04 Sep 2006

Psychosocial risk factors: how bad are they really for the patient Symposium

Prof. Hannah McGee

Session number: 918000
Session title: Psychosocial risk factors: how bad are they really for the patient?
Authors: McGee, H. Dublin, Ireland

Dr Annika Rosengren (Sweden) outlined a 52-country study of almost 30,000 people (INTERHEART) showing that across countries and in all regions of the world, stress (occupational, financial or home based) was associated with higher levels of heart disease. This was true when controlling for other risk factors such as blood pressure and obesity. The results are impressive in that they signal the impact of stress on heart disease across continents and cultures.

Dr Johan Denollet (Netherlands) then outlined type D personality (i.e. those with negative thoughts who are ALSO socially isolated) as a factor increasing the risk of cardiac events and/or poorer recovery. Identifying these patients means they can be targeted for more intense rehabilitation.

Dr Ronald von Kanel (Switzerkland) summarised the large body of evidence of the damaging effects of depression on the cardiac patient. He outlined possible biological pathways to explain how depression translated into poor cardiac outcome.Solutions for this are not so evident. Recent trials of pharmacotherapy and cognitive behavioural therapy have been only partially successful.

Finally, Dr Eric Brunner (England) described recent findings from the long-term study of UK civil servants (the Whitehall Study) which showed that iso-strain (job strain AND social isolation in work) combined to predict which staff were at increased risk of metabolic syndrome (a precursor to diabetes) almost 20 years later. Conclusion There is now strong evidence of the importance of psychosocial factors in the development and progression of heart disease. Interventions to use this evidence are wide-ranging – from working to develop heart-friendly workplaces to managing individual experiences of depression.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.