Handbook of Cardiovascular Behavioral Medicine

Description

Cardiovascular disease is the leading cause of morbidity and mortality in the United States and worldwide. It is well recognized that traditional risk factors for cardiovascular disease have limited predictive utility in the identification of new cardiovascular disease cases and outcomes. Thus, investigators have argued that application of a biopsychosocial research paradigm in this field may be of particular utility in understanding cardiovascular disease pathogenesis. Accordingly, a subdiscipline within the field of behavioral medicine – cardiovascular behavioral medicine – examines interrelations among biological, behavioral, psychological, social, and environmental factors in cardiovascular health and disease. In 1989, Schneiderman and colleagues published a seminal work entitled "Research Methods in Cardiovascular Behavioral Medicine." Since that time, there has been an exponential increase in the amount and scope of work in this topic area, but no similar edited volume has been undertaken. The present handbook provides a compendium of work in the field of cardiovascular behavioral medicine, the purposes of which are to summarize research in this area, promote transdisciplinary research and clinical practice, and encourage researchers and clinicians to consider all relevant facets of the disease process in their evaluation and study of cardiovascular disease pathogenesis and outcomes. This handbook has four sections: Section I provides perspectives on the past, present, and future of cardiovascular behavioral medicine, an overview of basic cardiovascular anatomy and physiology, cardiovascular disease classification, and application of the biopsychosocial model to the study of cardiovascular disease. Section IIcovers risk factors for cardiovascular disease from a behavioral medicine perspective, including sociodemographic, behavioral, psychosocial, biomedical, psychophysiological, and environmental risk factors for cardiovascular disease.These chapters offer a discussion of construct definitions, measurement issues, and epidemiological evidence for relations to cardiovascular disease. Section III offers review of multi-level influences in specific cardiovascular disease entities, the evidence- base for relevant biopsychosocial interventions, evaluation of the impact of cardiovascular diseases on behavior, and consideration of common co-morbidities. Section IV covers select statistical and bioethical topics relevant to the field of cardiovascular behavioral medicine. This volume is unique in several respects. First, there is no similar work available in terms of the scope of topic coverage. Second, the inclusion of relevant measurement issues and construct definitions of a comprehensive set of risk factors will be of great assistance to researchers and clinicians in this area who wish to improve their assessment of these variables yet are not familiar with or trained in the various methodologies. Third, the use of multidisciplinary contributors enhances the utility of the work. Representative disciplines include psychology, psychiatry, medicine (e.g., cardiology), nursing, epidemiology, and public health. The primary audiences for this work are researchers, clinicians, and students in each of these disciplines. Preface References Acknowledgments Contents About the Editors Contributors Section I: Cardiovascular Disease: Background and Biopsychosocial Model 1 Cardiovascular Behavioral Medicine: Past, Present, and Future Introduction Risk Factors Pathophysiology of Cardiovascular Disease Biobehavioral Interventions in Cardiovascular Disease Comment Present Context and Future Prospects References 2 Introduction to Cardiac Anatomy, Physiology, and Pathophysiology Cardiovascular Anatomy Cardiac Physiology Atherosclerotic Cardiovascular Disease Processes Cardiac Pathophysiology Clinical Syndromes Stable and Unstable Angina Acute Coronary Syndromes Diagnostic Tools in Clinical Cardiology Electrocardiogram Holter Monitor Exercise-ECG Stress Testing Echocardiogram Stress Testing Nuclear Stress Testing Mental Stress Testing Calcium Score CT Angiogram Coronary Catheterization Electrophysiology Congestive Heart Failure Types of Cardiomyopathy Conclusions References 3 Classification of Cardiovascular Diseases: Epidemiology, Diagnosis, and Treatment Risk Factors for Cardiovascular Disease Hypertension Epidemiology Diagnosis Mechanisms and Risk Factors Treatment Ischemic Heart Disease Myocardial Infarction Epidemiology Diagnosis Diagnostic Tests Mechanisms and Risk Factors Treatment Cardiomyopathies and Left Ventricular Hypertrophy Epidemiology Diagnosis Mechanisms and Risk Factors Treatment Heart Failure Epidemiology Diagnosis Mechanisms and Risk Factors Treatment Cardiac Arrhythmias and Sudden Cardiac Death Epidemiology Diagnosis Mechanisms and Risk Factors Treatment Stroke and Cerebrovascular Disease Epidemiology Diagnosis Mechanisms and Risk Factors Treatment Conclusions References 4 The Biopsychosocial Perspective on Cardiovascular Disease Introduction Origins and Challenges of the Biopsychosocial Perspective Animal Research in Cardiovascular Behavioral Medicine Laboratory and Clinical Mental Stress Testing Ambulatory Monitoring in Cardiovascular Behavioral Medicine Observational Epidemiological and Clinical Studies Synthesis References Section II: Relations of Cardiovascular Risk Factors to Cardiovascular Disease 5 Childhood Factors in Adult Risk for Cardiovascular Disease Early Emergence of ``Adult´´ Risk Factors Sex Race and Ethnicity Discrimination Hostility and Anger Depression Cardiovascular Stress Responses Risk Factors Specific to Childhood Childhood Adversity Socioeconomic Status Adverse Childhood Experiences Moderators and Mediators of Childhood Adversity Low Birth Weight Conclusion References 6 Aging Changes in Cardiovascular Structure and Function Demographics of Aging and Impact of Age on Cardiovascular Disease Aging Changes in the Vasculature Morphology of Aging Vasculature Physiological and Clinical Effects of Vascular Aging Aging Changes in Cardiac Structure and Resting Function Cardiovascular Response to Exercise and Other Stressors Orthostatic Stress Pressor Stress Aerobic Exercise Capacity and Aging Mechanisms of Impaired LV Ejection During Maximal Aerobic Exercise in Healthy Older Adults Sympathetic Modulation Deficits in Cardiac Beta-Adrenergic Receptor Signaling Electrocardiography Sinus Node Function P-Waves P-R Interval QRS Complex Repolarization Arrhythmias Atrial Arrhythmias Isolated Atrial Ectopic Beats Atrial Fibrillation Paroxysmal Supraventricular Tachycardia Ventricular Arrhythmias References 7 Risk Factors for Ischemic Heart Disease in Women Introduction Overview of IHD and Women Sex Differences in Symptoms, Diagnosis, and Treatment Microvascular Coronary Dysfunction and Cardiac Syndrome X Sex Hormones and IHD Limitations of Using the Framingham Risk Score in Women Differential Risk Factors Between Men and Women Unique Risk Factors in Women Psychosocial Factors and Risk for Incident IHD Type A, Hostility, and Anger Depression Anxiety Social Support Stress Psychosocial Factors in Women with IHD Depression Anxiety Hostility, Anger, and Type A Behavior Social Support Psychosocial Intervention for Women with IHD Sex Differences in Major Psychosocial Clinical Trials for IHD Patients The Montreal Heart Attack Readjustment Trial (M-HART) The Enhancing Recovery in Coronary Heart Disease (ENRICHD) Trial Meta-analyses of Psychosocial Interventional Studies in IHD Patients Cardiac Rehabilitation Program Services Recent Developments Conclusions References 8 Stress and Heart Disease in Women: The Stockholm Women´s Intervention Trial in Coronary Heart Disease Study Clinical Picture Why Are Women Under-Represented in the Coronary Care Units (CCUs)? Age Characteristics Sex Hormones The Stockholm Female Coronary Risk Study The Stockholm Women´s Intervention Trial in Coronary Heart Disease (SWITCHD) Topics Discussed at the Group Sessions Results from the SWITCHD Intervention Trial Subjective Experiences of Women´s (Group) Interactive Patterns Conclusions References 9 From Race to Racism in the Study of Cardiovascular Diseases: Concepts and Measures Race and Disease Human Races Revisited Conceptual Distinctions Empirical Findings Family Trees, Venns, and Trellises Human Variation, Genetics, and Cardiovascular Disease ``Race´´ and Hypertension Race and Genetic Markers of Health Whither the Study of Race and Cardiovascular Disease Racism and Cardiovascular Disease Racism Conceptualized The Study of Racism and Disease Methodological Advances The Promise of the Empirical Studies Future Directions Conclusion References 10 Socioeconomic Status and Cardiovascular Disease Conceptualization and Measurement of SES Traditional Indicators Childhood Indicators Life Course Approaches Area-Based Measures Subjective Social Status Conclusions Socioeconomic Gradients in CVD Indicators of Adult SES and CVD Indicators of Childhood SES and CVD Later in Life Life Course Approaches to Evaluating the SES and CVD Association Variability in the Pattern of the Gradient Conclusions What Are the Pathways Connecting SES with CVD and What Possibilities Exist for Intervention? Upstream/Structural Determinants Environmental Influences Healthcare Access and Quality Biobehavioral Risk Factors Psychosocial Risk and Resilience Factors Summary Concluding Comments References 11 Health Disparities and Cardiovascular Diseases A Conceptual Approach to Studying Health Disparities Racial/Ethnic Disparities in Cardiovascular Diseases Coronary Heart Disease Hypertension Heart Failure Stroke Recent Progress CVD Risk Factors and Racial Disparities Genetics Socioeconomic Status Traditional Risk Factors Psychosocial Factors Racism Multiple CVD Risk Factors Does Where You Live Matter? Geographic Disparities in CVD Risk Unequal Treatment Summary Future Directions: Closing the Gap Improving Socioeconomic Determinants and Policies Cultural Competency Among Healthcare Providers Increased Awareness of Health Disparities Diversity in Practice More Research, Better Research Conclusion References 12 Nicotine Dependence and Cardiovascular Diseases: Biobehavioral and Psychosocial Correlates Measurement Issues Acute Effects of Smoking on Cardiovascular System Interactive Effects of Nicotine and Acute Stress Smoking and Cardiovascular Diseases Coronary Artery Disease Stroke and Cerebrovascular Diseases Peripheral Vascular Diseases Mechanisms of Tobacco Effects on Cardiovascular Risk Psychosocial Correlates/Determinant of Smoking Effects Ethnic and Racial Factors Socioeconomic Status (SES) and Smoking Weight Concern After Smoking Cessation Treatment Option for Smoking Cessation Behavioral Intervention Pharmacologic Therapy Nicotine Replacement Therapy (NRT) Non-Nicotine Pharmacologic Therapy Effects of Cessation on Reversing Cardiovascular Diseases Discussion Conclusions References 13 Alcohol and the Cardiovascular System: Implications for Behavioral Medicine Facts About Alcohol Consumption Measurement of Alcohol Consumption Alcohol Consumption and Health Alcohol and the Cardiovascular System Hypertension Stroke Coronary Artery Disease Arrhythmia Cardiomyopathy Drinking Patterns and Cardiovascular Disease Risk Biopsychosocial Factors Contributing to Alcohol Use and Cardiovascular Disease Conclusions References 14 Impact of Specific Diets and Nutritional Supplements on Cardiovascular Diseases Specific Diets Mediterranean Diet DASH-Style Diet Low-Carbohydrate/High-Protein Diet Safety Fish Oil-Based Therapies: Omega-3 Fatty Acids Potential Mechanisms of Action Omega-6 Fatty Acids Dietary Recommendations Related to Omega-6 Fatty Acids Potentially Important Vitamin Supplements Vitamin D Vitamins E and Vitamin C Vitamin B and Folic Acid Co-enzyme Q10 Cardiovascular Benefits of CoQ10 Hypertension Myocardial Infarction Angina Pectoris CV Surgery Heart Failure Cardiac Arrest Adverse Effects of CoQ10 and Interactions L-Carnitine Chronic Stable Angina Myocardial Infarction Heart Failure Peripheral Arterial Disease L-Arginine Arginine and Vascular Effects Hypertension Diabetes Mellitus Obesity/Insulin Resistance Smoking Heart Failure Peripheral Arterial Disease Conclusions References 15 Understanding Obesity and Cardiometabolic Risk Obesity: Definition Obesity: Measurement Anthropomorphic Measures Body Mass Index (BMI) Waist-to-Hip Ratio and Waist Circumference Skinfold Calipers DEXA Scans Bioelectrical Impedance Analysis (BIA) Underwater Weighing Doubly Labeled Water (DLW) Bod Pod Obesity: Prevalence Adipose Tissue and Body Fat Distribution Adipose Tissue Body Fat Distribution Fat Distribution and Cardiometabolic Risk: Mechanisms PIMA Indians: A Case Example of Racial/Ethnic Differences in CVD and Obesity Understanding Ethnic Differences in Health Risks Associated with Obesity: Theories Obesity Treatment/Prevention: What to Do? Concluding Remarks References 16 Physical Activity/Exercise and Cardiovascular Disease Introduction Assessment of Physical Activity/Exercise Epidemiological Studies Evaluating the Association of Physical Activity/Exercise with CVD Stroke Hypertension Heart Failure Mediators in the Relationship Between PA and CVD Moderators in the Relationship Between PA and CVD Summary Exercise Interventions Among Patients with CVD Stroke Hypertension Heart Failure Peripheral Arterial Disease Mediating Factors in the Relationship Between Exercise Activity and CHD Outcomes Moderators in the Relationship Between Exercise and CVD Summary Discussion References 17 Sleep as a Bio-behavioral Risk Factor for Cardiovascular Disease Dimensions of Sleep Important to Health and Functioning Sleep Duration Sleep Duration: Definitions and Measurement Sleep Duration and Health: Evidence Sleep Continuity Sleep Continuity: Definitions and Measurement Sleep Continuity and Health: Evidence Sleep Architecture Sleep Architecture: Definitions and Measurement Sleep Architecture and Health: Evidence Sleep Quality Sleep Quality: Definitions and Measurement Sleep Quality and Health: Evidence Behavioral Medicine and Sleep: Future Directions Biological Mechanisms Linking Poor Sleep to Increased CVD Risk Potential Pathways Between Sleep and Cardiovascular Disease Interaction of Sleep and Psychosocial Factors in Disease Sleep as a Mediator of Psychosocial Factors and Disease Synergistic Effect of Sleep and Psychosocial Factors in Disease Clinical Interventions to Enhance Sleep and Reduce CVD Risk: The Role of Mindfulness Background References 18 Methodological Challenges Associated with the Measurement of Medication Adherence in Patients with Cardiovascular Disease Accuracy of Methods to Assess Medication Adherence Challenges in Adherence Measurement Methods to Assess Medication Adherence Direct Methods Biological Assays Direct Patient Observation Indirect Methods: Objective Measures Electronic Monitoring Devices Pill Counts Pharmacy Refill Records Indirect Methods: Self-Report Measures Patient Interviews Questionnaires Patient Diaries Agreement Among Adherence Measures Special Considerations when Selecting Self-Report Measures Conclusion Recent Developments References 19 Personality Factors in Cardiovascular Disease: The Big Five and Type D Personality Big Five Personality Traits Background Big Five Personality Traits and Health Outcomes Neuroticism Extraversion Openness to Experience Agreeableness Conscientiousness Type D Personality The Nature of Type D Personality Type D Personality and Patient-Reported Outcomes in CVD Type D Personality and Adverse Clinical Outcomes in CVD Coronary Heart Disease Congestive Heart Failure and Heart Transplantation Implantable Cardioverter Defibrillator Peripheral Artery Disease Mechanisms Linking Personality to Health Outcomes Physiological Mechanisms Arousability Cellular Processes Inflammatory Activation Neurobiological System Genetic Factors Behavioral Mechanisms Behavioral Interventions Conclusions References 20 Hostility and Health Components and Definitions Origins of Hostile Predispositions Developmental Influences Effects of Adult Adversity Genetic and Physiological Influences Social Environment Hostility and Health Outcomes Coronary Disease Development Prognosis of Those with Established Coronary Disease Total Mortality and Other Diseases Potential Demographic Moderators Mechanisms Linking Hostility and Health Social Stressors Physiological Links Between Social Stress and Disease Health Behaviors Interventions Conclusions References 21 Negative Emotions: Depression, Exhaustion, and Anxiety Pathways from Negative Affect to CVD Mechanisms Depression Definition Measurement Epidemiology Treatment Exhaustion Definition Measurement Epidemiology Treatment Anxiety Definition Measurement Epidemiology of Anxiety and Chronic Stress Treatment Implications for Research Conclusions References 22 Positive Psychological Well-Being and Cardiovascular Disease Indicators of Positive Psychological Well-Being Methods Studies in Healthy Populations Optimism Ikigai Other Indicators of Positive Psychological Well-Being Summary Studies in Patient Populations Optimism Other Indicators of Positive Psychological Well-Being Summary Discussion Future Questions What Features of Positive Psychological Well-Being Are Critical? What Effect Modifiers Are Pertinent? What Are the Pathways by Which Positive Psychological Well-Being Influences CVD? Concluding Remarks References 23 Stress and the Development of Atherosclerotic Cardiovascular Disease Stress Definition Measurement Issues Global Perceived Stress Work Stress Marital Stress Major Life Events Other Sources of Stress: Caregiving and Discrimination Stress Reduction and CVD Risk Have We Over-Adjusted Our Models? Mediators for Stress-CVD Association Health Behaviors Heightened Cardiovascular Responses to Acute Stress Platelet Activation, Coagulation, and Fibrinolysis Oxidative Stress Hypothalamic-Pituitary-Adrenal (HPA) Axis Activity Inflammation Moderators for Stress-CVD Association Conclusion References 24 Work and Cardiovascular Diseases Work and Cardiovascular Disease: Theoretical Background Empirical Evidence 1: Epidemiological Studies Empirical Evidence 2: Experimental and Quasi-experimental Studies Implications for Behavioural Medicine Interventions References 25 Social Support and Cardiovascular Disease Definitions of Social Support Structural Social Support: Social Integration and Social Networks Functional Social Support: Provision of Social Resources Perceived vs. Received Support Commonly Used Measures of Social Support Social Network Measures Role-Based Measures of Social Networks Social Participation Measures of Social Network Complex Social Network Measure Measures of Received Support Measures of Perceived Social Support The ENRICHD Social Support Instrument (ESSI) Interpersonal Support Evaluation List (ISEL) Epidemiologic Evidence of an Association between Social Support and CVD Social Support and CVD Incidence in Initially Healthy Populations Social Support and CVD-Specific and Total Mortality in Initially Healthy Populations Potential Gender Effects in Epidemiologic Research on Social Support and CVD Social Support and Adverse Outcomes in CVD Patients Prognostic Studies in CHD Patients Prognostic Studies in CHF and Stroke Patients Mechanisms through which Social Support May Affect CVD Social Support and CVD Risk Factor Behaviors Social Support and CVD-Related Physiological Mechanisms Evidence of Effects of Social Support Interventions on CVD Outcomes Summary and Recommendations for Future Research References 26 Racism, Ethnic Discrimination, and Cardiovascular Health: Conceptual and Measurement Issues Constructs and Definitions The Levels and Types of Racism and Ethnic Discrimination Cultural Racism Measurement Strategies and Limitations Health Effects Future Directions Institutional Racism Measurement Health Effects Future Directions Individual-Level and Interpersonal Racism Measurement Strategies and Limitations Health Effects Future Directions Internalized Racism Measurement Health Effects Future Directions Summary and Conclusions References 27 Religion, Spirituality, and Cardiovascular Disease Construct and Measurement Issues Construct Definition Measurement Concerns Conclusions Empirical Studies Studies of Denomination Effects Religion, Spirituality, and CV Mortality R/S and Coronary Artery Disease Non-surgical Studies Surgical Studies Possible Mechanisms Concluding Statements References 28 Aggregation of Psychosocial Risk Factors: Models and Methods Conceptual Models of Aggregation Models of Emotion, Personality, and Psychological Disorders Structure of Negative Affects and Related Traits and Diagnoses Taxonomies of Personality Models of Social Behavior Models of Associations Between Individual Differences and Social Relations Ecological Models of the Embedded Nature of Psychosocial Risk Aggregation over Time: Life Course Models Methodological Implications of Aggregated Risks The Guiding Role of Theory Approaches to Analysis Conclusions References 29 Contexts and Cardiovascular Health Research on Contexts and Cardiovascular Disease Social Contexts Social Economic Position Social Networks Social Stressors Social Marketing on Online Social Networking Sites Proximal Spatial Contexts Residential Housing Neighborhood Contexts and the Built Environment Choice Architecture for Prevention Organizational Contexts and Connectivity to Services Workplace, Schools, and Other Institutional Settings Coupling of Communities and Health Systems Methodological Issues and Advances A Potential Outcomes Approach to Casual Inference Exchangeability and Modern Tools for Inference Causal Inference and Multilevel Modeling for Contextual Factors Composition Versus Context Measuring Context Timing and Temporality Scale of Measurement Perception and Meaning Conclusions References 30 Environmental Toxicants and Cardiovascular Behavioral Medicine Neurotoxicology Toxins vs. Toxicants Detecting Toxicants Risk Assessment in Neurotoxicology Practical Considerations for the Researcher Toxicant Forms Chemical Mixtures Measurement Precision and Compartment Decisions Toxicants and Cardiovascular Health Lead (Pb) Mercury (Hg) Particulate Matter (PM) Persistent Organic Pollutants (POPs) Arsenic The Potential Importance to Cardiovascular Behavioral Medicine Model 1: Toxicant Exposure as a Distal Cause Model 2: Toxicant Exposure as a Mediator of Psychosocial-CVD Association Model 3: Toxicant Exposure as a Covariate Model 4: Toxicant Exposure as an Effect Modifier Conclusion References 31 Genetics in Cardiovascular Behavioral Medicine A Brief Introduction to Genetics Genome-Wide Association Studies in Cardiovascular Behavioral Medicine Cigarette Smoking and Nicotine Dependence Obesity and Diet Limitations of GWAS Gene-Environment Interaction Gene-Environment Interaction in Cardiovascular Behavioral Medicine Gene Expression Epigenetics Precision Medicine Summary References 32 Hypertension Historical Perspective on Blood Pressure Measurement Diagnosis of Hypertension Blood Pressure Goals Psychosocial Factors and Elevated Blood Pressure The Concept of ``True´´ Blood Pressure Office Blood Pressure, Ambulatory Blood Pressure, and the Circumstantial Misclassification of Hypertension Status White Coat Hypertension Masked Hypertension Selected Psychosocial and Behavioral Factors that Contribute to Differences Between Office and Ambulatory Blood Pressure Psychological Stress Hypertension Labeling and Stress Home Blood Pressure Monitoring as an Alternative to Ambulatory Blood Pressure Monitoring Conclusions References 33 The Measurement of Lipids and Lipoproteins in Behavioral Medicine Research Epidemiological Associations of Lipids and Lipoproteins to Cardiovascular Disease Measurement Decisions Regarding Which Lipids to Sample Collecting the Samples Hemoconcentration Processing the Samples Analysis Lipids, Lipoproteins, and Psychological Factors Stress Chronic and Episodic Stressors Acute Stressors Mood and Depression Cognition Variation in Lipids and Lipoproteins Potential Clinical Significance of Psychologically Associated Lipid Elevations Interventions Future Directions References 34 Insulin, Glucose, and the Metabolic Syndrome in Cardiovascular Behavioral Medicine Evolution of the Concept of the Metabolic Syndrome Definition of the Metabolic Syndrome Criteria Proposed for Clinical Diagnosis of the Metabolic Syndrome in Adults Criteria Proposed for Clinical Diagnosis of the Metabolic Syndrome in Children How to Measure Components of the Metabolic Syndrome Factors Underlying the Metabolic Syndrome Genetic Factors Neuroendocrine Factors Hypothalamic-Pituitary-Adrenal Axis Autonomic Nervous System Psychosocial Factors Prenatal Factors Conclusions References 35 Inflammation, Atherosclerosis, and Psychological Factors The Inflammatory Response Components of the Inflammatory Response: Proinflammatory and Anti-inflammatory Cytokines Triggers of Chronic Inflammation Atherosclerosis as an Inflammatory Disease: The Development of Hypotheses The Atherosclerosis and Lipid Hypothesis Atherosclerosis and the Response to Injury Hypothesis Atherosclerosis and the Inflammation Hypothesis Measures of Inflammation in Clinical and Research Settings: Relevance to Cardiovascular Behavioral Medicine Inflammation in Cardiovascular Behavioral Medicine: Shared Genetic Influences Inflammation and Psychological Factors: A Biopsychosocial Model of ACVD Personality Traits and Inflammation Personality Factors and Markers of Inflammation Trait Hostility and Anger Type D Personality Life Orientation, Optimism, and Pessimism Negative Affective States, Anxiety, Mood Disorders, and Inflammation Clustering of Psychosocial Factors and Inflammation Psychological Factors and Inflammation: Potential Bidirectional Pathways Conclusions Limitations References 36 Hemostasis and Endothelial Function Hemostasis Pathways Measurements of Hemostasis and Endothelial Factors Acute Psychosocial Stress Healthy Individuals Modulating Factors of the Acute Stress Response Sociodemographic Factors Cardiovascular Disease Medication Negative and Positive Affect Social Support Chronic Psychosocial Stress Physiologic Mechanisms with Acute Stress Chronic Psychosocial Stress Socioeconomic Status Job Stress Stress of Caregiving Traumatic Stress Social Support Psychological Distress Depression Anxiety Vital Exhaustion Physiological Mechanisms with Chronic Stress Summary and Conclusions References 37 Catecholamines and Catecholamine Receptors in Cardiovascular Behavioral Medicine Cardiovascular Epidemiology Stress Studies in Behavioral Medicine Issues Pertaining to Catecholamines in Plasma, Urine, and Gut Samples Catecholamine Assay Techniques Radioenzymatic Assays High-Performance Liquid Chromatography (HPLC) Immunoassays Assay Summary and Other Relevant Methodological Considerations Catecholamine Kinetics and Adrenergic Receptor Assays Catecholamine Kinetics Adrenergic Receptors Acute Stress Studies and Catecholamine Sampling The SNS and Genomics Summary References 38 The Assessment of Autonomic Influences on the Heart Using Impedance Cardiography and Heart Rate Variability Autonomic Balance and Health Aspects of Cardiac Function: Chronotropy, Inotropy, and Dromotropy The Baroreflex Impedance Cardiography The Genetics of Impedance-Derived Measures Summary Heart Rate Variability Physiological Regulation Emotional Regulation Cognitive Regulation Models of Neural Control of HRV The Polyvagal Theory The Model of Neurovisceral Integration Measures of HRV Time-Domain Indices of HRV Frequency Domain Indices of HRV Commonly Asked Questions on the Use of HRV The Genetics of HRV Summary Conclusion References 39 Hypothalamic-Pituitary-Adrenal Axis Hypothalamic-Pituitary-Adrenal Axis and Its Measures Hormones of the HPA Axis: CRH, ACTH, and Cortisol HPA Axis Functioning HPA Axis Activity HPA Axis Feedback Sensitivity Glucocorticoid Sensitivity of Target Tissues in the Periphery HPA Reactivity to Acute Psychosocial Stress HPA Axis and Allostatic Load The HPA Axis in Cardiovascular Disease (CVD) Altered HPA Axis Functioning and Stress Reactivity in Essential Hypertension HPA Axis Activity and Feedback Sensitivity Glucocorticoid Sensitivity of Target Tissues in the Periphery Stress Reactivity HPA Axis in Patients with CVD HPA Axis in Cardiovascular Patients: Cross-Sectional Findings HPA Axis and New Onset of CVD Exogenous Glucocorticoid Administration Endogenous Cortisol HPA Axis and Progression of Cardiovascular Disease Urinary Cortisol Salivary Circadian Cortisol Measures HPA Axis Feedback Sensitivity Stress Reactivity Potential Impact of Psychological Risk Factors for CVD on HPA Axis Measures in CVD Patients Type D Personality Depression Hostility Exhaustion Potential Mechanisms Underlying Associations Between Heightened CVD Risk with HPA Axis Alterations Direct Influences: Potential Modulation of the Disease Process by the HPA Axis Indirect Influences: Cortisol Excess Elevates Biological Risk Factors for CVD Conclusions References 40 Ambulatory Monitoring and Ecological Momentary Assessment Ambulatory Blood Pressure (ABP) Epidemiological Evidence Sociodemographic, Psychological, and Behavioral Correlates of Ambulatory Blood Pressure Measurement Issues Oscillometric Vs. Auscultatory Devices Cuff Sizing Validation Procedures Ambulatory Cortisol Assessment Epidemiological Evidence Sociodemographic, Psychological, and Behavioral Correlates Measurement Issues Sampling Compliance Moderators and Confounds Analysis and Reporting Interpretation Ambulatory Self-Report Assessment Epidemiological Evidence Sociodemographic, Psychological, and Behavioral Correlates Measurement Issues Sampling Psychometric Characteristics Measurement Reactivity Compliance Future Directions New Environmental Sampling Techniques Global Positioning System Monitoring Monitoring of Circadian-Related Light Exposures New Developments in Ambulatory Biological Measures Interstitial Fluid Assessment Wearable Computer Systems New Bioassay Approaches New Developments in Ambulatory Self-Report Assessment Computer Adaptive Testing Context-Sensitive Assessment References 41 Cardiovascular Reactivity and Risk for Cardiovascular Disease Definitions and Methodological Issues The First Published Reactivity Study A Trait Conceptualization of Cardiovascular Reactivity Cardiovascular Responses to Mental Stress Active Coping and Passive Coping Stressors Stability of Cardiovascular Reactivity Within Persons Over Time Do Cardiovascular Stress Responses Generalize to the Natural Environment? Evidence for CVR as a Predictor of Future HTN and Cardiovascular Disease: Cross-Sectional Studies of CVR and HTN in Adults Prospective Studies CVR and Future HTN in Adults Prospective Studies of CVR and Future Elevated BP in Children Prospective Studies of CVR and the Prediction of Subclinical and Clinical Endpoints Prediction of Left Ventricular Mass (LVM) Prediction of Carotid Atherosclerosis/Coronary Calcification Prediction of Clinical CVD or Its Progression Predictors/Determinants of CVR Genetic, Constitutional, Personality, and Situational Effects on CVR Effects of Family History of HTN Twin Studies Effects of Age Effects of Sex Menopause Menstrual Cycle Race Hostility Social Support New Developments Limitations of the Reactivity Hypothesis Summary Future Studies Measurement Studies Generalizability Studies Relations Among Predictors Cross-Sectional Relationships Between Risk Factor and Disease Prospective Studies Conceptual Studies Summary Procedural Framework for the Conduct of CVR Studies The Laboratory Setting May Have Powerful, Unintended Effects Experimenter Characteristics Experimenter Behavior Demand Characteristics Experimenter Expectancies Between-Subject and Within-Subject Designs Use of Multiple Stressors Within a Single Session Inter-task Baseline Sampling Framework Presession Instructions and Controls The Experimental Session Adaptation Baseline Reactive Measures Exposure to Stress Selection of the Stressor Validity Feasibility Psychometric Properties Usage Stressor/Task Domains and Specific Tasks Active and Passive Coping Emotional Arousal Social Interaction Tasks: Speech Tasks The Trier Social Stress Test (TSST) The Cold Pressor Duration of Stressor Exposure Manipulation Checks/Probe Measures Statistical/Measurement Issues Measurement Reliability Type I Error Assessment of Post-stress Recovery Summary References 42 Neuroimaging and the Study of Cardiovascular Stress Reactivity Stress Reactivity in Behavioral Medicine Research Cardiovascular Stress Reactivity: A Brief Background Example Applications of Neuroimaging Methods in Stress Reactivity Research Neuroimaging Methods Commonly Used in Stress Reactivity Research Laboratory Tasks and Cardiovascular Measurements Used in Neuroimaging Studies of Stress Reactivity Functional Neuroimaging of Stressor-Evoked Cardiovascular Reactivity The Brain as a Target of Peripheral Physiology Studies of Stressor-Evoked Neuroendocrine Reactivity Studies of Stressor-Evoked Inflammatory Reactivity Neuroimaging, Stress Reactivity, and Health-Relevant Outcomes Summary and Future Directions References 43 Asymmetric Innervation of the Heart Psychological and Social Factors in Stress-Induced Arrhythmia Asymmetric Autonomic Innervation of the Heart Brain Effects on the Heart Evidence for Brainstem and Subcortical Influences on Arrhythmogenesis Cortical Influences on Arrhythmogenesis Role of the Amygdala Lateralized Feedback from an Abnormal Heart Discussion References Section III: Biopsychosocial Factors in Cardiovascular Disease, Its Treatments, and Comorbidities 44 Biopsychosocial Factors in Coronary Artery Disease Psychosocial Epidemiology of Coronary Artery Disease Pathophysiology of CAD Atherosclerosis and CAD Hyperlipidemia and Endothelial Dysfunction in ATH Oxidative Stress and Inflammation in ATH Behavioral and Psychosocial Factors in ATH and CAD Social Environment, ATH, and CAD in Animal Models Psychosocial Stress and Endothelial Dysfunction in Humans and Animals Biopsychosocial Factors That May Attenuate ATH and CAD Role of Oxytocin in Disease Attenuation Human Psychosocial-Behavioral Interventions After Major Adverse Coronary Events Summary References 45 Chest Pain: Cardiac and Non-Cardiac Angina Pectoris History Psychological Influences Ischemic Silence/``Noisiness´´ and Putative Causes Risk of Coronary Heart Disease and the ``Open Artery´´ Hypothesis Anxiety, Depression, and Anger Noncardiac Chest Pain (NCCP) History Alternative Theories Emotional Distress Biopsychosocial Mechanisms References 46 Mental Stress-Induced Myocardial Ischemia: Prevalence, Clinical Significance, and Treatment Implications Transient Myocardial Ischemia During Daily Life Mental Stress-Induced Myocardial Ischemia in the Laboratory Tasks to Assess Mental Stress Ischemia Clinical Characteristics of Patients with Mental Stress-Induced Ischemia Mechanisms of Mental Stress-Induced Myocardial Ischemia Clinical Significance of Mental Stress-Induced Myocardial Ischemia Biobehavioral Interventions in the Treatment of Mental Stress-Induced Myocardial Ischemia Conclusions References 47 Acute Behavioral and Psychosocial Triggers of Myocardial Infarction Pathophysiology of MI The Role of External Triggers in the Pathophysiology of MI Methodological Issues in Studying Triggers Acute Versus Chronic Events Behavioral Triggers of Acute MI Physical Exertion Sexual Activity Alcohol Consumption Cigarette Smoking Marijuana and Cocaine Use Disturbed Sleep Summary of Behavioral Triggers Psychosocial and Emotional Triggers of Acute Myocardial Infarction Environmental Stress Natural Disasters Sporting Events War Summary of Environmental Stressors Psychosocial Stress Emotional Distress Bereavement Work Stress Anger Summary Discussion Methodological Considerations Use of Case-Crossover and Case-Control Design Methodology Other Issues Summary References 48 Cardiac Arrhythmias and Sudden Cardiac Death Pathophysiology of Ventricular Arrhythmia and Sudden Cardiac Death Epidemiology Diseases with Possible Applicability to Psychosocial Predictors/Triggers Research Methods Applied to Arrhythmia and Psychosocial Factors Ambulatory ECG Monitoring Laboratory Analogue Studies Other Arrhythmia Syndromes Associated with Psychosocial Risk Factors Stress Cardiomyopathy Long QT Syndrome (LQTS) Atrial Fibrillation (AF) Psychosocial Predictors of Arrhythmia: Clinical Studies Studies of Ventricular Arrhythmia: Anxiety and Depression Studies in ICD Cohorts Behavioral Interventions Conclusions References 49 Behavioral Medicine Treatments for Heart Failure Pathophysiology and Classification of Heart Failure Etiology of Heart Failure Coronary Artery Disease and Myocardial Infarction Hypertension Damaged Heart Valves Cardiomyopathy Heart Arrhythmias Tests for Diagnosing HF Echocardiogram Chest X-Ray Electrocardiogram (ECG) Other Imaging Modalities Blood Tests Natriuretic Peptides Diagnostic, Risk Assessment, and Prognostic Value of BNP Natriuretic Peptides for Screening and Early Intervention Markers of Cardiac Damage, Remodeling, and Inflammation Troponins Markers of Extracellular Matrix Remodeling Markers of Inflammation Drug Treatment of Heart Failure Angiotensin-Converting Enzyme (ACE) Inhibitors Beta-blockers Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Digoxin Diuretics Medical Devices and Transplant Surgery Implantable Cardioverter-Defibrillator (ICD) Cardiac Resynchronization Therapy (CRT) or Biventricular Pacing Heart Transplant Behavioral and Psychosocial Risk Factors for Heart Failure Medical Risk Factors with Behavioral Components Diabetes Sleep Apnea Hypertension Behavioral Risk Factors for HF Alcohol Abuse Amphetamine and Cocaine Abuse Obesity Lifestyle Factors: Exercise, Diet, and Smoking Psychosocial Factors Associated with HF Social Support Depression Positive Psychological Factors Underlying Biological Mechanisms of Depression and HF Relationship Between Cell Mobilization Factors and BDI Depression Ratings over Time PBMC Chemotaxis to a Bacterial Peptide and Chemokine in HF with Depression PBMC Chemotaxis to a ß-Adrenergic Agonist in HF with Depression Psychosocial and Behavioral Interventions Lifestyle Interventions Adherence Management Interventions for HF and Telehealth Meditation/Gratitude Journaling/Stress Reduction Standard Exercise in HF Tai Chi and HF Summary and Conclusions References 50 Stroke and Carotid Artery Disease Disease Pathophysiology Pathophysiology of Stroke Pathophysiology of Carotid Artery Disease Epidemiologic Data Epidemiology of Stroke Epidemiology of Carotid Artery Disease Traditional Risk Factors for Stroke and Carotid Artery Disease Biopsychosocial and Socioecological Approaches to Understanding Stroke Risk Psychosocial Factors Related to Stroke and Carotid Artery Disease Depression, Stroke Risk, and Carotid Artery Disease Stress, Risk for Stroke, and Carotid IMT Anger/Hostility, Stroke Risk, and Carotid IMT Psychosocial Factors and Racial Disparities in Stroke Biologic Mechanisms Linking Psychosocial Factors, Stroke, and Atherosclerotic Vascular Disease Future Directions Investigating Interrelationships Among Multiple Risk Factors Investigate the Influences of Upstream Factors Examine Factors That Contribute to Race/Ethnicity and Gender Differences in Stroke Risk and Carotid Artery Disease Develop Behavioral Medicine Interventions That are Culturally Sensitive and Community-Based Summary References 51 Congenital Heart Disease Children and Adolescents with Congenital Heart Disease Neurodevelopmental Issues Psychological Functioning Social Functioning Transition from Pediatric to Adult Cardiac Care Issues Related to Transfer of Pediatric to Adult HealthCare for CHD Patient Education Parent Education Adults with Congenital Heart Disease Neurocognitive Considerations Psychological Functioning of Adults with CHD Social Functioning Psychological Interventions in Adults with Congenital Heart Disease Conclusion References 52 Coronary Artery Bypass Grafting: Psychosocial Dimensions of a Surgical Procedure CABG: Indications, Procedures, and Referral CABG as a Crisis: Psychological and Physical Stress Effects The CABG Patient Experience and Outcomes The Presurgical Period Psychological Preparation for CABG The Postsurgical Hospital Stay Psychological Aspects of Recovery The Post-discharge Period Psychological Influences Following Hospitalization Long-Term Disease Management Post-discharge Status and Secondary Prevention Psychological Interventions for CABG Patients Presurgical Intervention In-Hospital Intervention Post-discharge Intervention Home-Based Nursing Telehealth Cardiac Rehabilitation Treatments for Depression Conclusions References 53 Heart Transplantation Natural History of the Heart Transplant Experience Psychiatric Issues in Transplant Patients Depression Depression in Pre-Transplant Patients Depression in Post-Transplant Patients Anxiety Anxiety Symptoms in Pre-Transplant Patients Anxiety in Post-Transplant Patients Other Psychiatric Issues Ventricular Assist Devices Psychiatric Effects of Post-Transplant Immunosuppressants Calcineurin Inhibitors Corticosteroids Psychological Implications of Internalizing a New Organ Psychiatric Assessment in Transplant Pre-Transplant: Psychiatric Assessment of Transplant Candidates Treatment Adherence and Non-adherence Assessment of Adherence Predictors of Non-adherence Interventions References 54 Measuring Behavioral Outcomes in Cardiac Rehabilitation AACVPR Outcomes Matrix Medication Adherence Supplemental Oxygen Usage Tobacco Use and Smoking Cessation Nutritional Assessment Individual Participant Group of Participants Attendance Rate Individual Participant Group of Participants Cardiac Disease Knowledge Score Individual Participant Group of Participants Exercise Compliance Individual Patient Group of Participants Conclusion References 55 The Psychological Treatment of Cardiac Patients The Nature of the Problem Cardiac Rehabilitation: Targets for Psychological Intervention Depression Anxiety Personality Factors Stress Social Support The Nature of Psychological Interventions for Cardiac Patients Research on the Efficacy of Psychological Interventions How Well Do Psychological Interventions Work? Factors Influencing Participation in Cardiac Rehabilitation Sex Differences in Participation and Outcomes of Cardiac Rehabilitation Conclusions and Recommendations for Clinical Practice Conclusion References 56 Quality of Life and Subjective Health: Strengthening the Subjective Perspective in Cardiology Historical Background Concepts of Quality of Life Assessment of Quality of Life General Principles, Psychometric and Cultural Considerations Generic Instruments Generic Scales Developed in Non-English Languages and Cultural Aspects Disease-Specific Instruments Utility Indices/Quality-Adjusted Life Years Quality of Life in Cardiac Patients Quality of Life in Different Cardiac Disease Entities and Functional States Effects of Cardiac Interventions on Quality of Life Association of Psychosocial Factors with Quality of Life in Heart Disease Quality of Life as Prognostic Indicator Summary and Implications for Patient Care and Research References 57 Cardiovascular Disease and Cognitive Function Cardiovascular Risk Factors and Neurocognitive Function Blood Pressure and Hypertension Lipids Body Mass Index and Obesity Glucose Parameters and Diabetes Inflammation Behavioral, Psychosocial, and Psychophysiological Risk Factors Summary Cardiovascular Diseases and Neurocognitive Function Cardiac Arrhythmias and Cardiac Arrest Subclinical Cardiovascular Disease Atherosclerosis Arterial Stiffness Endothelial Dysfunction Left Ventricular Hypertrophy Subclinical Vascular Disease Mechanisms Coronary Heart Disease (CHD) Peripheral Arterial Disease Heart Failure Summary Discussion References 58 Diabetes and Cardiovascular Disease Overview of Diabetes Mellitus Classification of Diabetes Prevalence Incidence Behavioral Risk Factors and Prevention of Type 2 Diabetes Cardiovascular Disease in Persons with Diabetes Epidemiology Pathophysiology Insulin Resistance and the Prediabetic State Dyslipidemia Hypertension Hyperglycemia Other Effects of Diabetes on the Cardiovascular System Management of Diabetes and Cardiovascular Risk Conclusion References 59 HIV-1 Spectrum Disease, Psychological Distress, and Cardiometabolic Risk Overview of HIV Spectrum Disease HIV Pharmacotherapy Psychological Factors and HIV Disease Severity Cardiovascular Structural and Functional Complications in HIV/AIDS Subclinical Cardiometabolic Complications in Adults Subclinical Cardiometabolic Complications in Children and Adolescents Inflammation and Oxidative Stress as Mediators of Subclinical Mechanisms Conclusion References Section IV: Statistical Modeling and Ethics in Cardiovascular Behavioral Medicine 60 Measuring Change Intention to Treat Antiquated Methods Exposition by Example Ordinary Multivariable Regression Mixed-Effects Regression Time-Invariant Versus Time-Varying Measures Measuring Time Centering Illustrations Results from Paired T-Test Compared with Mixed-Effects Regression Change in MAP Differences in Change in MAP Between Sexes Differences in Rates of Change in MAP by Sex Differences in Change in MAP by Time-Invariant and Time-Varying Covariates Change in a Dichotomous Measure Change in a Dichotomous Measure by Some Fixed and Time-Varying Measures Data Organization Full Disclosure Final Word References 61 Confounding, Mediation, Moderation, and General Considerations in Regression Modeling What is a Model and Why Use One? Models and Causation Confounding Causal Graphs Including Variables to Increase Precision Mediation Total, Direct, and Indirect Effects Why Mediation? Causal Knowledge as a Prerequisite for Mediation How to Analyze Mediation Adjustment for Path-Specific Confounding Measurement Error No Interaction Between Exposure and Mediator Decomposition of Total Effects and Indirect Effects Mediation and Interaction Interactions and Moderation The Assumption of Homogeneity Modeling Heterogeneity: Test Interactions, Not Within Groups An Important Aside: Preserve Measurement Information Wherever Possible Some Additional Considerations on Regression Models Sample Size in Multivariable Models Reducing the Degrees of Freedom in a Model Summary References 62 Systematic Reviews and Meta-analysis in Behavioral Medicine Narrative Reviews Systematic Reviews and Meta-analysis Correcting for Deficiencies in Narrative Reviews Conducting Systematic Reviews and Meta-analyses Ensuring Quality of Systematic Reviews and Meta-analysis Meta-analysis Versus Systematic Reviews Limitations to Systematic Reviews and Meta-analysis Limitations of Systematic Reviews Limitations of Meta-analysis Conclusion References 63 Ethical Issues in Cardiovascular Behavioral Medicine Research Unanticipated Problems Involving Risks to Subjects or Others Case Study No. 1 Incidental Findings Case Study No. 2 Students as Research Subjects Case Study No. 3A Case Study No. 3B Informed Consent for Decisionally Impaired Populations Case Study No. 4 Therapeutic Misconception in Cardiovascular Behavioral Medicine Future Directions References Index