If a decade ago it was quite hard to find information about coronary heart disease (CHD) in scientific publications, nowadays there is an extensive literature related to psycho-social factors of the CHD development. The most consistent determinant of the CHD is a socioeconomic status. It has repeatedly been shown in epidemiological studies all over the world that the CHD is more common among people of a lower rather than a higher socioeconomic status. The lower socioeconomic position is considered to be a factor which constitutes a source of chronic psychological stress where lower control at work and more negative social interactions play essential roles.
Work stress as a form of chronic stress should be mentioned here. Within the concept of work stress two models have been proven to be valuable in researching the CHD. The first is the demand-control model, in which strain is thought to be greatest when high demands are coupled with a low control over the work environment. Second, the effort-reward imbalance model according to which adverse health effects arise when the effort put into work is not matched by appropriate rewards. Work stress measured within both models has been found to be associated with the increased incidence of the CHD independently of standard risk factors. Other forms of chronic stress (e.g., threatening neighborhood, poor marital quality or strained domestic relationship) represent triggers of various heart diseases such as the acute coronary syndrome and a sudden cardiac death, especially in people who already have advanced disease.
Social networks and social support are factors that are relevant to the CHD. It has been shown that less integrated men are at substantially higher CHD risk over the next 15 years. This result proves the idea that the smaller network and higher isolation the individual experiences, the higher risk for the CHD onset.
The other group of risks for the CHD is psychological. It include such personality traits as depression, anxiety, hostility, and anger. A number of studies have shown that depression following the acute coronary syndrome is associated with an increased risk of future cardiac diseases and with greater mortality. Additionally, it has been revealed that anger could act as an acute trigger of the acute coronary syndrome incidence. Strike and Steptoe (2005) used an interview with the patients, who had survived the acute coronary syndrome indicated that a proportion of respondents reported having experienced severe anger in two hours before the symptom incidence. In addition, this relationship turned out to be greater in people with lover socio-economic status, assuming an interaction between long-term and acute psychosocial factors in promoting risk.
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