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Behavioral cardiology --has its time finally arrived?
Thomas Pickering1, Lynn Clemow, Karina Davidson
1Zena and Michael A Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.
Insights
Behavioral cardiology reveals heart disease stems from lifestyle and stress, not just genetics. Behavioral treatments can modify these factors, though patient compliance and healthcare system barriers exist.
Area of Science:
- Cardiology
- Behavioral Science
- Public Health
Background:
- Traditional cardiology focuses on mechanistic causes of heart disease.
- Behavioral cardiology proposes that lifestyle and psychosocial factors significantly contribute to cardiovascular disease development.
- Unhealthy lifestyles (smoking, overeating, inactivity) and psychosocial stressors (anxiety, anger, social isolation) are key risk factors.
Purpose of the Study:
- To highlight the shift from a mechanistic to a broader, behavioral approach in understanding heart disease.
- To emphasize the role of lifestyle and psychosocial factors in cardiovascular disease and obesity.
- To introduce behavioral treatment as a method to alter these risk factors.
Main Methods:
- Review of traditional and behavioral cardiology approaches.
- Identification of lifestyle factors (physical inactivity, caloric intake) contributing to obesity and diabetes.
- Analysis of psychosocial stressors implicated in cardiovascular disease (occupational stress, hostility, anger, Type A behavior).
Main Results:
- Heart disease is largely preventable through modification of lifestyle and psychosocial factors.
- Obesity and diabetes prevalence are increasing due to inactivity and overeating, potentially reversing declines in cardiovascular deaths.
- Psychosocial stressors significantly impact cardiovascular health.
Conclusions:
- Behavioral cardiology offers a comprehensive view of heart disease etiology.
- Behavioral treatments, involving patient-practitioner collaboration, can modify risk factors.
- Barriers to effective behavioral treatment include patient non-compliance, provider skill deficits, and systemic healthcare issues like reimbursement.
Abstract:
Traditional cardiology has taken a mechanistic approach to heart disease. But the new discipline of behavioral cardiology takes a broader view, concluding that heart disease is not inevitable, but develops largely from unhealthy lifestyles, such as smoking, overeating and physical inactivity, and from psychosocial stress. Physical inactivity and excessive caloric intake are also responsible for the epidemic of obesity, which is associated with a dramatic increase in the prevalence of diabetes. This increase in the incidence of diabetes may, in turn, reverse the recent decline of cardiovascular deaths in the US. A variety of psychosocial stressors have been implicated in the development of cardiovascular disease. These include occupational stress, anxiety, social isolation, hostility, anger, and type A behavior. There is clearly some overlap between these stressors, all of which may affect the heart adversely. Both the lifestyle and psychosocial factors can be altered by behavioral treatment, in which the patient and the practitioner work together. Unfortunately, various barriers can impair the successful implementation of behavioral treatment. These barriers include poor compliance by the patient, lack of skill in providing effective interventions by the health care provider, and lack of incentives within the health care system, particularly reimbursement.
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