Anxiety sensitivity in smokers with indicators of cardiovascular disease

There is growing recognition of the importance of understanding the nature of the associations between anxiety and cardiovascular disease (CVD), although limited research has examined mechanisms that may explain the anxiety-CVD link. Anxiety sensitivity (fear of anxiety-relevant somatic sensations) is a cognitive-affective risk factor implicated in the development of anxiety psychopathology and various behavioral risk factors for CVD, although has not been examined among individuals with CVD. Adult daily smokers (n = 619; 50.9% female; M_age = 44.0, SD = 13.67) completed an online survey that included the Anxiety Sensitivity Index-3 (ASI-3) and the Patient Health Questionnaire (PHQ). The presence of CVD was assessed via the presence of ≥1 of the following: heart attack, heart murmur, positive stress test, heart valve abnormality, angina, and heart failure. Smokers with CVD indicators (n = 66, 10.7%) had significantly higher scores on the ASI-3 (M = 33.5, SD = 22.15), relative to smokers without CVD (M = 22.0, SD = 17.92; Cohen’s d = .57). Those with CVD were significantly more likely to have moderate or high anxiety sensitivity (66.7%) relative to those without CVD (49.4%). Physical and social concerns about the meaning of somatic sensations were common among smokers with CVD.     

Bender-Gestalt emotional indicators and acting-out behavior in young children.

This study was designed to investigate the relationship between 15 emotional indicators on the Bender-Gestalt Test and acting-out behavior in young children. The subjects were 93 children ranging in age from five to 12 years. Each was administered the Bender. A measure of each subject's overt acting-out behavior was then obtained by having teachers rate each student on a Behavioral Rating Scale. Subjects' records were then divided into groups on the basis of both sex and age. Results indicated that neither the total number of Bender indicators nor any of the individual Bender indicators were correlated significantly with total scores on the rating scale. Use of the Bender as a projective device to measure acting-out behavior was seriously questioned.     

Cardiac autonomic reactivity and recovery in predicting carotid atherosclerosis: the cardiovascular risk in young Finns study.

The present study examined the association of cardiac autonomic task-induced reactivity and recovery to preclinical atherosclerosis. Thirty-three men and 33 women aged 24-39 years participated in the ongoing epidemiological Cardiovascular Risk in Young Finns study. The authors measured heart rate (HR), respiratory sinus arrhythmia (RSA), and preejection period (PEP) during the mental arithmetic and speech tasks in 1999. Carotid atherosclerosis was assessed by measuring the thickness of the common carotid artery intima-media complex (IMT) with ultrasound in 2001. Higher HR, RSA, and PEP reactivity were associated with lower IMT values even after adjusting for cardiovascular risk factors (lipid levels, obesity, and blood pressure). In addition, better HR recovery after the mental arithmetic task was associated with lower IMT values, and this association persisted after all adjustments. Thus, higher task-induced cardiac autonomic reactivity and better HR recovery were related to less preclinical atherosclerosis. The authors concluded that cardiac pattern of reactivity and quick recovery may be associated with better cardiovascular health, and therefore all reactivity occurring in challenging situations should not automatically be considered as potentially pathological.     

The role of cardiovascular risk factors in Alzheimer's disease

The distinction between Alzheimer's disease and vascular dementia, the two most common types of dementia, has been undermined by recent advances in epidemiologic, clinical, imaging, and neuropathological studies. Cardiovascular risk factors, traditionally regarded as distinguishing criteria between the two entities, have been shown to be associated with both AD and vascular dementia. In this article, we propose mechanisms of action of cardiovascular risk factors in AD, suggest possible explanations for the overlap with vascular dementia and discuss the implications this might have on future differential diagnosis, research, and treatment strategies.     

Hypertension risk and caffeine's effect on cardiovascular activity during mental stress in young men

Examined the cardiovascular effects of caffeine plus behavioral stress in men low versus high in risk of essential hypertension. Caffeine (3.3 mg/kg, equivalent to 2 to 3 cups of coffee) or placebo was given on alternate days to 19 low-risk men (negative for parental hypertension and low-normal resting blood pressure, BP) and 20 high-risk men (positive history, high-normal BP). Forty minutes later, each worked for 15 min on a demanding psychomotor task during which BP, cardiac output, and vascular resistance were determined. During rest, caffeine raised vascular resistance in both groups. During the task, it supra-additively increased the systolic BP response by enhancing the rise in cardiac output, producing equivalent BP rises in both groups. Due to the higher resting pressures of the high-risk men, caffeine plus the task resulted in 50% of these having transient BP of 140/90 mg Hg or greater. Caffeine in combination with mental stress may produce undesirable BP in those at risk for hypertension.     

Anger and cardiovascular risk in adolescents

The present investigation examined the relationship between anger and elevations in cardiovascular risk among adolescents (n = 213). The adolescents were assessed on an anger index and also on certain physical (e.g., blood pressure, cholesterol) and psychological (e.g., anxiety, life dissatisfaction) variables associated with increased risk of cardiovascular diseases. The anger index, a composite of items from various sources, was factor analyzed, producing a terminal solution of two factors: frequent anger directed outward (FAO) and anger-producing situations (AS). Two factor scores were then computed for each subject. Regression analyses, controlling for age and sex, showed that the factor scores were predictive of the physical and psychological measures of cardiovascular risk, and that the factor scores were differentially related to these indices. These preliminary findings are supportive of systematic study both of the multidimensional nature of anger and of the associations of the dimensions of anger with indices of cardiovascular risk.     

Being at risk for cardiovascular disease: perceptions and preventive behavior in people with and without a known genetic predisposition

This study compares and explains differences in perceptions of cardiovascular disease (CVD) risk and preventive behaviors in people with and without a known genetic predisposition to CVD. A cross-sectional study using two samples was performed. The first sample (genetic predisposition; n?=?51) consisted of individuals recently diagnosed with familial hypercholesterolemia (FH) through DNA testing. The second sample (no genetic predisposition; n?=?49) was recruited among patients with CVD-risk profiles based on family history of CVD, cholesterol levels, and blood pressure, registered at general practices. Participants filled out a postal questionnaire asking about their perceived risk, causal attributions (i.e. genetic and lifestyle), and about perceived efficacy and adoption of preventive behavior (i.e. medication adherence and adoption of a healthy diet and being sufficiently active). Perceived comparative risk, genetic attributions of CVD, and perceived efficacy of medication were higher in the "genetic predisposition" sample than in the "no genetic predisposition" sample. The samples did not differ on lifestyle attributions, efficacy of a healthy lifestyle, or preventive behavior. Individual differences in perceived risk, genetic attributions, perceived efficacy of medication, and adoption of a healthy lifestyle were best explained by family history of CVD. Our findings suggest that in people diagnosed with a single gene disorder characterized by a family disease history such as FH, family disease history may be more important than DNA information in explaining perceptions of and responses to risk.     

Assessing the relationship of Type A beliefs to cardiovascular disease risk and psychosocial distress

Investigators have begun to take a multimodal approach to the assessment and treatment of psychosocial risk factors for cardiovascular disease (CVD). For instance, cognitive responses have become the focus of contemporary research along with continued examination of overt Type A behaviors. Price (1982) has outlined a set of beliefs purportedly associated with Type A behavior and subsequent CVD risk. The current study examines the validity of this belief set as represented by a newly developed measure, the Type A Cognitive Questionnaire (TACQ). Subjects were 221 employed adults participating in a worksite CVD risk reduction program. They completed the TACQ as part of a pretreatment CVD risk screening protocol. As hypothesized, TACQ scores were significantly associated with Type A behavior, hostility, physiological mediators of CVD, and psychosocial distress. Discussion addresses continued refinement of the Type A belief construct.     

Psychological risk factors in cardiovascular diseases

Recent research has shown that psychological risk factors play an important role in the pathogenesis of cardiovascular diseases. The so-called ‘coronary prone behaviour pattern’ predominates, an important part of which is the ‘Type A behaviour pattern’. This is characterized by a marked ambition, a constant feeling of being under pressure, due to latent aggression and to a striving to dominate. For cerebrovascular diseases the so-called ‘pressured pattern’ as a risk factor has been found to be typical which is comparable to the Type A behaviour. Psychological risk factors and their components are not equally important for different vascular diseases. Besides the explanation of the question as to how far psychological processes really are involved in the development of vascular diseases, the research on psychological risk factors serves as a foundation for psychosomatic theories.     

Vigilance, active coping, and cardiovascular reactivity during social interaction in young men.

This study of 72 undergraduate men examined the effects of two determinants of cardiovascular response-active coping and vigilance-on blood pressure and heart rate responses to social stressors. Observation of a future debate partner (i.e., vigilance) evoked larger increases in blood pressure than did observation of a less relevant person, apparently through the combination of increases in cardiac output and vascular resistance. Preparation and enactment of efforts to exert social influence (i.e., active coping) evoked heightened blood pressure and heart rate responses through increased cardiac contractility and output. Thus, both vigilance and active coping in social contexts increased cardiovascular reactivity, but apparently through different psychophysiological processes.     

Stability and change in work values among male and female nurses and engineers

Gender related changes of work values were analyzed in a longitudinal questionnaire study of 173 male and 48 female engineers and 353 female and 31 male nurses at three measurement occasions covering about four and half years from the end of their vocational education. At all occasions, Social relations were rated as more important by women than by men and Altruism was given higher ratings by the nurses than by the engineers. Within both occupations women's mean Altruism ratings were higher than men's mean ratings, and in all groups except male engineers the mean ratings dropped between the three occasions. Women's ratings of Benefits and career and Influence were strengthened in both occupations, thereby eliminating an initial gender difference. The stability of work values is discussed in terms of challenges and norms in working life.     

Competitive state anxiety and performance in young female rhythmic gymnasts

The study was designed to examine the competitive state anxiety and self-confidence of rhythmic gymnasts participating in the Greek national competition. 86 participants, ages 11 and 12 years, completed the Competitive State Anxiety Inventory-2, 1 hr. before competition. The athletes, classified by performance (high and low performance) and participation in the finals (finalists and nonfinalists), responded to the three subscales: Cognitive Anxiety, Somatic Anxiety, and Self-confidence. Analyses indicated differences in Self-confidence between high versus low performance groups and finalists versus nonfinalists. No significant differences were found on Cognitive and Somatic Anxiety. In a regression analysis, Self-confidence was the only significant predictor of performance for this sample. Implications refer to the development of strategies to enhance self-confidence in order to improve the gymnast's performance during competition.     

Depression and distress predict time to cardiovascular disease in dementia caregivers.

OBJECTIVE: This study assessed the impact of depressive symptoms and distress from patient problem behaviors on time to developing a diagnosis of cardiovascular disease (CVD) in a sample of 643 dementia family caregivers. DESIGN: A longitudinal, prospective design was used. Over an 18-month period, caregivers free from a CVD diagnosis at baseline were assessed at 6, 12, and 18-month follow-ups for the onset of CVD. MAIN OUTCOME MEASURES: Days to the onset of CVD was the primary outcome. RESULTS: Over the length of the study, 32 participants (5%) reported a diagnosis of CVD. After adjusting for sociodemographic and health factors (e.g., high blood pressure, age, smoking history), greater depressive symptoms (p = .040) and distress from patient problem behaviors (p = .034) were significant predictors of time to CVD diagnosis. CONCLUSION: This study suggests that increased depressive symptoms and reaction to patient problem behaviors (i.e., distress) may increase caregivers' risk for experiencing negative health outcomes, specifically CVD.     

Models of personality and disease: an interactional approach to type A behavior and cardiovascular risk

Type A behavior has been established as a risk factor for coronary heart disease. Enhanced cardiovascular and neuroendocrine responsiveness to stressors has been suggested as a pathophysiological link between the behavior pattern and disease. The present article describes a model that places this link in an interactional context. Specifically, it is hypothesized that via cognitive and overt behaviors, Type As construct a subjective and objective environment rich in those classes of stimuli known to elicit enhanced physiological reactivity. This approach differs from previous ones by emphasizing that the Type A pattern represents an ongoing process of challenge and demand engendering behavior. That is, Type A persons do not simply respond to challenges and demands; they seek and create them through their cognitions and actions. This constructed environment also elicits and maintains further Type A behavior. The present view of Type A behavior as a challenge and demand engendering style is contrasted with other conceptual approaches, and implications are discussed.     

Implications of Amae for HIV risk in Japanese young adults

Assertiveness, defined as perceived confidence to express true feelings in interpersonal relationships, has been reported to correlate with HIV risk avoidance. However, Japanese social structure encourages amae or self-repression. The present study investigated the implications of amae for HIV risk avoidance among Japanese university students. The results indicated that amae was antithetical to risk reduction.     

Selective cardiovascular effects of stress and cigarette smoking in young women

In an earlier study, we found that men who smoked a cigarette and then engaged in a mildly stressful activity (video game) evidenced pronounced increases in heart rate and blood pressure, which were approximately equal to the sum of the effects produced by either smoking alone or stress alone. In the present study, a 2 (smoke vs. sham smoke) X 2 (stress vs. no stress) factorial design was used to evaluate the impact of stress and smoking on the cardiovascular responses of young women. The results revealed that the combination of stress and cigarette smoking produced blood pressure and heart rate responses that were larger than the additive effects of smoking and stress taken separately.     

Subjective social status, objective socioeconomic status, and cardiovascular risk in women.

OBJECTIVE: Subjective perceptions of personal social status may relate to health beyond the effects of objective socioeconomic status (SES). The authors examined the relationship between subjective social status (SSS) and psychosocial, behavioral, and physical cardiovascular risk factors in middle-aged women. DESIGN: Ninety-two women (90.2% White) completed ladder-based, pictorial self-report measures of SSS relative to others in their community and in the United States. Psychosocial measures of depression, anxiety, pessimism, stress, and social support and behavioral risk factors of fruit and vegetable consumption, leisure physical activity, and body-mass index were obtained. In addition, women underwent measurement of clinic blood pressure and assessment of daytime ambulatory systolic and diastolic blood pressure (SBP; DBP) over 2 consecutive days. RESULTS: Community SSS was significantly inversely related to anxiety, pessimism, stress, and daytime ambulatory DBP after controlling for objective SES and U.S. SSS. Women with lower U.S. SSS showed less healthy dietary and exercise behaviors and, contrary to predictions, lower clinic and ambulatory DBP. CONCLUSION: This study provides additional evidence that perceptions of one's position in the social hierarchy could have important health implications beyond the impact of objective SES. Further, the cardiovascular risk implications of perceived community versus U.S. social status appear to be distinct.