HHS Public Access Author manuscript Author Manuscript
Female Patient (Parsippany). Author manuscript; available in PMC 2016 February 26. Published in final edited form as: Female Patient (Parsippany). 2009 February ; 34(2): 42–45.
Heart Disease Risk for Female Cardiac Caregivers Brooke Aggarwal, EdD [Post-doctoral Research Fellow, Preventive Cardiology] and Lori Mosca, MD, MPH, PhD [Professor of Medicine and Director, Preventive Cardiology] Department of Medicine, Columbia University, New York, NY.
Abstract Author Manuscript
Care for patients with cardiac disease is primarily provided by female family members and spouses, most of whom are postmenopausal, adding a risk factor for cardiovascular disease in the caregiver herself. Approximately 33% of Americans have some form of cardiovascular disease (CVD), making it the leading killer of both men and women.1 Assistance with care for those diagnosed with CVD is primarily provided by informal caregivers—eg, family members and spouses—most of whom are women. Recent data suggest that women caring for family members or spouses with CVD may themselves be at higher risk for cardiac problems.2 This additional burden appears to increase the CVD risk for caregivers primarily due to lifestyle and psychosocial risk factors.
Author Manuscript
Despite the substantial body of literature on the health impact of caring for loved ones with diseases such as dementia or cancer, there are limited data available on cardiac caregivers’ own risk for heart disease. Because studies show that more than 50% of US women will care for a family member at some point during their adult lives, health care professionals need to be aware of the risks their patients may face when providing care for a spouse or relative with cardiac disease.3 Although spouses unquestionably offer social support for each other, all of the physical, emotional, and financial strain experienced after a coronary event may lead to depression and reduced quality of life for both the patient with CVD and the partner. This, in turn, can negatively affect recovery and increase patients’ morbidity and mortality.4 However, caregiving itself has recently been identified as an independent risk factor for coronary heart disease, with caregivers having an almost 2-fold higher risk.5
Author Manuscript
DEFINITIONS Cardiac caregivers are typically family members, spouses, or friends who provide assistance for patients who have been hospitalized for CVD. Caregivers of patients with cardiac disease are often responsible for managing the patient’s treatment regimen—administering medications, accompanying the patient to physician visits, and preparing prescribed meals for the patient. Caregiver strain can be quantified as the accumulated physical, emotional, and/or financial burden experienced by spouses, family, and friends who provide varying degrees of care for
Aggarwal and Mosca
Page 2
Author Manuscript
the patient.6 Caregivers may be subject to strain due to difficulties with navigating the health care system, disturbed sleep, family adjustments and restructuring of family roles, changes in personal plans, emotional upheaval, physical pain, time demands, distressing patient behavior, and financial problems.
PREVALENCE According to the CDC, approximately 53 million Americans are currently serving as informal caregivers for patients with a variety of illnesses. In a recent survey among California residents, 16% were serving as caregivers; of these, an estimated 59% to 75% were women, most of whom were married.7 The average age in this group of women was 51 years—ie, perimenopausal or postmenopausal.
Author Manuscript
Using data from the National Institutes of Health’s Family Intervention Trial for Heart Health (FIT Heart), the authors looked at the prevalence of caregiving among 501 family members of patients hospitalized with CVD who agreed to participate in a screening and educational intervention study. The study sought to document the association between caregiving and lifestyle and psychosocial risk factors associated with CVD (Table). It was found that 39% of the sample described themselves as primary caregivers, with 11% caring for patients most of the time, 32% providing care some of the time, and 18% not involved in caring for the patient.2 The overwhelming majority (81%) of the primary caregivers were women, and 12% of family members in this role were experiencing a high level of caregiver strain.
CAREGIVER STRAIN Author Manuscript
Caregiver strain may be an unrecognized barrier to adherence to CVD prevention strategies. In the FIT Heart study, participants experiencing high caregiver strain had significantly higher levels of depression and lower levels of social support compared with those who did not exhibit caregiver strain. Specifically, caregiver strain was associated with poor compliance with weight management behaviors such as decreasing saturated fat intake and waist circumference and increasing physical activity. Caregivers may have difficulty adhering to these CVD risk-reduction recommendations for diet and exercise due to excessive demands on their time, as well as fear and anxiety about the patient’s health. For example, caregivers may be afraid to leave the patient alone to participate in physical activity, and inactivity is a well established risk factor for CVD.8,9 FOCUSPOINT
Author Manuscript
Caregivers may have difficulty adhering to these CVD risk-reduction recommendations for diet and exercise due to demands on their time, as well as anxiety about the patient’s health. There may also be complex biologic pathways that contribute to the relationship between caregiving and poor health, with stress playing an important role.10 For example, one study showed that chronic stress, such as that experienced by mothers caring for a chronically ill child, is associated with accelerated shortening of telomeres—the markers of cellular aging.11 The authors found that caregiving itself was not predictive of telomere length
Female Patient (Parsippany). Author manuscript; available in PMC 2016 February 26.
Aggarwal and Mosca
Page 3
Author Manuscript
compared with controls, but rather that the risk factor was the number of years of caregiving stress. In a study of spousal caregivers of dementia patients, the caregivers who reported distress and a low level of social support experienced negative changes in immune function at 13-month follow-up.12 When a theoretical model connecting caregiving stress and coronary heart disease was tested, it was found that caregivers of patients with Alzheimer disease experienced chronic stress leading to the development of metabolic syndrome and, in turn, CVD.13 Caregiver strain may increase symptoms of depression, which increase strain even further and reduce the caregiver’s ability to cope with her responsibilities and stress. In addition, a large body of evidence suggests that depression is a significant risk factor for CVD.14,15
RECOMMENDATIONS Author Manuscript
Family members of patients with cardiac disease may represent a unique population at risk for CVD due to shared genes, lifestyle, and/or caregiving strain.16 Caregivers, in particular, may be less likely to participate in preventive health behaviors involving diet and exercise, and may be burdened by depression and a lack of support. All of these factors make this group of women candidates for urgent education and intervention by health care professionals.16 Specific strategies include:
Author Manuscript Author Manuscript
•
Discussing caregiving responsibilities as a routine part of assessment for CVD risk in all female patients, evaluating both the mental and emotional strain on the caregiver
•
Providing health information and emotional support for both the caregiver and the patient, as recommended by research on family systems and risk for CVD; caregivers often feel anxiety about the patient’s health, such that spouses may report greater psychological distress than patients with cardiac disease17
•
Screening female patients who are caregivers for depression and other psychosocial risk factors for CVD, as depression is often associated with caregiving; patients with positive results should be referred as appropriate
•
Implementing family-based approaches, which tend to be more effective in interventions related to illness18; treatment plans should focus on the family as a whole, and are more successful if, for example, the patient with cardiac disease is not the only one eating baked fish for dinner while the rest of the family is eating pizza
•
Integrating family therapy into medical practice and cardiac rehabilitation settings as part of the treatment plan, so that a comprehensive team is available to help address concerns of the patient and caregiver; as the family structure may undergo significant change following an acute cardiac event, health care professionals can direct patients and families to helpful resources such as the American Heart Association’s Web site for caregivers (www.americanheart.org/caregiver).
FOCUSPOINT
Female Patient (Parsippany). Author manuscript; available in PMC 2016 February 26.
Aggarwal and Mosca
Page 4
Author Manuscript
Family members of patients with cardiac disease may represent a unique population at risk for CVD due to shared genes, lifestyle, and/or caregiving strain. Overall, a treatment model that promotes optimal patient conditions while maintaining the caregiver’s well-being should be the target of all medical efforts, with the help of social and psychological services as needed.
CONCLUSION Health care professionals should be aware that female patients serving as cardiac caregivers may be at increased risk of CVD themselves. The high prevalence of women in this role certainly suggests that routine assessment of caregiving responsibilities in the clinical setting is appropriate, with liberal indications for referral to preventive, educational, and mental health services.
Author Manuscript
REFERENCES
Author Manuscript Author Manuscript
1. [Accesssed October 15, 2008] Heart disease and stroke statistics: 2008 Update At-A-Glance. American Heart Association Web site. www.americanheart.org/downloadable/heart/ 1200078608862HS_Stats%202008.final.pdf. 2. Aggarwal B, Liao M, Christian A, Mosca L. Influence of caregiving on lifestyle and psychosocial risk factors among family members of patients hospitalized with cardiovascular disease. J Gen Int Med. In press. 3. Moen P, Robison J, Fields V. Women’s work and caregiving roles: a life course approach. J Gerontol. 1994; 49(4):S176–S186. [PubMed: 8014401] 4. Vaccario V, Kasl SV, Abramson J, Krumholz HM. Depressive symptoms and risk of functional decline and death in pa-tients with heart failure. J Am Coll Cardiol. 2001; 38:199–205. [PubMed: 11451275] 5. Lee S, Colditz GA, Berkman LF, Kawachi I. Caregiving and risk of coronary heart disease in U.S. women: a prospective study. Am J Prev Med. 2003; 24(2):113–119. [PubMed: 12568816] 6. Robinson BC. Validation of a Caregiver Strain Index. J Gerontol. 1983; 38(3):344–348. [PubMed: 6841931] 7. Scharlach, A.; Sirotnik, B.; Bockman, S.; Neiman, M.; Ruiz, C.; Dal Santo, T. A Profile of Family Caregivers: Results of the California Statewide Survey of Caregivers. Berkeley, CA: Center for the Advanced Study of Aging Services, University of California Berkeley; 8. Sundquist K, Qvist J, Johansson SE, Sundquist J. The longterm effect of physical activity on incidence of coronary heart disease: a 12-year follow-up study. Prev Med. 2005; 41(1):219–225. [PubMed: 15917014] 9. McGrath PD. Review: exercise-based cardiac rehabilitation reduces all-cause and cardiac mortality in coronary heart disease. ACP J Club. 2004; 141(3):62–63. [PubMed: 15518446] 10. Vitaliano PP, Zhang J, Scanlan JM. Is caregiving hazardous to one’s health? A meta-analysis. Psychol Bull. 2003; 129(6):946–972. [PubMed: 14599289] 11. Epel ES, Blackburn EH, Lin J, et al. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci USA. 2004; 101(49):17312–17315. [PubMed: 15574496] 12. Kiecolt-Glaser JK, Dura JR, Speicher CE, Trask OJ, Glaser R. Spousal caregivers of dementia victims: longitudinal changes in immunity and health. Psychosom Med. 1991; 53(4):345–362. [PubMed: 1656478] 13. Vitaliano PP, Scanlan JM, Zhang J, Savage MV, Hirsch IB, Siegler IC. A path model of chronic stress, the metabolic syndrome, and coronary heart disease. Psychosom Med. 2002; 64(3):418– 435. [PubMed: 12021416] 14. Glassman AH, Shapiro PA. Depression and the course of coronary artery disease. Am J Psychiatry. 1998; 155(1):4–11. [PubMed: 9433332]
Female Patient (Parsippany). Author manuscript; available in PMC 2016 February 26.
Aggarwal and Mosca
Page 5
Author Manuscript
15. Mosovich SA, Boone RT, Reichenberg A, et al. New insights into the link between cardiovascular disease and depression. Int J Clin Pract. 2008; 62(3):423–432. [PubMed: 18028386] 16. Mosca L, Banka CL, Benjamin EJ, et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation. 2007; 115(11):1481–1501. [PubMed: 17309915] 17. Moser DK, Dracup K. Role of spousal anxiety and depression in patients’ psychosocial recovery after a cardiac event. Psychosom Med. 2004; 66(4):527–532. [PubMed: 15272098] 18. Campbell TL, Patterson JM. The effectiveness of family interventions in the treatment of physical illness. J Marital Family Ther. 2007; 21(4):545–583.
Author Manuscript Author Manuscript Author Manuscript Female Patient (Parsippany). Author manuscript; available in PMC 2016 February 26.
Aggarwal and Mosca
Page 6
Author Manuscript
Continuing Medical Education Goal To explore the connection between caring for patients after cardiac events and the development of cardiovascular disease (CVD) in women. Objectives
Author Manuscript
1.
To examine the various stress factors experienced by women caring for patients with cardiac disease.
2.
To look at how these factors in turn increase the risk of CVD in the female caregiver.
3.
To suggest ways in which health care professionals can screen for and reduce caregiver strain in female patients as a means of decreasing CVD risk.
Accreditation This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Albert Einstein College of Medicine and Quadrant HealthCom Inc. Albert Einstein College of Medicine is accredited by the ACCME to provide continuing medical education for physicians. This activity has been peer reviewed and approved by Brian Cohen, MD, Professor of Clinical ObGyn, Albert Einstein College of Medicine. Review date: January 2009. It is designed for ObGyns, primary care physicians, and nurse practitioners.
Author Manuscript
Albert Einstein College of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Participants who answer 70% or more of the questions correctly will obtain credit. To earn credit, see the instructions on page 00 and mail your answers according to the instructions on page 00. Conflict of Interest Statement
Author Manuscript
The “Conflict of Interest Disclosure Policy” of Albert Einstein College of Medicine requires that authors participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical or equipment company. Any author whose disclosed relationships prove to create a conflict of interest, with regard to their contribution to the activity, will not be permitted to publish. The Albert Einstein College of Medicine also requires that faculty participating in any CME activity disclose to the audience when discussing any unlabeled or investigational use of any commercial product, or device, not yet approved for use in the United States. The authors report no conflict of interest and no discussion of off-label use. Dr Cohen reports no conflict of interest. The staffs of CCME of Albert Einstein College of
Female Patient (Parsippany). Author manuscript; available in PMC 2016 February 26.
Aggarwal and Mosca
Page 7
Author Manuscript
Medicine and The Female Patient have no conflicts of interest with commercial interest related directly or indirectly to this educational activity.
Author Manuscript Author Manuscript Author Manuscript Female Patient (Parsippany). Author manuscript; available in PMC 2016 February 26.
Aggarwal and Mosca
Page 8
TABLE
Author Manuscript
Profile of the Cardiac Caregiver2 Characteristics associated with primary caregiving •
Female gender
•
Age ≥50
•
Married/living with partner
•
Lower education level
•
Unemployed
Cardiovascular risk factors associated with caregiving*
Author Manuscript
•
Depression
•
Decreased social support
•
Increased waist size
•
Reduced physical activity level
•
Higher saturated fat intake
•
Higher body mass index
*
Adjusted for age, gender, and marital status
Author Manuscript Author Manuscript Female Patient (Parsippany). Author manuscript; available in PMC 2016 February 26.
Female Patient (Parsippany). Author manuscript; available in PMC 2016 February 26. Published in final edited form as: Female Patient (Parsippany). 2009 February ; 34(2): 42–45.
Heart Disease Risk for Female Cardiac Caregivers Brooke Aggarwal, EdD [Post-doctoral Research Fellow, Preventive Cardiology] and Lori Mosca, MD, MPH, PhD [Professor of Medicine and Director, Preventive Cardiology] Department of Medicine, Columbia University, New York, NY.
Abstract Author Manuscript
Care for patients with cardiac disease is primarily provided by female family members and spouses, most of whom are postmenopausal, adding a risk factor for cardiovascular disease in the caregiver herself. Approximately 33% of Americans have some form of cardiovascular disease (CVD), making it the leading killer of both men and women.1 Assistance with care for those diagnosed with CVD is primarily provided by informal caregivers—eg, family members and spouses—most of whom are women. Recent data suggest that women caring for family members or spouses with CVD may themselves be at higher risk for cardiac problems.2 This additional burden appears to increase the CVD risk for caregivers primarily due to lifestyle and psychosocial risk factors.
Author Manuscript
Despite the substantial body of literature on the health impact of caring for loved ones with diseases such as dementia or cancer, there are limited data available on cardiac caregivers’ own risk for heart disease. Because studies show that more than 50% of US women will care for a family member at some point during their adult lives, health care professionals need to be aware of the risks their patients may face when providing care for a spouse or relative with cardiac disease.3 Although spouses unquestionably offer social support for each other, all of the physical, emotional, and financial strain experienced after a coronary event may lead to depression and reduced quality of life for both the patient with CVD and the partner. This, in turn, can negatively affect recovery and increase patients’ morbidity and mortality.4 However, caregiving itself has recently been identified as an independent risk factor for coronary heart disease, with caregivers having an almost 2-fold higher risk.5
Author Manuscript
DEFINITIONS Cardiac caregivers are typically family members, spouses, or friends who provide assistance for patients who have been hospitalized for CVD. Caregivers of patients with cardiac disease are often responsible for managing the patient’s treatment regimen—administering medications, accompanying the patient to physician visits, and preparing prescribed meals for the patient. Caregiver strain can be quantified as the accumulated physical, emotional, and/or financial burden experienced by spouses, family, and friends who provide varying degrees of care for
Aggarwal and Mosca
Page 2
Author Manuscript
the patient.6 Caregivers may be subject to strain due to difficulties with navigating the health care system, disturbed sleep, family adjustments and restructuring of family roles, changes in personal plans, emotional upheaval, physical pain, time demands, distressing patient behavior, and financial problems.
PREVALENCE According to the CDC, approximately 53 million Americans are currently serving as informal caregivers for patients with a variety of illnesses. In a recent survey among California residents, 16% were serving as caregivers; of these, an estimated 59% to 75% were women, most of whom were married.7 The average age in this group of women was 51 years—ie, perimenopausal or postmenopausal.
Author Manuscript
Using data from the National Institutes of Health’s Family Intervention Trial for Heart Health (FIT Heart), the authors looked at the prevalence of caregiving among 501 family members of patients hospitalized with CVD who agreed to participate in a screening and educational intervention study. The study sought to document the association between caregiving and lifestyle and psychosocial risk factors associated with CVD (Table). It was found that 39% of the sample described themselves as primary caregivers, with 11% caring for patients most of the time, 32% providing care some of the time, and 18% not involved in caring for the patient.2 The overwhelming majority (81%) of the primary caregivers were women, and 12% of family members in this role were experiencing a high level of caregiver strain.
CAREGIVER STRAIN Author Manuscript
Caregiver strain may be an unrecognized barrier to adherence to CVD prevention strategies. In the FIT Heart study, participants experiencing high caregiver strain had significantly higher levels of depression and lower levels of social support compared with those who did not exhibit caregiver strain. Specifically, caregiver strain was associated with poor compliance with weight management behaviors such as decreasing saturated fat intake and waist circumference and increasing physical activity. Caregivers may have difficulty adhering to these CVD risk-reduction recommendations for diet and exercise due to excessive demands on their time, as well as fear and anxiety about the patient’s health. For example, caregivers may be afraid to leave the patient alone to participate in physical activity, and inactivity is a well established risk factor for CVD.8,9 FOCUSPOINT
Author Manuscript
Caregivers may have difficulty adhering to these CVD risk-reduction recommendations for diet and exercise due to demands on their time, as well as anxiety about the patient’s health. There may also be complex biologic pathways that contribute to the relationship between caregiving and poor health, with stress playing an important role.10 For example, one study showed that chronic stress, such as that experienced by mothers caring for a chronically ill child, is associated with accelerated shortening of telomeres—the markers of cellular aging.11 The authors found that caregiving itself was not predictive of telomere length
Female Patient (Parsippany). Author manuscript; available in PMC 2016 February 26.
Aggarwal and Mosca
Page 3
Author Manuscript
compared with controls, but rather that the risk factor was the number of years of caregiving stress. In a study of spousal caregivers of dementia patients, the caregivers who reported distress and a low level of social support experienced negative changes in immune function at 13-month follow-up.12 When a theoretical model connecting caregiving stress and coronary heart disease was tested, it was found that caregivers of patients with Alzheimer disease experienced chronic stress leading to the development of metabolic syndrome and, in turn, CVD.13 Caregiver strain may increase symptoms of depression, which increase strain even further and reduce the caregiver’s ability to cope with her responsibilities and stress. In addition, a large body of evidence suggests that depression is a significant risk factor for CVD.14,15
RECOMMENDATIONS Author Manuscript
Family members of patients with cardiac disease may represent a unique population at risk for CVD due to shared genes, lifestyle, and/or caregiving strain.16 Caregivers, in particular, may be less likely to participate in preventive health behaviors involving diet and exercise, and may be burdened by depression and a lack of support. All of these factors make this group of women candidates for urgent education and intervention by health care professionals.16 Specific strategies include:
Author Manuscript Author Manuscript
•
Discussing caregiving responsibilities as a routine part of assessment for CVD risk in all female patients, evaluating both the mental and emotional strain on the caregiver
•
Providing health information and emotional support for both the caregiver and the patient, as recommended by research on family systems and risk for CVD; caregivers often feel anxiety about the patient’s health, such that spouses may report greater psychological distress than patients with cardiac disease17
•
Screening female patients who are caregivers for depression and other psychosocial risk factors for CVD, as depression is often associated with caregiving; patients with positive results should be referred as appropriate
•
Implementing family-based approaches, which tend to be more effective in interventions related to illness18; treatment plans should focus on the family as a whole, and are more successful if, for example, the patient with cardiac disease is not the only one eating baked fish for dinner while the rest of the family is eating pizza
•
Integrating family therapy into medical practice and cardiac rehabilitation settings as part of the treatment plan, so that a comprehensive team is available to help address concerns of the patient and caregiver; as the family structure may undergo significant change following an acute cardiac event, health care professionals can direct patients and families to helpful resources such as the American Heart Association’s Web site for caregivers (www.americanheart.org/caregiver).
FOCUSPOINT
Female Patient (Parsippany). Author manuscript; available in PMC 2016 February 26.
Aggarwal and Mosca
Page 4
Author Manuscript
Family members of patients with cardiac disease may represent a unique population at risk for CVD due to shared genes, lifestyle, and/or caregiving strain. Overall, a treatment model that promotes optimal patient conditions while maintaining the caregiver’s well-being should be the target of all medical efforts, with the help of social and psychological services as needed.
CONCLUSION Health care professionals should be aware that female patients serving as cardiac caregivers may be at increased risk of CVD themselves. The high prevalence of women in this role certainly suggests that routine assessment of caregiving responsibilities in the clinical setting is appropriate, with liberal indications for referral to preventive, educational, and mental health services.
Author Manuscript
REFERENCES
Author Manuscript Author Manuscript
1. [Accesssed October 15, 2008] Heart disease and stroke statistics: 2008 Update At-A-Glance. American Heart Association Web site. www.americanheart.org/downloadable/heart/ 1200078608862HS_Stats%202008.final.pdf. 2. Aggarwal B, Liao M, Christian A, Mosca L. Influence of caregiving on lifestyle and psychosocial risk factors among family members of patients hospitalized with cardiovascular disease. J Gen Int Med. In press. 3. Moen P, Robison J, Fields V. Women’s work and caregiving roles: a life course approach. J Gerontol. 1994; 49(4):S176–S186. [PubMed: 8014401] 4. Vaccario V, Kasl SV, Abramson J, Krumholz HM. Depressive symptoms and risk of functional decline and death in pa-tients with heart failure. J Am Coll Cardiol. 2001; 38:199–205. [PubMed: 11451275] 5. Lee S, Colditz GA, Berkman LF, Kawachi I. Caregiving and risk of coronary heart disease in U.S. women: a prospective study. Am J Prev Med. 2003; 24(2):113–119. [PubMed: 12568816] 6. Robinson BC. Validation of a Caregiver Strain Index. J Gerontol. 1983; 38(3):344–348. [PubMed: 6841931] 7. Scharlach, A.; Sirotnik, B.; Bockman, S.; Neiman, M.; Ruiz, C.; Dal Santo, T. A Profile of Family Caregivers: Results of the California Statewide Survey of Caregivers. Berkeley, CA: Center for the Advanced Study of Aging Services, University of California Berkeley; 8. Sundquist K, Qvist J, Johansson SE, Sundquist J. The longterm effect of physical activity on incidence of coronary heart disease: a 12-year follow-up study. Prev Med. 2005; 41(1):219–225. [PubMed: 15917014] 9. McGrath PD. Review: exercise-based cardiac rehabilitation reduces all-cause and cardiac mortality in coronary heart disease. ACP J Club. 2004; 141(3):62–63. [PubMed: 15518446] 10. Vitaliano PP, Zhang J, Scanlan JM. Is caregiving hazardous to one’s health? A meta-analysis. Psychol Bull. 2003; 129(6):946–972. [PubMed: 14599289] 11. Epel ES, Blackburn EH, Lin J, et al. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci USA. 2004; 101(49):17312–17315. [PubMed: 15574496] 12. Kiecolt-Glaser JK, Dura JR, Speicher CE, Trask OJ, Glaser R. Spousal caregivers of dementia victims: longitudinal changes in immunity and health. Psychosom Med. 1991; 53(4):345–362. [PubMed: 1656478] 13. Vitaliano PP, Scanlan JM, Zhang J, Savage MV, Hirsch IB, Siegler IC. A path model of chronic stress, the metabolic syndrome, and coronary heart disease. Psychosom Med. 2002; 64(3):418– 435. [PubMed: 12021416] 14. Glassman AH, Shapiro PA. Depression and the course of coronary artery disease. Am J Psychiatry. 1998; 155(1):4–11. [PubMed: 9433332]
Female Patient (Parsippany). Author manuscript; available in PMC 2016 February 26.
Aggarwal and Mosca
Page 5
Author Manuscript
15. Mosovich SA, Boone RT, Reichenberg A, et al. New insights into the link between cardiovascular disease and depression. Int J Clin Pract. 2008; 62(3):423–432. [PubMed: 18028386] 16. Mosca L, Banka CL, Benjamin EJ, et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation. 2007; 115(11):1481–1501. [PubMed: 17309915] 17. Moser DK, Dracup K. Role of spousal anxiety and depression in patients’ psychosocial recovery after a cardiac event. Psychosom Med. 2004; 66(4):527–532. [PubMed: 15272098] 18. Campbell TL, Patterson JM. The effectiveness of family interventions in the treatment of physical illness. J Marital Family Ther. 2007; 21(4):545–583.
Author Manuscript Author Manuscript Author Manuscript Female Patient (Parsippany). Author manuscript; available in PMC 2016 February 26.
Aggarwal and Mosca
Page 6
Author Manuscript
Continuing Medical Education Goal To explore the connection between caring for patients after cardiac events and the development of cardiovascular disease (CVD) in women. Objectives
Author Manuscript
1.
To examine the various stress factors experienced by women caring for patients with cardiac disease.
2.
To look at how these factors in turn increase the risk of CVD in the female caregiver.
3.
To suggest ways in which health care professionals can screen for and reduce caregiver strain in female patients as a means of decreasing CVD risk.
Accreditation This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Albert Einstein College of Medicine and Quadrant HealthCom Inc. Albert Einstein College of Medicine is accredited by the ACCME to provide continuing medical education for physicians. This activity has been peer reviewed and approved by Brian Cohen, MD, Professor of Clinical ObGyn, Albert Einstein College of Medicine. Review date: January 2009. It is designed for ObGyns, primary care physicians, and nurse practitioners.
Author Manuscript
Albert Einstein College of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Participants who answer 70% or more of the questions correctly will obtain credit. To earn credit, see the instructions on page 00 and mail your answers according to the instructions on page 00. Conflict of Interest Statement
Author Manuscript
The “Conflict of Interest Disclosure Policy” of Albert Einstein College of Medicine requires that authors participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical or equipment company. Any author whose disclosed relationships prove to create a conflict of interest, with regard to their contribution to the activity, will not be permitted to publish. The Albert Einstein College of Medicine also requires that faculty participating in any CME activity disclose to the audience when discussing any unlabeled or investigational use of any commercial product, or device, not yet approved for use in the United States. The authors report no conflict of interest and no discussion of off-label use. Dr Cohen reports no conflict of interest. The staffs of CCME of Albert Einstein College of
Female Patient (Parsippany). Author manuscript; available in PMC 2016 February 26.
Aggarwal and Mosca
Page 7
Author Manuscript
Medicine and The Female Patient have no conflicts of interest with commercial interest related directly or indirectly to this educational activity.
Author Manuscript Author Manuscript Author Manuscript Female Patient (Parsippany). Author manuscript; available in PMC 2016 February 26.
Aggarwal and Mosca
Page 8
TABLE
Author Manuscript
Profile of the Cardiac Caregiver2 Characteristics associated with primary caregiving •
Female gender
•
Age ≥50
•
Married/living with partner
•
Lower education level
•
Unemployed
Cardiovascular risk factors associated with caregiving*
Author Manuscript
•
Depression
•
Decreased social support
•
Increased waist size
•
Reduced physical activity level
•
Higher saturated fat intake
•
Higher body mass index
*
Adjusted for age, gender, and marital status
Author Manuscript Author Manuscript Female Patient (Parsippany). Author manuscript; available in PMC 2016 February 26.
