participate. Also, if adherence is geared toward the physical capacities of those
involved, and the demand is not too rigorous, the possibility of success is improved. Thus, regimens that avoid lengthy stress-reduction procedures, starvation
diets, and excessive exercise demands may require longer to achieve their goals,
but may be more likely to obtain adherence.
In summary, the studies reviewed in this chapter suggest that emotional stressors (including unstable environments), poor dietary practices (including alcohol
abuse and excessive ingestion of fats and sugar), and a sedentary lifestyle can
combine and interact to promote the pathogenesis of CHD. We have emphasized
the roles that insulin metabolism and activation of the SNS play in mediating
the relationships between behavioral variables on the one hand and CHD morbidity and mortality on the other hand. Throughout our discussion, we emphasized how emotional stressors, poor diet, and a sedentary lifestyle set the stage
for a cluster of health problems, including obesity, hypertension, NIDDM, and
dyslipidemia. Although genetic factors play a major role in each of these conditions, the expression of these conditions is heavily influenced by behavioral
factors. Just as the pathogenesis of these disorders is related to behavioral variables, a multimodal behavioral approach to primary and secondary prevention
could make a major contribution to reductions in CHD morbidity and mortality.
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