Heart disease is the leading cause of death globally. Risk factors split into non-modifiable (age, sex, family history) and modifiable (smoking, diet, exercise, stress). Cultural variations are significant: African Americans face roughly double the mortality risk of Asian Americans. Selye's General Adaptation Syndrome explains the physiological stress pathway, and psychological factors like hostility and depression independently increase risk.
Difficulty: Intermediate | Prerequisites: Biopsychosocial model, basic stress physiology (Selye's GAS)
This chapter examines heart disease through the health psychology lens: who gets it, why, and what can be done. It covers the biological risk factors but spends equal time on the psychological and social dimensions, from hostility and depression as risk factors to the role of social support in cardiac rehab. Cultural disparities are a major theme. You should understand the basics of the stress response and the biopsychosocial model before starting.
Cardiovascular disease (CVD)
A broad category of diseases affecting the heart and blood vessels, including coronary heart disease, stroke, and hypertension. The leading cause of death worldwide.
Selye's General Adaptation Syndrome (GAS)
A three-stage model of the body's stress response: alarm (fight-or-flight activation), resistance (body attempts to cope), and exhaustion (body breaks down). Think of it as the body running on emergency power until the generator fails.
Catecholamines
Stress hormones (including adrenaline and noradrenaline) released during the alarm stage. They increase blood flow and heart rate.
Cortisol
A stress hormone that, in excess, causes the body to metabolise food less optimally and contributes to cardiovascular damage.
Vital exhaustion
A state of extreme fatigue and depletion. People with CVD and vital exhaustion are 2x more likely to have recurring heart attacks.
Karoshi
A Japanese term for death by overwork. Illustrates the cultural dimension of work-related cardiovascular risk.
Cardiac invalidism
A pattern where cardiac patients become increasingly dependent and helpless, often within the family context. The family can either support recovery or reinforce dependence.
C-reactive proteins
Markers of inflammation in the body that are associated with increased cardiovascular risk.
Thrombolytic drugs
Medications used to help prevent damage to the myocardium (heart muscle) during a heart attack.
African Americans are 2x more likely to die from heart disease than Asian Americans.
African Americans born in the South have increased risk compared to those born in the North.
Death rates for whites, Native Americans, and Latinos fall in the intermediate range.
Russia has higher rates than Japan and France.
African American women are at 2x the risk for strokes compared to white women. About 49% of African American women aged 20 and up have some form of heart disease, yet only 1 in 5 believe they are at risk. Contributing factors include genetics, obesity, and diabetes.
Hispanic women: Only one-third know that heart disease is their number one cause of death. They tend to develop heart disease 10 years sooner than other non-Hispanic groups. Cultural factors include prioritising others' health (food, cooking, caregiving) over their own.
Control vs. constraint cultures: Higher stress and CVD risk in control-oriented cultures.
Neutral vs. affect cultures: Neutral (emotionally restrained) cultures are associated with higher CVD risk.
Executives and professionals face 4x increased risk.
Japan's concept of karoshi (death by overwork) illustrates extreme occupational cardiovascular risk.
People with CVD and vital exhaustion are 2x more likely to have recurring heart attacks.
Increased age, particularly after 45.
Sex: men have higher death rates. Men under 50 are at higher risk; post-menopausal women catch up.
Family history of heart disease.
Heart disease is the number one killer of women, accounting for 1 out of every 3 female deaths. Smoking and birth control increase risk. Even fit women with family history and high cholesterol remain at risk. A striking statistic: 64% of women who die suddenly from heart disease had no prior symptoms.
High LDL cholesterol with low HDL cholesterol.
Smoking, stress, obesity, diabetes, hypertension, physical inactivity.
Hostility independently increases cardiovascular risk.
Depression independently increases cardiovascular risk.
Education and awareness are protective: more education correlates with less risk.
C-reactive proteins are inflammation markers associated with increased risk.
Social support is protective, while lack of support increases risk.
Selye's GAS describes the body's response to sustained stress in three stages:
Alarm: The body activates the fight-or-flight response. Catecholamines and cortisol surge, increasing blood flow and heart rate. The body metabolises food less optimally.
Resistance: The body attempts to adapt to the stressor and maintain function.
Exhaustion: The body's resources are depleted and it breaks down.
This sequence explains why chronic stress damages the cardiovascular system over time.
Urban dwellers are 9x more likely to develop heart disease than rural populations.
Catastrophic events (natural disasters, terrorist attacks) produce spikes in cardiac events.
Even stressful sports games have been linked to increased heart attack risk in spectators.
Smoking: Smokers die 10 years sooner on average. Smoking creates a 3x increase in heart disease risk. Quitting helps at any point.
Diet: Influences cholesterol levels, blood pressure, and sugar tolerance. Hypertension is linked to high salt intake and obesity. A better diet means lower risk for stroke and CVD.
Exercise: Significantly reduces risk.
Social support: Helps change habits and encourages adherence to treatment.
Thrombolytic drugs are used to prevent damage to the myocardium during a heart attack.
Denial and anxiety are common immediate reactions to a heart attack.
Cardiac rehabilitation combines education, physical activity, and social support.
Behavioural interventions and treatment are central to recovery.
About 80% of cardiac patients return to work within one year, though some move to less demanding roles or fewer hours.
Family life can support or undermine recovery. Cardiac invalidism, where patients become increasingly dependent and helpless, is a risk when family dynamics reinforce passivity.
Students often assume heart disease is primarily a male problem. It is the number one killer of women, and 64% of women who die suddenly from it had no prior symptoms.
Hostility and depression are sometimes treated as mere risk markers rather than independent risk factors. Both independently increase cardiovascular risk, not just through correlated behaviours.
Many students think that being fit eliminates heart disease risk. Fit women with family history and high cholesterol can still develop heart disease.
The three stages of GAS (alarm, resistance, exhaustion) are frequently mixed up or conflated. Each is distinct.
⚠️ Know Selye's three stages of GAS and the hormones involved (catecholamines, cortisol).
⚠️ The 64% statistic (women dying suddenly without prior symptoms) is a commonly tested fact.
⚠️ Distinguish non-modifiable from modifiable risk factors.
⚠️ African American women's 2x stroke risk and the 49% prevalence figure are likely exam material.
⚠️ Know what cardiac invalidism is and how family dynamics affect it.
⚠️ Understand the 9x urban-rural difference in heart disease development.
True or False: Heart disease kills more men than women. (False. It is the number one killer of women: 1 in 3 female deaths.)
Fill in the blank: The three stages of Selye's GAS are alarm, resistance, and _______. (Exhaustion)
True or False: Urban dwellers are 9x more likely to develop heart disease than rural populations. (True)
Fill in the blank: _______ is a Japanese term for death caused by overwork. (Karoshi)
True or False: Quitting smoking has no benefit for heart disease risk. (False. Quitting helps at any point.)
Q: Name the three stages of Selye's General Adaptation Syndrome and briefly describe each.
A: Alarm (fight-or-flight response, catecholamines and cortisol surge), resistance (body tries to adapt), exhaustion (body's resources deplete and it breaks down).
Q: Why is heart disease particularly dangerous for women?
A: It is the number one killer of women (1 in 3 female deaths), and 64% of women who die suddenly from it had no prior symptoms. Smoking and birth control increase risk further.
Q: What is cardiac invalidism?
A: A pattern where cardiac patients become increasingly dependent and helpless, often reinforced by family dynamics.
Q: How does hostility relate to heart disease?
A: Hostility is an independent risk factor for cardiovascular disease, meaning it increases risk even after controlling for other factors.
Q: An African American woman aged 25 has a family history of heart disease. What statistics from this chapter are relevant to her risk?
A: 49% of African American women aged 20+ have some form of heart disease; African American women face 2x the stroke risk compared to white women; only 1 in 5 believe they are at risk.
Selye's GAS connects to the Pain chapter (Ch. 10), where the diathesis-stress model describes how biological traits interact with stressors. The cultural disparities here mirror those in Cancer (Ch. 13) and Patient-Provider Communication (Ch. 9). Social support as a recovery factor links to the broad exam theme of social determinants of health.
heart disease, cardiovascular disease, CVD, Selye's General Adaptation Syndrome, GAS, catecholamines, cortisol, vital exhaustion, karoshi, cardiac invalidism, cardiac rehabilitation, thrombolytic drugs, C-reactive proteins, hostility and heart disease, depression and heart disease, modifiable risk factors, non-modifiable risk factors, African American heart disease, Hispanic women heart disease, smoking and CVD, PSY 320, health psychology