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Gesundheitswesen 2005; 67(1): 1-8
DOI: 10.1055/s-2004-813907
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Psychosoziale Faktoren bei koronarer Herzkrankheit - wissenschaftliche Evidenz und Empfehlungen für die klinische Praxis

Psychosocial Factors in Coronary Heart Disease - Scientific Evidence and Recommendations for Clinical PracticeC. Albus1 , G. De Backer2 , N. Bages3 , H.-Ch Deter4 , C. Herrmann-Lingen5 , B. Oldenburg6 , S. Sans7 , N. Schneiderman8 , R. B. Williams9 , K. Orth-Gomer10
  • 1Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universität zu Köln
  • 2Abteilung für Public Health, Universität Ghent, Belgien
  • 3Institut für Konsil-Psychologie und -Psychiatrie, Universitäts-Klinik, Barcelona, Spanien
  • 4Abteilung für Psychosomatik und Psychotherapie, Charite - Universitätsmedizin, Berlin
  • 5Abteilung für Psychosomatik und Psychotherapie, Universität Göttingen
  • 6Abteilung für Public Health, University of Quensland, Australien
  • 7Institut für Gesundheitsforschung, Katalanische Gesundheitsbehörde Barcelona, Spanien
  • 8Abteilung für Psychologie, University of Miami, USA
  • 9Abteilung für Verhaltensmedizinische Forschung, Duke-University, North-Carolina, USA
  • 10Abteilung für Public Health, Karolinska Institutet, Stockholm, Schweden
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Publication History

Publication Date:
25 January 2005 (online)

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Zusammenfassung

Niedriger sozioökonomischer Status, Mangel an sozialer Unterstützung und soziale Isolation, Stress am Arbeitsplatz und im Privatleben sowie negative Emotionen, v. a. Depressivität und Feindseligkeit, erhöhen das Risiko für ein erstes kardiales Ereignis und führen zu einer schlechteren Prognose bei bestehender koronarer Herzkrankheit (KHK). Der Effekt vermittelt sich zum einen über negative Auswirkungen psychosozialer Risikofaktoren auf das Gesundheitsverhalten (z. B. Rauchen, Fehlernährung, Bewegungsmangel, niedrige Inanspruchnahme medizinischer Ressourcen), zum anderen über plausible psychophysiologische Mechanismen (z. B. Störungen der autonomen und hormonalen Regulation), die über metabolische, inflammatorische und hämostatische Auswirkungen direkt zur Pathogenese der KHK beitragen. Interventionen zur Beeinflussung psychosozialer Riskofaktoren sind verfügbar und haben mehrheitlich positive Effekte sowohl auf Risikofaktoren als auch - teilweise - auf den Verlauf der KHK gezeigt. Die Prävention der KHK sollte deshalb ein Screening hinsichtlich psychosozialer Risikofaktoren und die Einleitung geeigneter Interventionen einschließen. Empfehlungen zum Screening, zur Verhaltensmodifikation sowie zur weitergehenden Behandlung psychosozialer Risikofaktoren in der klinischen Praxis werden vorgestellt.

Abstract

Psychosocial risk factors like low socio-economic status, lack of social support and social isolation, chronic work or family stress, as well as negative emotions, e. g. depression and hostility, contribute significantly to the development and adverse outcome of coronary heart disease (CHD). Negative effects of psychosocial risk factors are conveyed via behavioural pathways including unhealthy lifestyle, e. g. food choice, smoking, sedentary life, inadequate utilisation of medical resources, and psychobiological mechanisms like disturbed autonomic and hormonal regulation: all these factors contribute to metabolic dysfunction and inflammatory and haemostatic processes, which are directly involved in the pathogenesis of CHD. Interventions to improve pychosocial factors are available and have demonstrated positive effects on risk factors and - at least in part - on CHD morbidity and mortality. The prevention of CHD should therefore include screening for psychosocial risk factors and adequate interventions. Recommedations for the screening of risk factors, behavioural change and further management of psychosocial risk factors in clinical practice are pointed out.

Schlüsselwörter

Koronare Herzkrankheit - psychosoziale Risikofaktoren - Prävention

Key words

Coronary heart disease - psychosocial risk factors - prevention

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Dr. med. Christian Albus

Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universität zu Köln

Joseph-Stelzmann-Straße 9

50924 Köln

Email: Christian.albus@uk-koeln.de