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

 

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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.

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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