1. Coronary Heart Disease

2. Leading Causes of Death Middle age –Sudden death due to heart attack or stroke –Cancer Elderly –Heart disease –Cancer –Stroke

3. Coronary Artery Disease Atherosclerosis Arteriosclerosiss  Ischemia  Coronary Heart Disease   Angina Myocardial Pectoris Infarction

4. Symptoms of a Heart Attack Uncomfortable pressure or pain in the center of the chest that lasts for more than a few minutes Pain spreading to shoulders, neck, or arms Shortness of breath Light-headed, fainting, sweating, nausea In women, severe abdominal pain or indigestion

5. When do heart attacks occur? Less likely during sleep. Among the employed, more often on a Monday between 6 and 11 am. –In part due to waking and becoming active shortly after dreaming which increases BP. –In part because of circadian rhythm effects, increases in arousal hormones and blood pressure.

6. Biological Risk Factors Age Gender Diabetes Family history Obesity

7. Behavioural Risk Factors Sociocultural Hypertension Cigarette smoking Cholesterol levels Diet Physical inactivity Stress Type A behaviour Hostility/anger

8. Type A Behaviours Achievement orientation Time urgency Anger/hostility Result = Coronary Prone Personality

9. Why is Type A linked to heart disease? Greater Physiological Reactivity Behavioural Factors Emotions

10. Hostility/Anger Cynicism Mistrust Denigration

11. Depression/Anxiety Evaluations of life Hopelessness and helplessness

12. Psychosocial Predictors of Sudden Cardiac Death 0 200 400 600 800 1.000.950.900.85 Survival in days Placebo, BDI <10 Placebo, BDI >10 AMIO, BDI <10 AMIO, BDI >10 ProportionSurviving

13. Rehabilitation Promote recovery Reduce risk of another attack

14. Rehabilitation Reduce behavioural risk factors Exercise Stress management