cardiovascular Risk
Conclusion
References
59 HIV-1 Spectrum Disease, Psychological Distress, and Cardiometabolic Risk
Overview of HIV Spectrum Disease
HIV Pharmacotherapy
Psychological Factors and HIV Disease Severity
Cardiovascular Structural and Functional Complications in HIV/AIDS
Subclinical Cardiometabolic Complications in Adults
Subclinical Cardiometabolic Complications in Children and Adolescents
Inflammation and Oxidative Stress as Mediators of Subclinical Mechanisms
Conclusion
References
Section IV: Statistical Modeling and Ethics in Cardiovascular Behavioral Medicine
60 Measuring Change
Intention to Treat
Antiquated Methods
Exposition by Example
Ordinary Multivariable Regression
Mixed-Effects Regression
Time-Invariant Versus Time-Varying Measures
Measuring Time
Centering
Illustrations
Results from Paired T-Test Compared with Mixed-Effects Regression
Change in MAP
Differences in Change in MAP Between Sexes
Differences in Rates of Change in MAP by Sex
Differences in Change in MAP by Time-Invariant and Time-Varying Covariates
Change in a Dichotomous Measure
Change in a Dichotomous Measure by Some Fixed and Time-Varying Measures
Data Organization
Full Disclosure
Final Word
References
61 Confounding, Mediation, Moderation, and General Considerations in Regression Modeling
What is a Model and Why Use One?
Models and Causation
Confounding
Causal Graphs
Including Variables to Increase Precision
Mediation
Total, Direct, and Indirect Effects
Why Mediation?
Causal Knowledge as a Prerequisite for Mediation
How to Analyze Mediation
Adjustment for Path-Specific Confounding
Measurement Error
No Interaction Between Exposure and Mediator
Decomposition of Total Effects and Indirect Effects
Mediation and Interaction
Interactions and Moderation
The Assumption of Homogeneity
Modeling Heterogeneity: Test Interactions, Not Within Groups
An Important Aside: Preserve Measurement Information Wherever Possible
Some Additional Considerations on Regression Models
Sample Size in Multivariable Models
Reducing the Degrees of Freedom in a Model
Summary
References
62 Systematic Reviews and Meta-analysis in Behavioral Medicine
Narrative Reviews
Systematic Reviews and Meta-analysis
Correcting for Deficiencies in Narrative Reviews
Conducting Systematic Reviews and Meta-analyses
Ensuring Quality of Systematic Reviews and Meta-analysis
Meta-analysis Versus Systematic Reviews
Limitations to Systematic Reviews and Meta-analysis
Limitations of Systematic Reviews
Limitations of Meta-analysis
Conclusion
References
63 Ethical Issues in Cardiovascular Behavioral Medicine Research
Unanticipated Problems Involving Risks to Subjects or Others
Case Study No. 1
Incidental Findings
Case Study No. 2
Students as Research Subjects
Case Study No. 3A
Case Study No. 3B
Informed Consent for Decisionally Impaired Populations
Case Study No. 4
Therapeutic Misconception in Cardiovascular Behavioral Medicine
Future Directions
References
Index