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      Psychosocial Risk Factors and Cardiovascular Disease: Epidemiology, Screening, and Treatment Considerations

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          The recognition that psychosocial risk factors contribute to the pathogenesis of cardiovascular disease has led to the development of a new field of behavioral cardiology. The initial impetus for this field was studies performed in the 1980s and 1990s that provided epidemiological evidence and a pathophysiological basis for a strong link between a number of psychosocial risk factors and cardiovascular disease, including depression, anxiety, hostility, job stress, and poor social support. In recent years, additional psychosocial risk factors have been identified, including pessimism; other forms of chronic stress, such as childhood abuse and trauma, and the psychological stress that may be associated with chronic medical illness; lack of life purpose; and the syndrome of “vital exhaustion,” which consists of a triad of exhaustion, demoralization, and irritability. New research in the last decade has also established that positive psychosocial factors, such as optimism, positive emotions, a vibrant social life, and a strong sense of life purpose, can have an important health-buffering effect through their favorable influence on health behaviors and promotion of positive physiological functioning. Patients can be screened for psychosocial risk factors in clinical practice through either the use of open-ended questions, which can be integrated into a physician’s standard review of systems, or the use of short questionnaires. Physicians can assist in the treatment of psychosocial risk factors in various ways, such as screening patients for psychological distress and making appropriate referrals when indicated, providing patients with practical lifestyle suggestions, and employing office personnel to teach patients behavioral or psychosocial interventions that can promote a sense of well-being and/or reduce stress.

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            Growing epidemiological evidence identifies key domains relevant to behavioral cardiology, including health behaviors, emotions, mental mindsets, stress management, social connectedness, and a sense of purpose. Each of these domains exists along a continuum, ranging from positive factors that promote health, to negative factors, which are pathophysiological. To date, there has been relatively little translation of this growing knowledge base into cardiology practice. Four initiatives are proposed to meet this challenge: 1) promulgating greater awareness of the potency of psychosocial risks factors; 2) overcoming a current "artificial divide" between conventional and psychosocial risk factors; 3) developing novel cost-effective interventions using Internet and mobile health applications, group-based counseling, and development of tiered-care behavioral management; and 4) in recognition that "one size does not fit all" with respect to behavioral interventions, developing specialists who can counsel patients in multidisciplinary fashion and use evidence-based approaches for promoting patient motivation and execution of health goals.
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                Author and article information

                Cardiovascular Innovations and Applications
                Compuscript (Ireland )
                September 2016
                October 2016
                : 1
                : 4
                : 417-431
                1Division of Cardiology, Mount Sinai St. Luke’s Hospital, Mount Sinai Heart, and Icahn School of Medicine at Mount Sinai, New York, NY 10025, USA
                Author notes
                Correspondence: Alan Rozanski, MD, Division of Cardiology, Mount Sinai St. Luke’s Hospital Center, 1111 Amsterdam Avenue, New York, NY 10025, USA, E-mail: arozanski@ 123456chpnet.org
                Copyright © 2016 Cardiovascular Innovations and Applications

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.



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