Alan Rozanski|James A. Blumenthal|Karina W. Davidson|Patrice G. Saab|Laura D. Kubzansky
The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice
St. Luke's-Roosevelt Hospital Center|Columbia University|Duke University Hospital|Duke Medical Center|Columbia University|Icahn School of Medicine at Mount Sinai|University of Miami|Harvard University
observational studies indicate psychologic factors strongly influence course coronary artery disease cad review examine new epidemiologic evidence association psychosocial risk factors cad identify pathologic mechanisms may responsible association describe paradigm studying positive psychologic factors may act buffer psychosocial risk factors highly prevalent associated unhealthy lifestyles describe potential role cardiologists managing factors management approaches include routinely screening psychosocial risk factors referring patients severe psychologic distress behavioral specialists directly treating patients milder forms psychologic distress brief targeted interventions number behavioral interventions evaluated ability reduce adverse cardiac events among patients presenting psychosocial risk factors although efficacy standalone psychosocial interventions remains unclear exercise multifactorial cardiac rehabilitation psychosocial interventions demonstrated reduction cardiac events furthermore recent data suggest psychopharmacologic interventions may also effective despite promising findings clinical practice guidelines managing psychosocial risk factors cardiac practice lacking thus review new approaches improve delivery behavioral services patient adherence behavioral recommendations efforts part emerging field behavioral cardiology based understanding psychosocial behavioral risk factors cad highly interrelated also require sophisticated health care delivery system optimize effectiveness