The effect of a self-directed lifestyle change programme on cardiac patients

D.Litt. et Phil. (Psychology)Over the past four decades we have witnessed the emergence of amazingly sophisticated means of cardiovascular diagnosis and therapy. For the first time in many years, some Western countries could report a decline in cardiovascular deaths. During this same span of years we have witnessed the remarkable development of an array of technological achievements that include the means for invasive diagnostic procedure such as cardiac catherization, and non-invasive methods of echocardiography, magnetic, radio-isotopic and positron imagery which provide detailed diagnostic and prognostic information. This innovations along with synthetic grafts have permitted surgical interventions that would not have been conceivable at the outset of this cardiovascular odyssey. Another major advance has been the appearance of new pharmacological modalities; the diuretics, the beta-adrenergic receptors and angiotension converting enzyme inhibitors, the calcium antagonists and other anti-hypersensitive agents, a spectrum of antiarrhythmic compounds, anticoagulants and fibrinolytic therapy, and the promise of still more innovative and novel modes of therapy which will appear via genetic engineering. Over the past years there has been equally significant development in the area of cardiovascular epidemiology. These advances include the demonstration of validity and the efficacy of various therapeutic programmes by the unique development of complex multi-center trials, as well as long-term population-based studies. Through this endeavours specific risk factors that impart independent risk ofpremature cardiovascular morbidity and mortality has been identified. Some of these risk factors are clearly not modifiable such as advancing years, male gender and race. Others are at least partly modifiable: predisposition to diabetes myelitis and increased body mass. By virtue of multi-center trials we have clear evidence that cigarette smoking, rising systolic and diastolic arterial pressures, serum cholesterol levels, and diabetes are modifiable. It is a known fact that not all individuals with coronary artery disease are cured by medication or by means of a surgical intervention. In addition to this, the reduction of traditional biomedical risk factors have been shown to be insufficient in averting the reocclusion and the further occlusion of coronary arteries in patient populations