6 From the Heartland Culture, Psychological Factors, and Coronary Heart Disease

This chapter describes relationship between psychological factors (emotions, attitudes, and behavior) and coronary heart disease (CHD) among different cultural groups. Health promotion in respect to risk factor modification has led to a reduction in CHD rates in Western countries; however, there remains a sharp discrepancy in these practices, as well as in health utilization in socially disadvantaged groups such as African Americans in the United States. Rapid socioeconomic and political changes, increasing urbanization, and the adoption of a westernized lifestyle contribute to the increasing rates of CHD in developing countries. Conventional and established risk factors, which may be influenced directly by lifestyle practices, are seen in varying degrees with different ethnic groups. These practices may aggravate or be protective in terms of CHD development. For example, on exposure to urban environments, certain ethnic groups are susceptible to physiological vulnerabilities (such as glucose intolerance) leading to the progression of CHD. There is a close interrelationship among culture, psychological factors, and development of CHD. This can be delineated by affect of lifestyle measures such as dietary practices, which may be harmful or protective; variations in smoking behavior; sedentary lifestyle; efforts at health compliance; socioeconomic factors; and migration and acculturation on CHD.