Chapter 13: Heart Disease, Hypertension, Stroke, and Type II Diabetes

Heart Disease, Hypertension, Stroke, and Type II Diabetes conditions share common underlying mechanisms involving vascular dysfunction, metabolic dysregulation, and inflammatory processes, while also reflecting the physiological and psychological impacts of modern lifestyle and chronic stress. Coronary heart disease, the leading cause of mortality in the United States, develops through atherosclerotic narrowing of coronary arteries supplying the heart muscle, a process accelerated by metabolic syndrome, smoking, physical inactivity, and psychosocial factors including chronic stress, job strain, and cynical hostility. Low-grade systemic inflammation, measured by C-reactive protein, emerges as a significant pathological marker. Hypertension, affecting approximately one in four American adults, remains largely asymptomatic and thus underdiagnosed, with nearly 90 percent of cases classified as essential hypertension of unknown origin. Psychological stress reactivity, emotional excitability, genetic predisposition, and socioeconomic disadvantage all contribute to elevated blood pressure, with African American populations experiencing disproportionately higher prevalence linked to racism exposure and neighborhood-level stressors. Stroke, the third leading cause of death, results from either thrombotic or embolic arterial occlusion or cerebral hemorrhage, with consequences varying by hemisphere involved, including motor deficits, cognitive impairments such as aphasia, and emotional disturbances ranging from severe depression to emotional blunting. Type II diabetes, characterized by insulin resistance at the cellular level, represents a growing pandemic driven largely by obesity, aging, and socioeconomic disparities, with stress hormones like cortisol directly undermining glucose regulation. Across all four conditions, psychological factors including depression, anger expression, and low social support independently predict disease onset and progression. Treatment approaches integrate pharmacological interventions with behavioral modifications emphasizing stress management, cognitive-behavioral therapy, weight reduction, physical activity, dietary restriction, and addressing comorbid depression. A critical challenge across these diseases involves medication and lifestyle adherence, particularly when asymptomatic conditions or demanding self-management regimens create barriers to patient compliance.