Coronary Heart Disease, Hypertension, and Diabetes

Coronary Heart Disease (CHD)

  • Definition: A general term for illnesses caused by atherosclerosis.
  • Atherosclerosis:
    • Narrowing of the coronary arteries.
    • These arteries supply the heart with blood.
  • Angina Pectoris:
    • Pain radiating across the chest and arms.
    • Caused by a temporary shortage of oxygen to the heart.
  • Myocardial Infarction:
    • Heart attack.

CHD Overview

  • Leading cause of death in the U.S.
    • Accounts for more than one in five deaths.
  • A disease associated with modernization.
    • Linked to alterations in diet and reduction in physical activity levels.
  • Major chronic disease with millions of Americans experiencing symptoms.

CHD and Women

  • Women appear to be protected at younger ages compared to men.
  • Leading killer of women in the U.S.
  • Women have a 50% chance of dying from their first heart attack, compared to 30% for men.

Risk Factors for CHD

  • Smoking
  • Lack of exercise
  • Family history
  • Obesity
  • High cholesterol
  • Metabolic Syndrome:
    • Abdominal obesity
    • Hypertension
    • Low HDL (high-density lipoprotein) levels
    • Difficulty metabolizing blood sugar
  • Socioeconomic Status (SES)
  • Minority status

Psychological Factors in CHD

  • Development of CHD is associated with cardiovascular reactivity to stress.
  • Acute stress and negative emotions can precipitate sudden clinical events.
  • Depression
  • Type A personality/Hostility

Cardiovascular Reactivity and Hostility

  • Hostility reflects an oppositional orientation toward people, developing in childhood.
  • Related to cardiovascular reactivity.
  • Cynical Hostility:
    • Characterized by suspiciousness, resentment, frequent anger, antagonism, and distrust of others.
    • Individuals with cynical hostility often have difficulties with social support.

Management of Heart Disease and Treatment Delay

  • Patients often delay seeking treatment.
  • Reasons for delay:
    • Inability to accept they are having a heart attack.
    • Interpreting symptoms as a mild disorder.
  • Individuals likely to delay:
    • Older patients
    • African American patients
    • Patients who have consulted a physician or self-treated symptoms.
    • Those with a history of angina or diabetes.

Hypertension

  • High blood pressure.
  • Prevalence: One in four U.S. adults has it.
  • Lack of symptoms: One-third of those with hypertension are unaware they have it.
  • Risk factor for other medical problems:
    • Kidney failure
    • Stroke
    • Cognitive difficulties
  • Essential hypertension: In most cases, the exact cause is unknown.

Hypertension Risk Factors

  • Age:
    • Prior to age 50, men are at greater risk.
    • After age 55, women and men have a 90% chance of developing it.
  • Genetic factors.
  • Obesity
  • Lower SES
  • Stress (especially low control)
  • Hostility/Expressed anger

Hypertension in African Americans

  • Particular medical problem in African American communities.
  • Partly due to general risk factors.
  • Linked to stress of racial discrimination.
  • Live Chair Health initiative: Puts blood pressure cuffs in community locations like churches, barbershops, and salons.

Diabetes Overview

  • Common chronic disease and a leading cause of death in the U.S.
  • A chronic condition of impaired metabolism due to insulin dysfunction.
  • Insulin acts as a "key" to permit glucose to enter cells.
  • Without insulin, glucose stays in the blood.

Diabetes Health Implications

  • Diabetes is associated with:
    • Thickening of the arteries due to buildup of wastes in the blood.
    • High rates of CHD.
    • Kidney failure.
    • Nervous system damage.
    • Leading cause of blindness among adults.

Types of Diabetes

  • Type I Diabetes (5% of all diabetes):
    • Develops relatively early in life.
    • Abrupt onset of symptoms.
    • The pancreas doesn’t produce insulin.
  • Type II Diabetes:
    • Cells lose the ability to respond fully to insulin (insulin resistance).
    • The pancreas temporarily increases insulin production.
    • Insulin-producing cells may eventually fail.

Type II Diabetes Risk Factors

  • Overweight
  • Little exercise
  • High blood pressure
  • Sibling or parent with diabetes
  • Having had a baby weighing over 9 pounds at birth
  • Member of a high-risk ethnic group (African Americans, Latinos, Native Americans, Asian Americans, and Pacific Islanders)

Diabetes Treatment

  • Type I Patients:
    • Monitor glucose levels
    • Regular insulin injections
    • Strict dietary control
  • Type II Patients:
    • Often unaware of health risks they face.
    • Must reduce sugar and carbohydrate intake.
    • Weight loss
    • Exercise (helps use up glucose in the blood)
  • Adherence is problematic for both types.

Special Problems of Adolescent Diabetics

  • Adolescents usually have Type I diabetes.
  • More severe.
  • Restrictions of diabetes interfere with issues of independence and self-concept.
  • Peer culture may stigmatize those who are different.
  • When parents are actively involved in diabetes management tasks, there is better control of the disease.