Explain Stress and Psychosocial Tension in lifestyle risk factors?
Stress and psychosocial tension are other lifestyle factors in initiating coronary artery disease and precipitating 'heart attacks'. Many prospective and case-control studies have assessed for correlation oS depression, anxiety and neuroticism with CAD and almost all the studies consistently reported that emotional distress precedes the development of symptoms of coronary artery disease. Chronic stressful situations in jobs, family and social areas may aggravate the disease process. Material stress among women with established CAD has been shown to predict a poorer prognosis. Job related factors that appear to influence the induction or exacerbation of CAD include perceived job stress, role ambiguity, job autonomy, high demand and low decision latitude, change of assignment, unemployment and retirement etc.
The effect of stress is mediated through the sympathetic nervous system and hormones - the stress hormones like adrenaline and nor-adrenaline; the steroid hormone such as cortisols and other hormones like renin and aldosterone, These hormones increase heart rate and blood pressure, cause endothelial damage and dysfunction, promote atherosclerosis and thrombosis, and cause coronary spasm.
In the predisposition to CAD the role of personality especially the type A has also been considered to be of some importance. Type A people are characterised as highly ambitious, competitive, exacting in attitude, impatient, deadline oriented and in a constant struggle with the environment. In contradistinction, Type B people are more passive, not in a hurry, take time to relax, pursue hobbies and other recreations 'and less disturbed by environmental stress. The Western collaborative Study Group showed that Type A men had more than twice the prevalence of CAD as Type B men. In the Framingham Heart Study Type A behaviour patterns were associated with a two-fold increase in the development of angina pectoris and also a high rate of silent myocardial infarction. The mechanism by which Type A personality traits could influence atherogenesis is not clear. But it could be related to increase in the risk imparted by stress and the whole process modulated by the personal response. Studies have shown increased adrenergic receptor density in the healthy offspring of parents with documented premature CAD and Type A personality and this increased receptor density is compatible with increased peripheral alpha-receptor activity, rise in blood pressure and coronary vasoconstriction. However Type A people react differently even in non-stressful situations and so stress cannot be talent as the sole mechanism of increased risk in such type of persons. Not all the elements in behaviour of Type A personality have significant coronary risk; it is mostly the negative elements like hostility, cynicism etc., that confer the increased risk in such persons.