The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practiceThe emerging field of behavioral cardiology Export

@article{citeulike:1622784, abstract = {Observational studies indicate that psychologic factors strongly influence the course of coronary artery disease (CAD). In this review, we examine new epidemiologic evidence for the association between psychosocial risk factors and CAD, identify pathologic mechanisms that may be responsible for this association, and describe a paradigm for studying positive psychologic factors that may act as a buffer. Because psychosocial risk factors are highly prevalent and are associated with unhealthy lifestyles, we describe the potential role of cardiologists in managing such factors. Management approaches include routinely screening for psychosocial risk factors, referring patients with severe psychologic distress to behavioral specialists, and directly treating patients with milder forms of psychologic distress with brief targeted interventions. A number of behavioral interventions have been evaluated for their ability to reduce adverse cardiac events among patients presenting with psychosocial risk factors. Although the efficacy of stand-alone psychosocial interventions remains unclear, both exercise and multifactorial cardiac rehabilitation with psychosocial interventions have demonstrated a reduction in cardiac events. Furthermore, recent data suggest that psychopharmacologic interventions may also be effective. Despite these promising findings, clinical practice guidelines for managing psychosocial risk factors in cardiac practice are lacking. Thus, we review new approaches to improve the delivery of behavioral services and patient adherence to behavioral recommendations. These efforts are part of an emerging field of behavioral cardiology, which is based on the understanding that psychosocial and behavioral risk factors for CAD are not only highly interrelated, but also require a sophisticated health care delivery system to optimize their effectiveness.}, author = {Rozanski, Alan and Blumenthal, James A. and Davidson, Karina W. and Saab, Patrice G. and Kubzansky, Laura}, citeulike-article-id = {1622784}, citeulike-linkout-0 = {http://dx.doi.org/10.1016/j.jacc.2004.12.005}, citeulike-linkout-1 = {http://linkinghub.elsevier.com/retrieve/pii/S0735109704023903}, citeulike-linkout-2 = {http://www.sciencedirect.com/science/article/B6T18-4FJCW93-1/2/d8e5de2bc26c2292fb2c6e67b935c9cb}, day = {01}, doi = {10.1016/j.jacc.2004.12.005}, issn = {07351097}, journal = {Journal of the American College of Cardiology}, keywords = {behaviour, chd, cvd, factors, management, pathways, practice, psychosocial, rehabilitation, risk}, month = {March}, number = {5}, pages = {637--651}, posted-at = {2009-11-11 13:53:02}, priority = {2}, title = {The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practiceThe emerging field of behavioral cardiology}, url = {http://dx.doi.org/10.1016/j.jacc.2004.12.005}, volume = {45}, year = {2005} }

TY - JOUR ID - citeulike:1622784 L3 - citeulike-article-id:1622784 N2 - Observational studies indicate that psychologic factors strongly influence the course of coronary artery disease (CAD). In this review, we examine new epidemiologic evidence for the association between psychosocial risk factors and CAD, identify pathologic mechanisms that may be responsible for this association, and describe a paradigm for studying positive psychologic factors that may act as a buffer. Because psychosocial risk factors are highly prevalent and are associated with unhealthy lifestyles, we describe the potential role of cardiologists in managing such factors. Management approaches include routinely screening for psychosocial risk factors, referring patients with severe psychologic distress to behavioral specialists, and directly treating patients with milder forms of psychologic distress with brief targeted interventions. A number of behavioral interventions have been evaluated for their ability to reduce adverse cardiac events among patients presenting with psychosocial risk factors. Although the efficacy of stand-alone psychosocial interventions remains unclear, both exercise and multifactorial cardiac rehabilitation with psychosocial interventions have demonstrated a reduction in cardiac events. Furthermore, recent data suggest that psychopharmacologic interventions may also be effective. Despite these promising findings, clinical practice guidelines for managing psychosocial risk factors in cardiac practice are lacking. Thus, we review new approaches to improve the delivery of behavioral services and patient adherence to behavioral recommendations. These efforts are part of an emerging field of behavioral cardiology, which is based on the understanding that psychosocial and behavioral risk factors for CAD are not only highly interrelated, but also require a sophisticated health care delivery system to optimize their effectiveness. IS - 5 JF - Journal of the American College of Cardiology SN - 07351097 EP - 651 TI - The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practiceThe emerging field of behavioral cardiology VL - 45 SP - 637 KW - behaviour KW - chd KW - cvd KW - factors KW - management KW - pathways KW - practice KW - psychosocial KW - rehabilitation KW - risk AU - Rozanski, Alan AU - Blumenthal, James AU - Davidson, Karina AU - Saab, Patrice AU - Kubzansky, Laura PY - 2005/03/01/ UR - http://dx.doi.org/10.1016/j.jacc.2004.12.005 ER -