The epidemiology, pathophysiology and management of psychosocial risk factors in cardiac practice - The emerging field of behavioral cardiology

被引:842
作者
Rozanski, A
Blumenthal, JA
Davidson, KW
Saab, PG
Kubzansky, L
机构
[1] St Lukes Roosevelt Hosp, Div Cardiol, New York, NY 10025 USA
[2] Columbia Univ, Coll Phys & Surg, Dept Med, New York, NY USA
[3] Duke Univ, Med Ctr, Dept Psychiat & Behav Sci, Durham, NC USA
[4] Columbia Coll Phys & Surg, Div Gen Med, New York, NY USA
[5] Mt Sinai Sch Med, Cardiovasc Inst, New York, NY USA
[6] Univ Miami, Dept Psychol, Coral Gables, FL 33124 USA
[7] Harvard Univ, Sch Publ Hlth, Dept SocHuman Dev & Hlth, Boston, MA 02115 USA
关键词
D O I
10.1016/j.jacc.2004.12.005
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Observational studies indicate that psychologic factors strongly influence the course of coronary artery disease (CAD). In this review, we examine new epidemiologic evidence for the association between psychosocial risk factors and CAD, identify pathologic mechanisms that may be responsible for this association, and describe a paradigm for studying positive psychologic factors that may act as a buffer. Because psychosocial risk factors are highly prevalent and are associated with unhealthy lifestyles, we describe the potential role of cardiologists in managing such factors. Management approaches include routinely screening for psychosocial risk factors, referring patients with severe psychologic distress to behavioral specialists, and directly treating patients with milder forms of psychologic distress with brief targeted interventions. A number of behavioral interventions have been evaluated for their ability to reduce adverse cardiac events among patients presenting with psychosocial risk factors. Although the efficacy of stand-alone psychosocial interventions remains unclear, both exercise and multifictorial cardiac rehabilitation with psychosocial interventions have demonstrated a reduction in cardiac events. Furthermore, recent data suggest that psychopharmacologic interventions may also be effective. Despite these promising findings, clinical practice guidelines for managing psychosocial risk factors in cardiac practice are lacking. Thus, we review new approaches to improve the delivery of behavioral services and patient adherence to behavioral recommendations. These efforts are part of an emerging field of behavioral cardiology, which is based on the understanding that psychosocial and behavioral risk factors for CAD are not only highly interrelated, but also require a sophisticated health care delivery system to optimize their effectiveness. (C) 2005 by the American College of Cardiology Foundation.
引用
收藏
页码:637 / 651
页数:15
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