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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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          Research on dispositional optimism as assessed by the Life Orientation Test (Scheier & Carver, 1985) has been challenged on the grounds that effects attributed to optimism are indistinguishable from those of unmeasured third variables, most notably, neuroticism. Data from 4,309 subjects show that associations between optimism and both depression and aspects of coping remain significant even when the effects of neuroticism, as well as the effects of trait anxiety, self-mastery, and self-esteem, are statistically controlled. Thus, the Life Orientation Test does appear to possess adequate predictive and discriminant validity. Examination of the scale on somewhat different grounds, however, does suggest that future applications can benefit from its revision. Thus, we also describe a minor modification to the Life Orientation Test, along with data bearing on the revised scale's psychometric properties.
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              Insomnia and risk of cardiovascular disease: a meta-analysis.

              Increasing evidence suggests an association between insomnia and cardiovascular disease. We performed a systematic review with meta-analysis of all the available prospective studies that investigated the association between insomnia and risk of developing and/or dying from cardiovascular disease. Systematic review and meta-analysis of prospective cohort studies. We conducted an electronic literature search through MedLine, Embase, Google Scholar, Web of Science, The Cochrane Library and bibliographies of retrieved articles up to December 2011. Studies were included if they were prospective, had assessment of insomnia or sleep complaints at baseline, evaluated subjects free of cardiovascular disease at baseline and measured the association between insomnia and risk of developing and/or dying from cardiovascular disease. After the review process 13 prospective studies were included in the final analysis. These studies included 122,501 subjects followed for a time ranging from three to 20 years. A total of 6332 cardiovascular events occurred during the follow-up. Insomnia was assessed through questionnaire and defined as either difficulty of initiating or maintaining sleep or presence of restless, disturbed nights. The cumulative analysis for all the studies under a random-effects model showed that insomnia determined an increased risk (+45%) of developing or dying from cardiovascular disease during the follow-up (relative risk 1.45, 95% confidence interval 1.29-1.62; p < 0.00001), with no evidence of heterogeneity across the studies (I 2: 19%; p = 0.14). Insomnia is associated with an increased risk of developing and/or dying from cardiovascular disease.

                Author and article information

                Cardiovascular Innovations and Applications
                Compuscript (Ireland )
                September 2016
                October 2016
                : 1
                : 4
                : 417-431
                [1] 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/.

                Self URI (journal page): http://www.ingentaconnect.com/content/cscript/cvia

                General medicine,Medicine,Geriatric medicine,Transplantation,Cardiovascular Medicine,Anesthesiology & Pain management
                stress,psychosocial factors,behavioral cardiology,coronary heart disease,atherosclerosis


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