Difficulty: Intermediate | Prerequisites: Stress and coping foundations, biopsychosocial model, Chapter 9 material on health disparities.
Heart disease is the leading cause of death globally and a textbook case for health psychology because nearly every major risk factor, aside from age and genetics, is behavioural or psychological. This chapter covers how culture, gender, SES, personality (especially hostility), and stress interact with physiological risk factors to produce cardiovascular disease. You need a solid understanding of Selye's General Adaptation Syndrome and the stress response before tackling this material. The core takeaway is that prevention, through diet, exercise, social support, and stress management, is more effective and far cheaper than treatment.
Heart disease kills more people worldwide than anything else, and most of its risk factors are modifiable: smoking, diet, inactivity, stress, and hostility. Cultural background and gender shape both risk and outcomes in important ways (African Americans face disproportionate risk; heart disease is the number one killer of women). Selye's General Adaptation Syndrome explains the physiological pathway from chronic stress to cardiovascular damage.
Cardiovascular disease (CVD)
A broad category of diseases affecting the heart and blood vessels, including coronary heart disease, stroke, and hypertension.
Selye's General Adaptation Syndrome (GAS)
A three-stage model of the body's response to prolonged stress: alarm (fight-or-flight activation), resistance (the body attempts to cope), and exhaustion (resources are depleted and the body breaks down). Think of it as: the body can handle stress for a while, but eventually the system crashes.
Catecholamines
Stress hormones (including adrenaline and noradrenaline) released during the alarm stage. They increase blood flow and heart rate.
Cortisol
A stress hormone released alongside catecholamines. Chronic elevation contributes to cardiovascular damage and poor metabolic function.
Karoshi
A Japanese term meaning "death from overwork." It refers to fatal heart attacks or strokes triggered by extreme occupational stress.
Vital exhaustion
A state of unusual fatigue, increased irritability, and demoralisation. People with CVD and vital exhaustion are 2x more likely to have recurring heart attacks.
Cardiac invalidism
A pattern where heart disease patients become increasingly dependent and helpless, often enabled by family dynamics. Think of it as: the patient gives up on independence after a cardiac event.
Cardiac rehab
A structured programme combining education, physical activity, and social support to help heart disease patients recover.
Thrombolytic drugs
Medications used to dissolve blood clots and prevent some damage to the myocardium (heart muscle) during a heart attack.
C-reactive proteins
Markers of inflammation in the body. Elevated levels are associated with increased cardiovascular risk.
Heart disease is the leading cause of death globally; 11% of Americans report a heart problem.
African Americans are 2x more likely to die from heart disease than Asian Americans. Those born in the South have higher risk than those in the North.
Death rates for whites, Native Americans, and Latinos are intermediate.
Russia has higher rates than Japan and France.
African American women: 2x risk of stroke compared to white women. 49% of AA women aged 20+ have some form of heart disease, yet only 1 in 5 believe they are at risk. Key drivers include genetic factors, obesity, and diabetes.
Hispanic women: Only one-third know heart disease is their number one cause of death. They tend to develop heart disease 10 years sooner than non-Hispanics. Cultural patterns around food, cooking, and prioritising others' health over their own contribute.
Control vs. constraint cultures: Higher stress and CVD risk in cultures emphasising control.
Neutral vs. affect cultures: Neutral (emotionally restrained) cultures are associated with higher CVD risk.
Executives and professionals face 4x increased risk.
Japan: karoshi (death from overwork) is a recognised phenomenon.
People with CVD and vital exhaustion are 2x more likely to have recurring heart attacks.
Risk increases after age 45. Men have a higher death rate, but heart disease is the number one killer of women (1 in 3 female deaths).
For women: smoking and birth control together increase risk. Fit women can still develop heart disease with family history and high cholesterol. 64% of women die suddenly from heart disease without prior symptoms.
Risk factors: High LDL with low HDL cholesterol, smoking, stress, obesity, diabetes, hypertension.
Non-modifiable factors: Age, sex (men under 50 at higher risk; post-menopausal women's risk increases), family history.
Modifiable factors: High blood pressure, diabetes, high cholesterol, inactivity, obesity.
More education correlates with less risk.
Hostility increases cardiovascular risk.
Depression increases cardiovascular risk.
Stressor leads to state of alarm, then resistance to stress, then state of exhaustion (body breaks down).
During alarm: catecholamines and cortisol rush, increasing blood flow, heart rate, and impairing metabolic function.
Urban dwellers are 9x more likely to develop heart disease.
Catastrophic events and even stressful sports games can trigger cardiac events.
Smoking: Smokers die 10 years sooner, face a 3x increase in heart disease risk. Quitting helps immediately.
Diet: Influences cholesterol, blood pressure, and sugar tolerance. Hypertension is linked to high salt intake and obesity. A better diet reduces risk for stroke and CVD.
Exercise: Significantly reduces risk.
Social support: Helps change habits and encourages adherence to treatment.
Thrombolytic drugs help prevent damage to the myocardium. Denial and anxiety are common reactions to heart attacks.
Cardiac rehab combines education, physical activity, and social support.
80% of cardiac patients return to work within one year, though some take less demanding roles.
Family life can help or hinder recovery. Cardiac invalidism occurs when patients become increasingly dependent and helpless.
Students often think heart disease is primarily a men's issue. Heart disease is the number one killer of women, responsible for 1 in 3 female deaths, and 64% of women die suddenly without prior symptoms.
Students sometimes confuse non-modifiable and modifiable risk factors. Age, sex, and family history cannot be changed; blood pressure, cholesterol, activity level, and obesity can be.
Students may assume that being physically fit protects against heart disease in all cases. Fit women with a family history and high cholesterol can still develop it.
Students frequently mix up karoshi (death from overwork, a Japanese concept) with vital exhaustion (a clinical state of fatigue and demoralisation linked to recurrent heart attacks). They are related but distinct.
⚠️ Know Selye's General Adaptation Syndrome and its three stages (alarm, resistance, exhaustion).
⚠️ Heart disease is the number one killer of women. Expect a question on this, possibly framed as a "most people assume" scenario.
⚠️ African American women: 2x stroke risk vs. white women; 49% age 20+ have heart disease.
⚠️ Hispanic women develop heart disease 10 years sooner than non-Hispanics.
⚠️ Hostility and depression both independently increase cardiovascular risk.
⚠️ Urban dwellers are 9x more likely to develop heart disease.
⚠️ Know what cardiac invalidism is and how family dynamics contribute to it.
True or False: Heart disease is the second leading cause of death among women. (False: it is the number one killer of women.)
Fill in the blank: The three stages of Selye's General Adaptation Syndrome are alarm, ________, and exhaustion. (Resistance.)
True or False: African American women have twice the risk of stroke compared to white women. (True.)
Fill in the blank: The Japanese term for death from overwork is ________. (Karoshi.)
True or False: Urban dwellers are 3x more likely to develop heart disease than rural residents. (False: they are 9x more likely.)
Q: A 52-year-old woman with no prior symptoms collapses suddenly from a cardiac event. Her family is shocked because she seemed healthy. What statistic from the course material explains why this is not unusual?
A: 64% of women die suddenly from heart disease without prior symptoms. Heart disease in women often presents differently and is frequently undetected until a fatal event.
Q: Describe the physiological pathway by which chronic stress contributes to heart disease, using Selye's model.
A: A stressor triggers the alarm stage, releasing catecholamines and cortisol, which increase blood flow and heart rate. During resistance, the body attempts to cope but remains physiologically activated. If stress persists, the body enters exhaustion, where resources are depleted, metabolic function degrades, and cardiovascular damage accumulates.
Q: How does hostility increase heart disease risk?
A: Hostility is a psychological risk factor that independently increases cardiovascular risk, likely through chronic activation of the stress response (elevated catecholamines and cortisol), which damages blood vessels and promotes inflammation over time.
Q: A cardiac patient's spouse does everything for them, to the point where the patient no longer attempts any self-care. What is this pattern called?
A: Cardiac invalidism, where the patient becomes increasingly dependent and helpless, often enabled by well-meaning family members.
Selye's General Adaptation Syndrome reappears in every stress-related topic in the course, including cancer (Ch. 13) and HIV/AIDS (Ch. 12). The cultural disparities here (African American, Hispanic, SES-related) mirror the patterns in Patient-Provider Communication (Ch. 9) and Cancer (Ch. 13). Hostility as a risk factor connects to personality and health behaviours discussed in the Pain chapter (Ch. 10).
Heart disease, cardiovascular disease, CVD, coronary heart disease, stroke, hypertension, Selye's General Adaptation Syndrome, GAS, alarm resistance exhaustion, catecholamines, cortisol, karoshi, death from overwork, vital exhaustion, cardiac invalidism, cardiac rehab, thrombolytic drugs, C-reactive proteins, hostility and heart disease, depression and heart disease, LDL cholesterol, HDL cholesterol, modifiable risk factors, non-modifiable risk factors, women and heart disease, African American heart disease, Hispanic heart disease