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Identifier

000388633

Title

Κλινικές,βιοχημικές και ψυχοκοινωνικές συνιστώσες της καρδιαγγειακής νόσου σε ένα αγροτικό πληθυσμό της Κρήτης

Alternative Title

Clinical biochemical and psychosocial determinants of cardiovascular disease in a rural population of Crete

Author

Ανυφαντάκης, Δημήτριος

Thesis advisor

Λιονής, Χρήστος
Καστανάς, Ηλίας
Τσέτης, Δημήτριος

Reviewer

Μαργιωρής, Ανδρέας
Βγόντζας, Αλέξανδρος
Τζανάκης, Νικόλαος
Φιλαλήθης, Αναστάσιος

Abstract

Objective: The current thesis aimed at exploring the role of psychosocial determinants in the development of cardiovascular disease. Among the study objectives were: (a) the investigation through an extensive literature review of the relationship between psycho-social factors and cardiovascular disease (b) the design of a research protocol within primary health care environment that will illustrate with feasibility and relevance data of cardiovascular morbidity in relation to non traditional risk factors and c) the study of the effects of particular psycho-social determinants such as the sense of coherence, the religiosity and spirituality in a rural Cretan population, characterized by low levels of cardiovascular morbidity. Study population and methods In order to investigate the link between cardiovascular disease and psycho-social factors we performed a literature research of published articles in the electronic database MEDLINE (PubMed) by using MeSH terms. Two literature reviews were performed. As inclusion criteria for the first and second literature research were used: 1. studies that examined the effect of psycho-social factors in the development of cardiovascular disease 2. studies that evaluated to what extend chronic psycho-social stress represents an autonomous determinant of cardiovascular disease As exclusion criteria for the second literature search were used: 1. Studies published in non-English language 2. Non-randomized clinical trials. After that a research protocol was organized with the aim to study the role of psychosocial determinants and evaluate the cardiovascular risk in a primary care population of rural Crete. More 13 specifically we studied the role of religiosity/spiritually and of the sense of coherence with the use of international questionnaires translated into the Greek language and linguistically validated in association with other biological markers of cardiovascular disease. Among the parameters examined were: hypertension, diabetes, hyperlipidemia and smoking. Furthermore, we tested stress markers (serum cortisol levels) as well as preclinical markers of cardiovascular disease (ultrasound measurement of carotid intimae media thickness). Results: Literature research led to the classification of studies in five groups of psycho-social factors: personality A, socio-economical status, chronic stress, depression and social support. Organization of the research protocol concerned the second follow up of the SPILI cohort and examined the hypothesis of potential cardio-protective effect that may exert specific psychosocial factors in a high cardiovascular risk population with paradoxically low levels of cardiovascular disease. The main findings of this observational study was that participants with higher levels of religious and spiritual beliefs presented lower levels of carotid intimae media thickness and lower levels of serum cortisol levels. Furthermore, highly religious participants presented lower prevalence of hypertension, diabetes and cardiovascular disease. Furthermore sense of coherence was positively associated with religiosity and spirituality. Conclusions This project attempted to establish a link between psycho-social factors and cardiovascular health within a rural primary care setting in Greece. Despite the technical difficulties of the project, this is the first report in Europe of an inverse association between religiosity/spirituality in relation to carotid IMT. Furthermore, these findings are expected to shift the evaluation of the total cardiovascular risk towards a holistic model that takes also into account others non traditional cardiovascular risk factors.

Language

English

Subject

Cardiovascular disease

Psychosocial

Καρδιαγγειακή νόσος

Ψυχοκοινωνικές συνιστώσες

Issue date

2014-12-04

Collection

School/Department--School of Medicine--Department of Medicine--Doctoral theses

Type of Work--Doctoral theses