Российский кардиологический журнал (Oct 2017)
RISK FACTORS HIERARCHY
Abstract
Risk factors (RF) management is the key component of the primary and secondary prevention of non-communicable diseases. It applies fully to cardiovascular medicine. From biopsychosocial point of view RF can be distinguished to somatic, psychological and social. And management of RF might be framed by such distiction.Aim. Based upon the data from recent literature and original studies, to formulate the concept of the RF hierarchy related with their position on somatic, psychological and socio-cultural levels.Material and methods. The study includes systematic literary review and empirical work with myocardial infarction (MI) patients. Systematic review included 430 sources primaly published last year, on psychosomatic aspects of MI and course of postinfarction period. Empirical part consisted of the in-depth interviews study (n=18), semi-structured interview (n=32) and a range of quiestionnaires (n=304) of post-MI patients, during the time frame 4 days to 3 months after event.Results. Based upon the interdisciplinary data, the relationship constructed, of somatopsychic and psychosomatic processes around the MI. Taking the meanings from the humanities, neurophilosophy, the bottom-up and top-down biopsychocultural processes are considered, in the biopsychocultural interrelation, that describe social and cultural influence on somatic state, and of somatics on behavior of an ill person (MI patient) in the society. Based on the study of MI patients, the specifics studied, of psychological and socio-cultural components of the illness — that preceded the MI and the continuing. Risk factors, traditionally addressed in cardiology and being the target of cardiorehabilitation and secondary prevention, are stratified to 7 levels of hierarchy: morpho-functional, neurohumoral, psychophysiological, cognitiveaffective, phenomenological, sociocultural, and (epi)genetic.Conclusion. Such theoretical model might be applied to any RF and to help practitioner by stratification of approaches and efforts in modification, and in facilitation of healthy behavior changes.
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