Behavioral patterns, social and moral attitudes as additional risk factors for myocardial infarction

The dissertation is devoted to the study of behavioral patterns, as well as social and moral attitudes of the personality as additional, relatively independent of traditional biological factors, predictors of the occurrence and course of myocardial infarction in patients with coronary heart disease. The work aims to improve cardiovascular risk stratification by incorporating psychological characteristics into the comprehensive assessment: life-meaning orientations, personality self-actualization, and behavioral patterns. Based on clinical, functional, and psychological examination of patients with coronary heart disease and a control group, as well as statistical and factor analysis of the obtained data, the contribution of personality characteristics to the development of an acute coronary event, the features of the clinical course of myocardial infarction, and the social and professional functioning of patients prior to its development are evaluated. The study is aimed at identifying high-risk groups for whom early preventive and prophylactic interventions are indicated.

Relevance

Cardiovascular diseases are the leading cause of death among men and women in Europe and account for half of all mortality on the continent [Belyalov F.I., 2002; Skoromets A.A. et al., 2003; Oganov R.G. et al., 2005; European Charter for Heart Health, 2008]. The causes of the high morbidity and mortality from cardiovascular diseases in Russia were global social upheavals, as a result of which an increase in mortality from myocardial infarction has been observed since 2001 [Oshtchepkova E.V., 2009].

Psychogenic, personality, and socio-psychological factors play a leading role in the development of cardiovascular diseases [Smulevich A.B., Syrkin A.L., 2005; Dovzhenko T.V., 2005; Gafarov V.V., 2006; Poluektova E.A., 2006]. A consequence of the development of civilization is a sharp increase in mental and informational loads and the complication of social adaptation [Oganov R.G. et al., 2005; Boeva O.I., 2006; Shapiro P., 1996; Havranek E. and al., 1999; Tango R.C., 2003]. The level of activity and initiative of the individual decreases [Pogosova G.V., 2002]. Social maladaptation sets in, and the meaning of life and its values change [Denollet J., 2003, 2005].

In recent years, interest has grown in the comorbidity of affective disorders and myocardial infarction [Vasyuk Yu.A., 2009].

The main strategy for the prevention and treatment of cardiovascular diseases is the reduction of total cardiovascular risk, which has the greatest medical and social effect [Oganov R.G., 2007]. All this dictates the need for timely identification and adequate treatment of psychoemotional disorders in patients with cardiovascular diseases [Buldakova N.G., 2006; Poluektova E.A., 2006; Jürgen B., 2005]. The search for new psychological factors whose role in the pathogenesis of coronary heart disease has yet to be determined is relevant [Gafarov V.V. et al., 2006; Chi J.S., Kloner R.A., 2003].

The aim of the study is to improve the stratification of myocardial infarction risk by examining personality characteristics in patients with coronary heart disease (life-meaning orientations, self-actualization, and behavioral patterns) as independent risk factors for its development and various courses.

Research objectives:

1. To investigate in patients with coronary heart disease the quantitative and qualitative changes in life-meaning orientations, self-actualization, and role patterns that precede the development of myocardial infarction over a number of years.

2. To study the considered psychological characteristics in patients with various risk factors for the onset and progression of coronary heart disease and to evaluate them as independent risk factors for the development of myocardial infarction.

3. To identify the characteristics of the course of myocardial infarction in patients with and without concomitant personality changes.

4. To investigate the social and professional functioning of patients with coronary heart disease before the development of myocardial infarction and the influence of changes in life-meaning orientations, self-actualization, and role patterns on functioning.

5. To evaluate the contribution of personality characteristics to the development of myocardial infarction in various clinical groups of patients with coronary heart disease.

Scientific novelty of the research:

— it has been established that changes in life-meaning orientations, self-actualization, and role patterns in patients with coronary heart disease are risk factors for the development of myocardial infarction;

— it has been proven that the course and prognosis of myocardial infarction are associated with personality characteristics in patients with coronary heart disease prior to the development of an acute coronary event;

— it has been revealed that patients with coronary heart disease who have high scores on the methods for studying life-meaning orientations and behavioral patterns seek medical care belatedly when symptoms of acute coronary syndrome occur, and as a result they do not receive systemic thrombolytic therapy;

— it has been established that in all the considered clinical groups of patients with myocardial infarction, personality characteristics (life-meaning orientations, self-actualization, and behavioral patterns) explain more than 50% of the sample variance.

Practical significance of the research results

The practical significance of the study lies in the fact that the use of psychological questionnaires for studying life-meaning orientations, behavioral patterns, and the self-actualization test makes it possible to:

— identify groups of individuals without biological and fixed risk factors for the onset and progression of coronary heart disease who are predisposed to the development of myocardial infarction;

— based on the study of personality characteristics, modify the management tactics for individuals predisposed to the development of myocardial infarction;

— improve the implementation of preventive measures in the identified risk groups;

— anticipate the probability of a complicated course of myocardial infarction and apply appropriate preventive measures to combat the development of its complications at earlier stages of medical care.

Propositions submitted for defense:

1. Patients with coronary heart disease have features of life-meaning orientations, personality self-actualization, and behavioral patterns that precede the development of myocardial infarction.

2. In patients with myocardial infarction who have various risk factors for the development and progression of coronary heart disease, changes in life-meaning orientations, self-actualization, and behavioral patterns differ in their degree of expression, are independent of biological and fixed risk factors, and influence the course of myocardial infarction.

3. The diversity of personality changes in patients with myocardial infarction is determined by hidden regularities (factors) that can be identified and described in the form of corresponding factor structures.