Behavioral Medicine Approaches to Cardiovascular Disease Prevention

By Kristina Orth-Gomér; Neil Schneiderman | Go to book overview
is present and reduce the likelihood of developing premature CHD in the first place. One self-help approach to achieve these behavioral changes in hostile persons is described in a recent book I co-authored with Virginia Williams ( 41).What are needed now are large-scale, multicenter, randomized clinical trials that evaluate behavioral, pharmacological (serotonin-enhancement), and combination approaches to the reduction of hostility and its health-damaging biobehavioral correlates in post-MI patients ( 36). If these trials show hostility control to be effective in improving prognosis, it will be the most direct possible proof that hostility and other psychosocial factors (like depression) are true risk factors. Such an outcome would also constitute a major improvement in the secondary prevention of CHD, with primary prevention trials the next logical step.
SUMMARY AND CONCLUSIONS
1. The psychological trait of hostility predisposes to increased incidence of CHD, as well as deaths from all causes.
2. A cluster of biobehavioral characteristics has been identified in hostile persons, which makes a strong case for the biological plausibility of hostility as a factor that would predispose to both CHD and cancer. Exciting new research is beginning to apply the tools of cell and molecular biology to strengthen this case and identify the specific proximate cellular and molecular pathways whereby hostility contributes to pathogenesis.
3. The clustering of a particular set of biobehavioral characteristics in hostile persons also suggests a possible neurobiological basis for this clustering: deficient brain serotonergic function.
4. Both pharmacological (to enhance brain serotonergic function) and behavioral (to improve stress-coping skills and ability to control hostility) approaches should be evaluated in clinical trials aimed first at patients already suffering from both CHD and cancer, and ultimately at healthy persons at high risk due to increased hostility.

ACKNOWLEDGMENTS

This chapter was supported in part by grants from The National Heart, Lung and Blood Institute (HL36587, HL44998), the National Institute of Mental Health (MH70482), and Clinical Research Unit Grant MOI-RR-30.


REFERENCES
1.
Review Panel. Coronary-prone behavior and coronary heart disease: a critical review. Circulation 1981; 63: 1199-1215.
2.
Shekelle RB, Hulley SB, Neaton JD, et at. "The MRFIT behavior pattern study. II. Type A behavior and incidence of coronary heart disease". Am J Epidemiol 1985; 122: 559-70.

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