Difficulty: Intermediate | Prerequisites: Biopsychosocial model, basics of cardiovascular system
Heart disease is examined here through the health psychology lens: what psychological and cultural factors contribute to cardiovascular disease (CVD), how personality and stress interact with heart health, and what behavioural interventions can reduce risk. This is not a cardiology unit. The focus is on modifiable risk factors, cultural disparities in heart disease mortality, and the role of personality traits (hostility, depression) in coronary heart disease (CHD). You should already know the biopsychosocial model.
Heart disease is the number one killer of women and disproportionately affects African Americans. Risk factors split into non-modifiable (age, sex) and modifiable (blood pressure, cholesterol, diet, exercise, smoking). Personality factors like hostility and depression significantly increase CHD risk. Stress, especially in urban settings, is a major contributor. The Ornish programme (strict vegetarian diet, no alcohol or caffeine) has shown better outcomes than standard cardiologist recommendations alone.
Coronary heart disease (CHD)
Disease of the heart caused by narrowing or blockage of the coronary arteries. In simple terms, the blood vessels feeding the heart get clogged.
Cardiovascular disease (CVD)
A broader category covering all diseases of the heart and blood vessels, including CHD and stroke.
Non-modifiable risk factors
Risk factors you cannot change: age and sex.
Modifiable risk factors
Risk factors that can be changed through behaviour or treatment: high blood pressure, diabetes, high cholesterol, inactivity, obesity.
Control vs. constraint
Cultural beliefs about how much power an individual has over their own destiny versus believing everything is controlled by a higher power. This distinction affects health behaviours and willingness to take preventive action.
Neutral vs. affect cultures
Neutral cultures (e.g. Japan) do not promote open expression of emotion. Affect cultures (e.g. Italy) encourage emotional display. This shapes how patients express cardiac symptoms.
Ornish programme
A lifestyle intervention for heart disease involving a strict vegetarian diet with no alcohol or caffeine, plus stress management. Patients on this programme showed improvement, while those following standard cardiologist recommendations alone got worse.
African Americans are 2x as likely to die from heart disease
Southern US African Americans have the highest mortality rates
Death rates for whites, Native Americans, and Latinos fall in an intermediate range
Russia has high rates; Japan has low rates
Heart disease is the number one killer of women (1 in 3 deaths)
64% of women who die suddenly from heart disease had no prior symptoms
African American women are 2x as likely to have a stroke
49% of African American women aged 20+ have heart disease, but only 1 in 5 believe they are at risk
Hispanic women tend to develop heart disease 10 years earlier than non-Hispanic women
Personality:
Hostility: men who scored high on an anger trait had increased CHD risk
Depression: clinically significant depression increases CHD risk by 30-90%
Stress:
Urban dwellers are 9x more likely to develop CVD
Watching sports increases risk of CVD (acute stress response)
Cultural psychology:
Control vs. constraint: whether someone believes they can influence their own destiny versus seeing everything as controlled by a deity shapes how they approach prevention
Neutral cultures (Japan) suppress emotional expression; affect cultures (Italy) encourage it. This affects how cardiac symptoms are communicated and experienced.
Smokers die on average 10 years sooner
Smoking triples CVD risk
Diet influences cholesterol, blood pressure, and sugar tolerance
Salt intake and obesity impact hypertension
A key comparison from the course material:
Patients following standard cardiologist recommendations got worse over time
Patients on the Ornish programme (strict vegetarian diet, no alcohol, no caffeine, plus stress management) got better
This illustrates how comprehensive lifestyle change can outperform conventional advice alone
The Ornish programme is a real clinical intervention that has been tested against standard care. The finding that 64% of women who die suddenly from heart disease had no prior symptoms underscores the importance of preventive screening for women, a population often overlooked in heart disease education. The statistic that only 1 in 5 African American women with heart disease believe they are at risk points to a gap in health awareness that public health campaigns can target.
Students often assume heart disease primarily affects men. It is the number one killer of women.
Depression is sometimes seen as a consequence of heart disease rather than a risk factor. Clinically significant depression increases CHD risk by 30-90%, meaning it contributes to the disease, not just follows it.
The Ornish programme is not simply a diet. It includes stress management and is a comprehensive lifestyle intervention.
Students sometimes confuse non-modifiable and modifiable risk factors. Age and sex cannot be changed; blood pressure, cholesterol, and weight can.
Heart disease as the number one killer of women (1 in 3 deaths) is a high-yield exam fact
African Americans 2x as likely to die from heart disease; African American women 2x as likely to stroke
Know the modifiable vs. non-modifiable risk factor split
Depression increasing CHD risk by 30-90% is a testable statistic
Urban dwellers 9x more likely to develop CVD
Be able to compare the Ornish programme with standard cardiologist care
True or False: Heart disease is the number one killer of men in the US. (False, it is the number one killer of women.)
Fill in the blank: Clinically significant depression increases CHD risk by -% (30-90%)
True or False: Age is a modifiable risk factor for heart disease. (False, age is non-modifiable.)
Fill in the blank: Urban dwellers are ___x more likely to develop CVD. (9x)
True or False: Hispanic women develop heart disease at the same age as non-Hispanic women. (False, they develop it about 10 years earlier.)
Q: What are the non-modifiable and modifiable risk factors for heart disease?
A: Non-modifiable: age and sex. Modifiable: high blood pressure, diabetes, high cholesterol, inactivity, and obesity.
Q: How does personality relate to heart disease risk?
A: Hostility (high anger trait) increases CHD risk in men. Clinically significant depression increases CHD risk by 30-90%.
Q: Describe the Ornish programme and how it compares to standard care.
A: The Ornish programme involves a strict vegetarian diet with no alcohol or caffeine, plus stress management. Patients on it improved, while those following standard cardiologist recommendations alone got worse.
Q: Why is heart disease sometimes called an "equal opportunity" disease, and where does this claim break down?
A: It affects all demographic groups, but not equally. African Americans are 2x as likely to die from it, African American women are 2x as likely to stroke, Hispanic women develop it 10 years earlier, and 64% of women who die suddenly had no prior symptoms.
The modifiable risk factors here overlap with cancer (smoking, diet, exercise). The role of depression as a risk factor parallels HIV/AIDS, where depression is associated with poorer immune function. Cultural disparities mirror those in the cancer unit. The control vs. constraint concept connects to adherence in the patient-provider communication notes.
Heart disease, cardiovascular disease, CVD, coronary heart disease, CHD, modifiable risk factors, non-modifiable risk factors, hypertension, obesity, cholesterol, depression and heart disease, hostility, Ornish programme, cultural disparities, African American health, women and heart disease, stroke, health psychology, PSY 320, Michigan State University