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Rapid response to:


Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP)

BMJ 2011; 342 doi: (Published 07 February 2011) Cite this as: BMJ 2011;342:d442

Rapid Response:

Consideration of psychosocial factors in improving cardiovascular health.

RE: Improving cardiovascular health at population level: 39 community
cluster randomized trial of Cardiovascular Health Awareness Program (CHAP)
Kaczorowski BMJ 2011; 2011; 342:d442

The debate of Psychosocial factors as a major coronary heart disease
(CAD) risk factor is ongoing. Many studies in the recent years have shown
that psychosocial factors promote atherosclerosis and adverse cardiac
events and they adversely contribute to the risk of coronary heart disease
and adherence to treatment . These include emotional factors like
affective disorder such as depression and anxiety disorders as well as
anger and hostility. Emotional factors can be further complicated by
chronic stressors like low social support, low socioeconomic status, work
stress, marital stress, and caregiver strain.

It is important to include the screening for psychosocial risk
factors in any community based cardiovascular health awareness programme.
The team can include a community psychiatric nurse along with the family
doctor, community nurse and pharmacist. There should be an appropriate
pathway for identification, appropriate intervention and follow-up with a
mental health team for patients with significant psychological and
behavioural distress and maladjustment.
The cardiovascular health awareness programme could incorporate
relaxation, exercise and stress management training and psycho education.

The etiological link of psychosocial factors as a risk for CAD
justifies the incorporation of behavioural and psychological interventions
in communities at risk of coronary heart disease and to improve the
prognosis of those with established CAD.


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Competing interests: No competing interests

16 February 2011
Dr Sobia Rafi
CT-3 Psychiatry
Dr Mustafa Sajeel SpR A&E
West Midland Deanery