Many biological traits, clinical disorders or behaviors like elevated cholesterol; hypertension and smoking are known to increase the risk of Coronary heart disease (CHD). Nevertheless, most of these factors are rather poor predictors of heart disease in individuals. It is worth noting that even major risk factors are not necessary for CHD to occur. Thus, heart disease may occur in a non-smoker, who exercises daily and maintains normal blood cholesterol, normal glucose levels and a normal blood pressure. In most instances, mechanisms by which these factors increase the risk of CHD are also not entirely clear. The risk factor-CHD link therefore, is not so firm and clear, as is commonly thought. So, these factors better qualify as predictors or at the most contributors rather than causes of CHD.
Failure of classical risk factors to qualify as causative factors has prompted investigators to accept that CHD is a disease with multi-factorial causes. This has also broadened the search for other explanations for clinical CHD. One line of research has been pursuing the role of psycho-social factors like Type A behavior and stress in past 3 decades or so.
Type A is Coronary Prone Behavior
The concept of Type A behavior was introduced by Friedman and Rosenman. Persons with Type A behavior are ambitious, impatient, competitive, irritable and may respond to environmental challenges with hostility. In contrast, people with Type B behavior are more relaxed, deferent and unhurried (Table 1).
Contrasting Behavior Patterns
Type A
Type B
Chronic sense of urgency
Absence of time urgency
Impatience
Not impatient
Explosive speech
Calm and composed
Hostility
Absence of hostility
Guilt while relaxing
Relaxes without guilt
Cannot work in team
Co-operative
Over-critical
Encourages trust and openness in team
Association between Type A behavior and CHD was documented in 2 large
studies in the United States of America. One study conducted by Western
Collaborative Group in California found that CHD risk was 2-4 times
higher in men, with extreme Type A behavior. In Framingham Heart Study,
Type A behavior was significantly correlated with the risk of CHD
in both men and women.
Stress, Other Psycho-social Factors and the Risk of Coronary
Heart Disease
In addition to Type A behavior, stress may also increase the risk
of CHD. Stress is particularly common in certain situations such
as changes in life styles, retirement, grief and work-site challenges.
Negative emotions like anxiety, fear, boredom or depression are
also thought to increase the risk of CHD. Recently hostility and
anger were found to be important risk factors for CHD. Both letting
out anger and suppressing anger produce negative emotions, which
increases the risk of CHD.
Studies by Rahe and his colleagues documented that major life events
like retirement or death of the spouse precede heart attacks commonly.
Socio-cultural changes such as changes in living arrangements or
occupation have also been associated with an increase in the risk
of a heart attack.
How does Stress manifest ?
People differ in their capacity to deal with stress. Often, stress
may remain unnoticed due to insidious onset. Human body is equipped
to deal with stress up to a certain level. Persistent stress may
however, interfere with normal functioning, resulting in physical
symptoms and mood and behavioral changes as well as some psychosomatic
illnesses (Tables 2 and 3).
Manifestations of Stress
Physical
Emotional
Behavioral
Muscle tension
Loss of concentration
Changes in appetite
Shallow breathing
Anxiety
Difficulty sleeping
Nausea
Depression
Emotional swings
Headache
Negative feelings
Social withdrawal
Palpitations
Problems in solving difficulties
Excessive smoking
Backache
Drinking
Common Psychosomatic Illnesses
Bronchial asthma
Back ache
Irritable bowel syndrome
Migraine
Tension headache
Eczema
What can be done to help a stressed individual?
A number of stress management techniques are practiced for stress
management and altering coronary prone behavior. No single approach
or treatment has all the answers for a wide variety of human behavior.
The best strategy is to adopt an eclectic approach.
Relaxation Techniques
Persistent muscle tension associated with anxiety may disrupt normal
functioning of the body and may raise blood pressure too. Jacobsonian
method is a widely used relaxation technique. It consists of progressive
and systematic contraction and relaxation of each muscle group of
the body, starting from face, up to the toe, in order to attain a
state of complete relaxation. Deep breathing and physical massage
are other effective relaxation techniques (Table 4).
Relaxation Techniques
Direct Approaches
Indirect Approaches
Muscle relaxation
Music
Massage
Reading
Sauna
Recreation
Deep breathing
Walking
Yoga And Meditation
Yoga tones up muscles and joints of the body. These asanas (postures)
and meditation relieve physical tension and improve psychological
function.
