Difficulty: Intermediate | Prerequisites: Familiarity with basic anatomy (cardiovascular system), stress physiology, and behavioural health concepts from earlier PSY 320 lectures.
This lecture covers the major chronic conditions where psychology intersects with cardiovascular and metabolic health. Coronary heart disease (CHD), hypertension, stroke and Type 2 diabetes are all conditions where stress, personality, behaviour and social support play measurable roles in onset, progression and recovery. You should already be comfortable with the basics of the stress response (HPA axis, sympathetic activation) and the biopsychosocial model. If those feel shaky, revisit Lectures 6 and 8 before diving in here.
CHD results from atherosclerosis and is worsened by stress, hostility, depression and metabolic syndrome. Hypertension is largely symptomless, driven by unknown causes in 90% of cases, and best managed with a combination of medication and cognitive-behavioural techniques. Stroke disrupts blood flow to the brain and requires neurorehabilitation. Type 2 diabetes is stress-sensitive and responds well to lifestyle intervention, dietary changes and cognitive-behavioural approaches alongside medication.
Coronary heart disease (CHD)
The narrowing of the coronary arteries caused by atherosclerosis, reducing blood flow to the heart muscle. In simple terms, plaque builds up inside the arteries that feed the heart, and over time the heart gets less blood than it needs.
Atherosclerosis
A condition in which fatty deposits (plaques) accumulate on the inner walls of arteries, causing them to harden and narrow. Think of it as a slow clogging of the pipes that carry blood.
Metabolic syndrome
A cluster of conditions, including central obesity, high blood pressure, low HDL cholesterol, high triglycerides and impaired blood sugar metabolism, that together predict elevated risk for heart attack. In simple terms, it is a collection of warning signs that your cardiovascular and metabolic systems are under strain.
Cardiac invalidism
A pattern in which patients and their spouses perceive the patient's physical abilities as lower than they are following a myocardial infarction. Think of it as an overestimation of disability after a heart event.
Myocardial infarction (MI)
A heart attack, occurring when blood flow to part of the heart muscle is blocked long enough to cause tissue damage.
Coronary artery bypass graft (CABG)
A surgical procedure that reroutes blood flow around blocked coronary arteries using a graft vessel. Think of it as building a detour road around a blocked motorway.
Hypertension
Chronically elevated blood pressure, measured by systolic and diastolic readings, that acts as a risk factor for heart disease, kidney failure and cognitive impairment. In simple terms, the force of blood pushing against artery walls is consistently too high.
John Henryism
A personality disposition to cope actively with psychosocial stressors, particularly relevant to understanding hypertension among African Americans facing racial discrimination and low socioeconomic status.
Stroke (cerebrovascular accident)
A disturbance in blood flow to the brain, caused by either an interruption (ischaemic stroke) or a haemorrhage (cerebral haemorrhage), resulting in motor, cognitive or emotional problems.
Neurorehabilitation
The process of rewiring the brain following stroke so that unaffected areas take on functions previously handled by damaged regions.
Type 2 diabetes
A metabolic condition in which the body becomes resistant to insulin or does not produce enough, leading to chronically elevated blood sugar. It is sensitive to stress and responsive to lifestyle changes.
High cholesterol
High blood pressure
Elevated levels of inflammation
Diabetes
Cigarette smoking
Obesity
Lack of exercise
Metabolic syndrome is a diagnostic cluster that helps predict heart attacks. A person is diagnosed when they present with obesity centred around the waist, high blood pressure, low levels of HDL cholesterol, difficulty metabolising blood sugar and high levels of triglycerides.
Stress reactivity plays a direct role in CHD development. The cumulative effects of repeated stress responses lead to damage of the endothelial cells lining the blood vessels. This damage is reflected in a prolonged cardiovascular recovery period after stressful events.
Both chronic and acute stress are linked to CHD and adverse clinical events
Stress interacts with genetic factors to increase the likelihood of CHD
Stress is associated with increased inflammatory activity
CHD is the leading cause of death in women in developed nations. Oestrogen has a protective effect, reducing sympathetic nervous system arousal and lowering the incidence of high blood pressure and neuroendocrine and metabolic responses. After menopause, when oestrogen levels decline, women's risk increases substantially.
Negative emotions increase risk for both metabolic syndrome and CHD. Hostility can develop from insecure and negative feelings, poor child-rearing practices, adverse family environments and genetic factors.
Hostile emotions are linked with higher incidence of CHD, interpersonal conflicts and reduced social support
Hostile emotions are a social manifestation of cardiovascular reactivity
Hostile individuals show a weak antagonistic response to sympathetic activity and larger, longer-lasting blood pressure responses
Depression affects the development, progression and mortality from CHD. It is linked to risk factors including metabolic syndrome, inflammation, likelihood of heart attack, and heart failure among the elderly. Depression is also associated with higher mortality after coronary artery bypass graft surgery.
Delay in seeking treatment is one of the main reasons for high mortality and disability following heart attacks.
Initial treatment:
CABG surgery to treat blockage of major arteries
Close monitoring following myocardial infarction (MI)
Anxiety predicts complications during the hospital phase, including reinfarction and recurrent ischaemia
Cardiac rehabilitation aims to help patients attain their optimal physical, medical, psychological, social, emotional, vocational and economic status.
Medication:
Beta-adrenergic blocking agents (self-administered)
Aspirin, prescribed for people recovering from or at risk for heart attacks
Statins, prescribed following an acute coronary event
Dietary instructions and exercise programmes
Stress management: Patients are taught to recognise stressful situations and either avoid or manage stress.
Targeting depression: Cognitive-behavioural therapy is used.
Social support:
Predicts exercise tolerance
Targeted for intervention during recovery
Can be problematic: primary relationships are threatened, lifestyle changes can increase marital strife
Cardiac invalidism is a common consequence of MI, where both patients and spouses underestimate the patient's abilities
Evaluation of cardiac rehabilitation:
Interventions targeting weight, blood pressure, smoking and quality of life reduce heart disease risk
Psychosocial treatments should be added to standard cardiac rehabilitation programmes
Hypertension is a form of cardiovascular disease (CVD) that occurs when the supply of blood through the vessels is excessive, either because cardiac output is too high or in response to peripheral resistance. It is measured by systolic and diastolic blood pressure levels.
Hypertension is a risk factor for heart disease and kidney failure, and can affect cognitive functioning if left untreated.
90% of cases are of unknown origin (essential hypertension)
5% are caused by kidney failure
5% result from a combination of other factors
Childhood temperament and blood pressure
Stress reactivity
Gender
Genetic factors
Emotional factors
Family environment
Stress
Hypertension is disproportionately prevalent among African Americans, tied to the stress of racial discrimination and low socioeconomic status (SES). Contributing factors include hereditary predisposition, lower income, and obesity. John Henryism describes a personality disposition to cope actively with psychosocial stressors, which may contribute to sustained physiological arousal.
Lifestyle and pharmacological approaches:
Drug treatments
Low-sodium diet
Reduction of alcohol
Weight reduction in overweight patients
Exercise
Caffeine restriction
Cognitive-behavioural treatments:
Biofeedback
Progressive muscle relaxation
Hypnosis
Meditation
Deep breathing and imagery
Anger management
Cognitive-behavioural interventions can reduce drug requirements. The best approach to managing hypertension is a combination of cognitive-behavioural techniques and medication.
Hypertension is often called the "silent killer" because it is symptomless. Diagnosis typically occurs incidentally during medical examinations, which means many people live with it unaware.
Stroke results from a disturbance in blood flow to the brain, caused either by interrupted blood flow to localised areas (ischaemic stroke) or by cerebral haemorrhage.
Motor problems
Cognitive problems
Emotional problems
Medication
Psychotherapy
Cognitive remedial training
Movement therapies
Use of structured, stimulating environments to challenge the patient's capabilities
Neurorehabilitation: rewiring the brain so that areas unaffected by the stroke take on the functions of the damaged region
Type 2 diabetes is sensitive to the effects of stress. Self-management is the cornerstone of treatment.
Dietary intervention: reduce sugar and carbohydrate intake
Patients are encouraged to achieve normal weight
Exercise improves adherence to treatment
Weight control improves glycaemic control
Self-management and problem-solving skills training
Social skills training
Behaviour modification
Pharmacological therapy alongside behavioural approaches
Lifestyle intervention combined with medication can greatly reduce the incidence of diabetes.
Students often think hypertension has noticeable symptoms. It does not. It is called the "silent killer" for this reason, and most cases are discovered incidentally during medical exams.
Students sometimes assume CHD is primarily a men's disease. It is the leading cause of death in women in developed nations; the protective effect of oestrogen delays onset, but risk climbs after menopause.
Students confuse metabolic syndrome with a single disease. It is a cluster of conditions (central obesity, high blood pressure, low HDL, high triglycerides, impaired blood sugar metabolism) that together predict elevated cardiovascular risk.
Students often underestimate the role of psychological factors in cardiac rehabilitation. Social support, depression treatment and stress management are all directly relevant to recovery outcomes, not supplementary nice-to-haves.
Know the five diagnostic criteria for metabolic syndrome and how it predicts heart attacks
Understand the link between hostility, cardiovascular reactivity and CHD (personality as a risk factor)
Be able to explain cardiac invalidism and why it matters for recovery
Know that 90% of hypertension cases are of unknown origin
Understand John Henryism and its relevance to hypertension among African Americans
Be clear on why the best approach to hypertension management is a combination of cognitive-behavioural techniques and drugs
Know the three main consequences of stroke (motor, cognitive, emotional) and the concept of neurorehabilitation
Understand why lifestyle intervention plus medication is the recommended approach for Type 2 diabetes
True or False: Hypertension usually presents with obvious symptoms such as headaches and dizziness.
False. Hypertension is largely symptomless and is often called the "silent killer."
Fill in the blank: The five components of metabolic syndrome are central obesity, high blood pressure, low ______, difficulty metabolising blood sugar and high triglycerides.
HDL (high-density lipoprotein)
True or False: Oestrogen increases women's risk of CHD.
False. Oestrogen is protective; risk increases after menopause when oestrogen declines.
Fill in the blank: ______ is the term for when patients and spouses underestimate the patient's abilities after a heart attack.
Cardiac invalidism
True or False: The best approach to managing hypertension is cognitive-behavioural techniques alone, without medication.
False. The best approach is a combination of cognitive-behavioural techniques and drugs.
Q: What is metabolic syndrome, and why is it clinically significant?
A: Metabolic syndrome is a cluster of conditions, including central obesity, high blood pressure, low HDL cholesterol, difficulty metabolising blood sugar and high triglycerides. It is clinically significant because its presence helps predict heart attacks.
Q: How does depression affect coronary heart disease?
A: Depression affects the development, progression and mortality from CHD. It is linked to risk factors for CHD itself, metabolic syndrome, inflammation, likelihood of heart attack, heart failure in the elderly, and mortality after CABG surgery.
Q: What is cardiac invalidism?
A: A pattern following myocardial infarction in which patients and their spouses perceive the patient's physical abilities as lower than they are. It is a consequence of MI that can hinder recovery.
Q: Why is hypertension described as a "hidden disease"?
A: Because it is symptomless. Most people are unaware they have it until it is discovered during a routine medical examination.
Q: What is neurorehabilitation in the context of stroke recovery?
A: Neurorehabilitation is the process of rewiring the brain so that areas not affected by the stroke take on the functions that the damaged region previously handled.
Q: Name three cognitive-behavioural treatments used for hypertension.
A: Any three of: biofeedback, progressive muscle relaxation, hypnosis, meditation, deep breathing and imagery, anger management.
The stress-disease link here connects directly to earlier material on the HPA axis and sympathetic nervous system activation (Lectures 6 and 8). The role of social support in cardiac rehabilitation ties into broader themes about coping resources covered in psychosocial factors and health. Depression as a risk factor for CHD connects to Lecture 13's material on negative affect and immune functioning.
Coronary heart disease, CHD, atherosclerosis, metabolic syndrome, cardiovascular reactivity, hostility and heart disease, depression and CHD, cardiac invalidism, myocardial infarction, MI, CABG, coronary artery bypass graft, cardiac rehabilitation, beta-blockers, statins, hypertension, high blood pressure, silent killer, essential hypertension, John Henryism, African American health disparities, biofeedback, progressive muscle relaxation, stroke, cerebrovascular accident, neurorehabilitation, ischaemic stroke, cerebral haemorrhage, Type 2 diabetes, glycaemic control, insulin resistance, cognitive-behavioural interventions, PSY 320, health psychology