Behavior and Arteriosclerosis

189 Pages·1983·11.41 MB·English

by  J. Alan Herd (auth.)

Behavior and
Arteriosclerosis
Behavior and
Arteriosclerosis
Edited by
J. Alan Herd
The Methodist Hospital
Houston, Texas
and
Stephen M. Weiss
National Heart, Lung, and Blood Institute
Bethesda, Maryland
Plenum Press . New York and london
Library of Congress Cataloging in Publication Data
Main entry under title:
Behavior and arteriosclerosis.
Includes bibliographical references and index.
1. Arteriosclerosis-Psychological aspects. I. Herd, J. Alan. II. Weiss, Stephen M.
[DNLM: 1. Arteriosclerosis. 2. Behavior. WG 550 B419]
RC692.B431983 616.1'36'0019 83-10932
ISBN-13: 978-1-4613-3675-4 e-ISBN-13: 978-1-4613-3673-0
001: 10.1007/978-1-4613-3-3673-0
© 1983 Plenum Press, New York
Softcover reprint of the hardcover 1st edition 1983
A Division of Plenum Publishing Corporation
233 Spring Street, New York, N.Y. 10013
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
Contributors
FLOYD E. BLOOM, M.D. Professor, The Salk Institute, P.O. Box 85800, San
Diego, California 92138
JOSEPH V. BRADY, PH.D. Professor of Behavioral Biology, Division of Behav
ioral Biology, The Johns Hopkins University, Baltimore, Maryland
21205
ROBERT S. ELIOT, M.D. Professor and Chairman, Department of Preventive
and Stress Medicine, University of Nebraska Medical Center,
Omaha, Nebraska 68105
RICHARD I. EVANS, PH.D. Professor of Psychology, Department of Psychol
ogy, University of Houston, Cullen Boulevard, Houston, Texas 77004
JOHN W. FARQUHAR, M.D. Director, Stanford Heart Disease Prevention
Program, Stanford University Medical School, Stanford, California
94305
DAVID C. GLASS, PH.D. Professor of Psychology, Graduate School and Uni
versity Center, City University of New York, 33 West 42 Street,
New York, New York 10036
L. HOWARD HARTLEY, M.D. Associate Professor of Medicine, Cardiovas
cular Division, Brigham & Women's Hospital, 75 Francis St., Bos
ton, Massachusetts 02115
J. ALAN HERD, M.D. Medical Director, Sid W. Richardson Institute for Pre
ventive Medicine, The Methodist Hospital, 6565 Fannin, MS S400,
Houston, Texas 77030
JOSEPH D. MATARAZZO, PH.D. Professor of Medical Psychology, Health Sci
ences Center, University of Oregon, Portland, Oregon 97201
PEKKA PUSKA, M.D. National Public Health Institute, Mannerheimintie
166, 00280 Helsinki 28, Finland
TERESA SEEMAN Doctoral Candidate, Epidemiology Program, Department
of Biomedical and Environmental Health Sciences, School of Public
Health, University of California, Berkeley, California 94720
S. LEONARD SYME, PH.D. Professor of Epidemiology, Department of
Biomedical and Environmental Health Sciences, School of Public
Health, University of California, Berkeley, California 94720 v
vi Contributors
STEPHEN WEISS, PH.D. Chief, Behavioral Medicine Branch, National Heart,
Lung & Blood Institute, Federal Building, Room 604, 7550 Wiscon
sin Avenue, Bethesda, Maryland 20205
DR. REDFORD B. WILLIAMS, M.D. Professor, Duke University Medical Cen
ter, Department of Psychiatry, Box 3416, Durham, North Carolina
27710
Preface
During the past decade, cardiovascular medicine has made significant strides
in the diagnosis and treatment of coronary heart disease and related disorders
as well as developing a better understanding of potential preventive, risk-reduc
ing measures. Highly sophisticated diagnostic instrumentation, surgical pro
cedures, and emergency medical care have undoubtedly contributed greatly to
the trend of declining mortality from cardiovascular events. In the course of
the extensive research efforts associated with this area, it has become increas
ingly apparent that the identified coronary risk factors share the common ele
ment of lifestyle as a major determiner of health behaviors associated with
these factors. Further, it is suspected that behavioral and environmental factors
may playa significant contributory role toward the etiology and progression of
arteriosclerosis through their effects on the central and peripheral nervous sys
tems and associated neurohormonal response.
Considerable research effort has been devoted to identifying the risks asso
ciated with smoking, elevated blood pressure, and serum cholesterol. Research
development and modification is being vigorously pursued. Behavioral research
exploring the role of psychological stress factors, social support networks,
stressful life events, and the Type AlB behavior patterns has uncovered poten
tially meaningful associations between behavioral factors and arteriosclerosis,
as discussed in the succeeding chapters of this book.
Continued progress toward ultimately identifying both the most effective
behavioral health approaches as well as toward uncovering biobehavioral
"mechanism" linkages will be limited by two factors: 1) the development of
conceptual models which adopt an integrative framework in assessing the rel
ative contributions of behavioral, neural, genetic, dietary constitutional, and
developmental factors to disease (as well as the synergistic or catalytic poten
tial resulting from interactions of the above); and 2) the development of train
ing opportunities necessary to prepare a cadre of scientists capable of taking
full advantage of such multidisciplinary approaches toward understanding the
mechanism of action as well as the techniques to treat and prevent cardiovas
cular disease.
This volume will attempt to address these issues by examining the various
lines of evidence linking behavioral and environmental factors to the develop
ment, progression, treatment, and prevention of arteriosclerosis. Following the
introduction, Behavior and Arteriosclerosis is organized into Parts: (I) biobe- vii
viii Prefaca
havioral research relating to arteriosclerosis; (II) the basic arteriosclerosis dis
ease process; (III) clinical manifestations and management; (IV) prevention of
arteriosclerosis; (V) research training; and (VI) overview and synthesis.
Part I, biobehavioral research, describes some of the findings of this new
interdisciplinary science that combines basic, clinical, and epidemiologic
research relating to arteriosclerosis.
Part II, the basic arteriosclerotic disease process, begins with consider
ation of the neurochemical mechanisms whereby somatomotor behavior and
associated physiological processes are influenced by environmental events. The
discovery of neurochemical substances and neurophysiological processes that
mediate pain, subjective responses, and neuroendocrine activities has provided
links between environmental events, brain biochemistry, and behavior.
The section continues with a consideration of the behavioral and physio
logical responses elicited by environmental events. Studies of behavior under
controlled laboratory conditions have revealed psychological mechanisms that
determine the behavioral and physiological responses to stressful, challenging
situations.
Next, Part II addresses the sociocultural factors associated with arterio
sclerotic cardiovascular disease. The relationship of social and cultural mobil
ity, type A-coronary-prone behavior patterns, and stressful life events with cor
onary heart disease suggests that interrupted social ties predispose individuals
to arteriosclerotic cardiovascular disease. Prospects for future research include
studies of the physiological mechanisms linking behaviors elicited by social fac
tors to pathogenesis of arteriosclerosis.
Finally, Part II discusses the pathogenesis of complications associated
with arteriosclerotic cardiovascular disease. The morbid consequences of this
disease are influenced not only by site and extent of lesions but also by neu
roendocrine mechanisms affecting cardiac rhythm, myocardial oxygen require
ments, platelet aggregation, and· thrombosis.
Part III, clinical manifestations and management, begins with principles
of behavior analysis. Experimental and clinical studies have revealed basic
determinants of behavior, and many research programs currently are con
cerned with the application of these principles to cardiovascular risk factor
reduction. Most attention has been given to the role of reinforcement schedules
and stimulus control factors in initiating desired behaviors. Future research
will reveal the role of these factors in maintaining behaviors for prevention of
arteriosclerosis over long periods of time.
The section continues with a discussion of patient characteristics that
influence outcomes of medical and surgical treatments. Just as clinical and
hemodynamic data can be used to predict the outcome of treatments, so can
behavioral and psychosocial variables be used to predict the benefits of medical
Preface ix
and surgical therapies. The need to identify predictors of pain relief with sur
gical management is especially salient at the present time.
Programs of cardiac rehabilitation are studying the interactions between
physical and psychological processes. Research results indicate that clinical
responses of patients recovering from myocardial infarction are influenced by
behavioral as well as physiological recovery processes. Much more information
is needed concerning the correlates of cardiovascular function and the behav
ioral consequences of severe cardiac disease. More attention needs to be
directed to methods for improving adherence to medical regimens for reducing
risk factors and increasing capacity for physical work.
Part IV, prevention of arteriosclerosis, begins with an analysis of psycho
social processes influencing behavior. Most of the processes related to risk fac
tors begin in childhood, and their development can be understood only by the
study of children and adolescents. A basic assumption for our efforts to prevent
arteriosclerosis is that risk factors are more capable of being prevented in chil
dren than of being reversed in adults. This assumption must be tested rigor
ously. In the meantime, it is apparent that once risk factors are established in
adults, intensive psychological, social, and educational efforts are required to
reverse them.
Part IV continues with a report of the results from comprehensive com
munity programs for control of cardiovascular diseases in this country and in
Europe. The main objective of these programs has been to reduce morbidity
and mortality from cardiovascular disease and to reduce risk factors for arte
riosclerosis. Even though enormous efforts must be made to reduce risk factors
in the community, some progress has been made. In addition, the recent reduc
tion in mortality from coronary heart disease in this country may be the result
of sociocultural influences occurring spontaneously; our approaches to preven
tion seek to harness the relevant social, psychological, and behavioral forces.
Prospects for biobehavioral research in the future depend on building our
resources for this research. Interdisciplinary research depends on training
young investigators in more than one field and supporting their research activ
ities. Because of the need for scientists with interdisciplinary experience, Part
V recommends instituting programs for training scientists in the psychological
and behavioral aspects of arteriosclerosis. The record shows that the National
Heart, Lung and Blood Institute has provided leadership in developing these
resources for biobehavioral research.
Part VI attempts to synthesize the issues raised and to suggest pros
pects for future biobehavioral research and research training in arteriosclerosis.
The impetus for this book came from several sources. We are indebted to
many senior investigators involved in various Arteriosclerosis Specialized Cen
ters of Research around the country, to the Working Group on Arteriosclerosis
of the National Heart, Lung and Blood Institute, to the Committee on Human
x Preface
Resources of the National Research Council, and to the many behavioral and
biomedical scientists who have devoted major portions of their scientific careers
to investigating the issues described herein.
Collectively, these sources of inspiration identified the basic concerns; our
efforts were directed, therefore, toward collation and synthesis into a single
volume to serve as a reference to the growing biobehavioral science community.
If the past ten years of activity presage the future, the next decade should
witness new insights into our understanding of the dynamics and interplay of
biobehavioral factors in health and illness. No greater contribution toward the
extension and quality of life can be achieved than acquiring such knowledge in
the prevention and control of the primary source of coronary heart disease:
arteriosclerosis.
Contents
Introduction: Emergence of Behavioral Medicine
J. Alan Herd
Part I. Biobehavioral Research Relating to Arteriosclerosis
1. Biobehavioral Research Relating to Arteriosclerosis 11
J. Alan Herd
Part II. Etiology and Pathogenesis of Arteriosclerosis
Overview: Biobehavioral Mechanisms in the Etiology and
Pathogenesis of Coronary Heart Disease 27
Redford B. Williams, Jr.
2. Physiologic and Neurobiologic Mechanisms in
Arteriosclerosis 33
Floyd E. Bloom and J. Alan Herd
3. Psychosocial Influences and the Pathogenesis of
Arteriosclerosis 45
David C. Glass
4. Sociocultural Risk Factors in Coronary Heart Disease 55
S. Leonard Syme and Theresa E. Seeman
5. Coronary Heart Disease and Sudden Death 73
Robert S. Eliot
Part III. Diagnosis, Treatment, and Rehabilitation
Overview: Biobehavioral Factors in the Clinical
Management of Arteriosclerotic Cardiovascular Disease 83
Redford B. Williams, Jr.
6. Behavior Analysis and Cardiovascular Risk Factors 87
Joseph V. Brady
7. Behavioral Processes and Treatment Outcomes in
Coronary Heart Disease 101
Redford B. Williams, Jr.
xi