Smith Patrick J, Blumenthal James A
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA.
Rev Esp Cardiol. 2011 Oct;64(10):924-33. doi: 10.1016/j.recesp.2011.06.003. Epub 2011 Sep 1.
Psychosocial and behavioral factors, including mood (depression, anxiety, anger, and stress), personality (Type A, Type D, and hostility), and social support, are associated with both the development and progression of cardiovascular disease. "Negative" emotions have been associated with increased rates of cardiovascular death and recurrent cardiac events, although the mechanisms responsible for this association remain unclear. A number of pathophysiological mechanisms have been proposed to explain these relationships, including hypothalamic-pituitary-adrenal axis dysregulation, platelet activation, and inflammation. Behavioral factors also have been implicated, such as nonadherence to prescribed medical therapies and physical inactivity. Several randomized trials of patients with cardiovascular disease have examined the impact of pharmacologic and behavioral treatments on hard cardiovascular disease events as well as on cardiovascular disease biomarkers of risk. Although psychological treatments generally have been shown to improve quality of life and psychological functioning among cardiac patients, the benefit of psychological interventions with respect to improving clinical outcomes has not been conclusively demonstrated.
心理社会和行为因素，包括情绪（抑郁、焦虑、愤怒和压力）、人格类型（A型、D型和敌意）以及社会支持，与心血管疾病的发生和发展均相关。“负面”情绪与心血管疾病死亡率和心脏事件复发率的增加有关，尽管导致这种关联的机制尚不清楚。已经提出了许多病理生理机制来解释这些关系，包括下丘脑 - 垂体 - 肾上腺轴失调、血小板活化和炎症。行为因素也有牵连，如不遵守规定的药物治疗和身体活动不足。几项针对心血管疾病患者的随机试验研究了药物和行为治疗对严重心血管疾病事件以及心血管疾病风险生物标志物的影响。虽然心理治疗通常已被证明可改善心脏病患者的生活质量和心理功能，但心理干预在改善临床结局方面的益处尚未得到确凿证明。
