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Published on: January 15, 2022
Psychological and social factors in coronary heart disease
1Department of Psychosomatic Medicine and Psychotherapy, University of Cologne, Cologne, Germany. Christian.albus@uk-kolen.de
Insights
Psychosocial factors like stress and depression significantly increase coronary heart disease (CHD) risk and impact patient outcomes. Addressing these factors through interventions and therapy is crucial for managing CHD.
Area of Science:
- Cardiology
- Psychology
- Public Health
Background:
- Decades of research link psychosocial risk factors to coronary heart disease (CHD) development and prognosis.
- Factors include low socioeconomic status, lack of social support, stress, depression, anxiety, and hostility.
- These factors can impede treatment adherence and lifestyle modifications.
Purpose of the Study:
- To review the impact of psychosocial risk factors on coronary heart disease (CHD).
- To outline clinical assessment and management strategies for psychosocial risk in CHD patients.
- To discuss the role of psychobiological mechanisms in CHD pathogenesis.
Main Methods:
- Review of empirical research spanning over six decades.
- Identification of psychobiological mechanisms involved in CHD pathogenesis.
- Clinical practice recommendations for assessment and intervention.
Main Results:
- Psychosocial factors are established contributors to CHD risk and prognosis.
- These factors can act as barriers to effective treatment and lifestyle changes.
- Psychobiological mechanisms directly implicated in CHD pathogenesis have been identified.
Conclusions:
- Clinical assessment of psychosocial risk factors is essential for CHD patients.
- Multimodal behavioral interventions and psychotherapy/medication (SSRIs) are recommended for elevated risk and symptoms.
- While effective for emotional well-being, the direct impact of these interventions on cardiac endpoints requires further documentation.
Abstract:
More than six decades of empirical research have shown that psychosocial risk factors like low socio-economic status, lack of social support, stress at work and family life, depression, anxiety, and hostility contribute both to the risk of developing coronary heart disease (CHD) and the worsening of clinical course and prognosis in patients with CHD. These factors may act as barriers to treatment adherence and efforts to improve life-style in patients and populations. In addition, distinct psychobiological mechanisms have been identified, which are directly involved into the pathogenesis of CHD. In clinical practice, psychosocial risk factors should be assessed by clinical interview or standardized questionnaires, and relevance with respect to quality of life and medical outcome should be discussed with the patient. In case of elevated risk, multimodal, behavioural intervention, integrating counselling for psychosocial risk factors and coping with illness, should be prescribed. In case of clinically significant symptoms of depression and anxiety, patients should be referred for psychotherapy, and/or medication according to established standards (especially selective serotonin reuptake inhibitors (SSRIs)) should be prescribed. Psychotherapy and SSRIs appear to be safe and effective with respect to emotional disturbances; however, a definite beneficial effect on cardiac end-points has not been documented.
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