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d. his diet
32. Judith has Type 1 diabetes, which is a risk factor for cardiovascular disease. Therefore,
Judith
a. can do nothing to protect herself against cardiovascular disease.
b. has a behavioral risk factor for cardiovascular disease and can engage in certain
behaviors to eliminate her risk.
c. cannot eliminate her risk for cardiovascular disease, but she can learn to manage
her disorder and thus lower her risks.
d. has a physiological risk for cardiovascular disease and can learn to reduce her risk
to that of a person with no risk factors for cardiovascular disease.
33. In general, men and women have a similar death rate from cardiovascular disease, but
there is a discrepancy, with men ___________ having a significantly higher risk.
a. below age 20
b. during middle age
c. over 75
d. who are married
34. Compared with European Americans, African Americans
a. have higher rates of hypertension and higher rates of cardiovascular mortality.
b. have lower rates of hypertension but higher rates of cardiovascular mortality.
c. lower rates of hypertension and lower rates of cardiovascular mortality.
d. lower rates of cardiovascular reactivity.
35. African Americans experience _____, which tends to increase blood pressure.
a. a diet higher in salt than European Americans
b. a diet lower in fat and higher in fiber
c. larger and more cohesive families
d. discrimination based on skin color
36. The strongest physiological risk factor for cardiovascular disease is
a. lack of social support.
b. hypertension.
c. obesity.
d. smoking.
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206
37. Differences in hormones may help explain some of the differing rates of cardiovascular
disease in men and women; ______ are responsible for much of the gender gap in heart
disease.
a. behavioral factors
b. physiological factors
c. psychological factors
d. both b and c
38. Which ethnic group has the highest risk for cardiovascular death?
a. Native Americans
b. Hispanic Americans
c. African Americans
d. Asian Americans
39. All of the following are physiological risk factors for cardiovascular disease EXCEPT:
a. cholesterol
b. hypertension
c. inflammation
d. physical activity levels
40. Currently, most authorities believe that __________ is the most critical element in
linking cholesterol to cardiovascular disease.
a. a balance of total cholesterol to HDL
b. a balance of LDL to HDL levels
c. total HDL level
d. total LDL level
41. Overall, women have a higher level of ______, which may help explain the gender gap in
heart disease.
a. total cholesterol levels
b. HDL levels
c. LDL levels
d. the balance of total cholesterol to HDL
42. Factors that contribute to inflammation, such as _______ and depression, may also
increase the risk for cardiovascular disease.
a. anxiety
b. insomnia
c. stress
d. diabetes
43. All of the following are behavioral risk factors for cardiovascular disease EXCEPT:
Behavioral Factors in Cardiovascular Disease
a. smoking
b. diet
c. physical activity levels
d. educational level
44. People who currently smoke are _________to suffer a heart attack that people who have
never smoked.
a. three times as likely
b. just as likely
c. ten times as likely
d. twice as likely
45. Extra weight carried around which body part is related to an increase risk for heart
attack?
a. the hips
b. the abdomen
c. the chest
d. the thighs
46. Kelly currently eats a diet that consists mainly of red meat, junk food, and soda. To lower
her risk of heart disease, she should:
a. maintain the same diet but also increase intake of carbohydrates
b. maintain the same diet but also increase intake of fruits and veggies
c. reduce her intake of red meat, junk food, and soda and increase intake of fruits
and veggies
d. reduce her intake of red meat, junk food, and soda and increase intake of
carbohydrates
47. Individuals from low socioeconomic backgrounds are at a(n) ______ risk for
cardiovascular disease and this finding can be explained by ______________.
a. decreased; modifiable lifestyle factors
b. decreased; psychological factors
c. increased; modifiable lifestyle factors
d. increased; psychological factors
48. Research indicates that the effects of socioeconomic background on cardiovascular
disease __________.
a. begins in early adulthood
b. begins in early adolescence
c. begins in late adulthood
d. are set from the time a person is born.
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49. _______ is a risk factor for cardiovascular disease, and, in the elderly, is associated with
the occurrence of a second, fatal heart attack.
a. Loneliness
b. Anxiety
c. Gum disease
d. Reactivity
50. Of the following individuals, who is the least at risk for cardiovascular disease?
a. Betty, a 50-year old widow who lives by herself
b. Anna, a 50-year old married woman who has many friends
c. Pete, a 50-year old married man who has many friends
d. Frank, a 50-year old unmarried man who lives by himself
51. The component of Type A personality that is most associated with risk for cardiovascular
disease is
a. competitiveness.
b. a sense of urgency.
c. hostility.
d. competitiveness, a sense of urgency, and hostility.
52. Anger is a(n) ________ accompanied by physiological arousal, whereas hostility is a
negative ______ toward others.
a. attitude; emotion
b. attitude; reaction
c. reaction; emotion
d. emotion; attitude
53. ________ may be related to higher rates of hypertension among African Americans.
a. Obesity
b. Cardiac reactivity
c. Hostility
d. Suppressed anger
54. Carrie and her boyfriend argued last night and this argument led to the end of their
relationship. A week later, Carrie is thinking about the argument and is replaying
everything she said over and over again. This type of self-focus is called
a. expressed anger.
b. reactivity.
c. depression.
d. rumination.
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209
55. Other than advancing age, ______ is the single most important risk factor for
cardiovascular disease.
a. gender
b. hypertension
c. high cholesterol
d. ethnic background
56. According to the Framingham study, not all cholesterol is equally implicated as a
cardiovascular risk. _______ was found to offer some protection against heart attack, but
______ was positively related to cardiovascular disease.
a. Total cholesterol level . . . omega-3 fatty acid
b. Lipoproteins . . . cholesterol
c. Low-density lipoprotein . . . high-density lipoprotein
d. High-density lipoprotein . . . low-density lipoprotein
57. With regard to serum cholesterol levels and risk of heart disease among middle-aged
people, research suggests that
a. cholesterol level may not be a risk factor.
b. the ratio of total cholesterol to HDL may be more important than total cholesterol.
c. low-density lipoprotein may protect against heart disease.
d. a high ratio of total cholesterol to HDL is desirable.
58. Which combination yields the lowest risk of cardiovascular disease?
a. moderate total levels of cholesterol with a ratio of total cholesterol to HDL of
more than 6 to 1
b. moderate total levels of cholesterol with a 3.5 to 1 ratio of total cholesterol to
LDL
c. low levels of total cholesterol with a ratio of total cholesterol to HDL of less than
4.5 to 1
d. low total levels of cholesterol with a 3.5 to 1 ratio of LDL to total cholesterol
59. When health care researchers refer to problems in glucose metabolism, they are
describing
a. either Type 1 or Type 2 diabetes
b. one component of the metabolic syndrome.
c. a combination of elevated blood pressure and elevated cholesterol.
d. both a and b.
60. Glucose metabolism problems are a risk factor for CVD
a. even if the problems are not sufficiently severe to quality as diabetes.
b. only in overweight people.
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210
c. if the problem results in the overproduction of insulin.
d. only in people who have high cholesterol.
61. Taking anti-inflammatory drugs such as aspirin lowers the risk for CVD because
a. anti-inflammatory drugs make the blood more acidic, which dissolves blood clots.
b. anti-inflammatory drugs lower blood pressure, which is an important risk factor.
c. anti-inflammatory drugs lower cholesterol, which is an important risk factor.
d. anti-inflammatory drugs reduce inflammation, which is a risk for CVD.
62. Cigarette smoking is the leading behavioral risk factor for cardiovascular death in the
United States. However,
a. cigar and pipe smoking are unrelated to cardiovascular deaths.
b. the increase in men’s smoking habits would predict an even greater risk of
cardiovascular deaths in the future.
c. declining rates of smoking have led to decreases in cardiovascular death due to
cigarette smoking.
d. diet remains the leading behavioral risk factor for cardiovascular death in other
parts of the world.
63. With regard to obesity and heart disease, it can be stated that
a. obesity is causally related to heart disease.
b. obesity is an independent risk factor in heart disease.
c. obesity is related to hypertension, which is related to heart disease.
d. obesity is unrelated to heart disease.
64. An analysis of fruit and vegetable consumption in countries around the world indicated
that
a. higher consumption of these foods could decrease heart disease by over 30%.
b. people in developing countries eat more fruits and vegetables than is optimal for
good health.
c. wealthy people in industrialized countries eat an adequate amount of these foods,
but poor people in industrialized countries do not.
d. both b and c
65. A diet high in ___________ offers protection against cardiovascular disease.
a. monosaturated fats
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211
b. fruits, vegetables, and fish
c. high-fiber cereals and grains
d. high-oxidant foods
66. Flavonoids may protect against CVD, and one food very rich in flavonoids is
a. dark chocolate.
b. milk chocolate.
c. chocolate milk.
d. any of these, which have about the same flavonoid content.
67. The advantages of physical activity to protect against heart disease
a. appear in middle-aged individuals but not young adults.
b. appear in older adults but not middle-aged or young adults.
c. appear in young adults, but the benefits decrease over the lifespan.
d. appear during childhood and persist over the lifespan.
68. People with low levels of education have high rates of death from cardiovascular disease.
The most valid explanation for this observation is that
a. low educational levels cause CVD.
b. high educational levels protect against CVD.
c. educational level is related to hypertension, obesity, and access to the health care
system.
d. educational level is related to gender, which is related to amount of smoking,
which is related to CVD.
69. High social rank and status
a. are risks for heart disease.
b. are risks for all-cause mortality.
c. offer protection against cardiovascular disease.
d. are related to educational level but not to health.
70. In general, which of these groups of people have the highest risk for cardiovascular
disease?
a. married men
b. single, divorced, or widowed men
c. single women
d. single, divorced, or widowed women
71. Marriage seems to offer some people some protection against heart disease. The best
explanation for this protection is that marriage is related to ______, which in turn relates
to _____.
a. income level . . . gender
b. gender . . . hypertension
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212
c. social support . . . seeking health care
d. diet . . . cigarette smoking
72. Individuals with few people in their social networks
a. are more than twice as likely to die of coronary artery disease than those with
larger social networks.
b. are about half as likely to die of coronary artery disease as those with larger social
networks.
c. are at higher risk for heart disease if they are married.
d. are not at elevated risk for heart disease unless they also score high on loneliness.
73. You are MOST at risk for heart disease if you
a. are a woman.
b. are an unmarried man.
c. eat lots of fruits and vegetables.
d. never or seldom become angry.
74. Research most strongly suggests that anxiety and depression are
a. negatively related to the development of heart disease.
b. positively related to the development of heart disease.
c. positively related to the development of heart disease but negatively related to its
progression.
d. unrelated to the development of heart disease.
75. Which of these is NOT part of the original Type A behavior pattern?
a. a sense of time urgency
b. a job requiring constant decision making
c. hostility
d. a high level of competitiveness
76. Recent research concerning the Type A behavior pattern has indicated that one of the
behaviors of the pattern may be more critical than the others as a predictor of heart
disease. This behavior pattern is marked by
a. impatience.
b. hostility.
c. time urgency.
d. greediness.
77. Grace owns a large manufacturing firm. She is competitive, nearly always angry, and
constantly in a hurry to get things done. Grace’s greatest risk for heart disease is
a. her anger.
b. the great number of decisions she has to make.
c. her sense of time urgency.
Behavioral Factors in Cardiovascular Disease
d. her competitiveness.
78. Research has indicated that the _____ of anger is positively related to cardiac reactivity.
a. experience
b. nonexistence
c. expression
d. awareness
79. Brady is a 22-year old college student who smokes, eats high-fat foods, and doesn’t
exercise. Brady knows that heart disease is the leading cause of death in the United
States, yet he views his chances of dying of heart disease as near zero. Weinstein would
call Brady’s attitude
a. blind faith.
b. unconscious denial.
c. optimistic bias.
d. a rationalization.
80. Reducing hypertension is difficult because
a. hypertension has no visible symptoms.
b. no drugs have yet proven effective in lowering blood pressure.
c. most cardiologists do not consider hypertension as a risk factor for heart disease.
d. high cholesterol is a powerful side-effect of reductions in blood pressure.
81. For people who are obese and hypertensive,
a. weight loss is more important than lowering their blood pressure.
b. losing weight is likely to raise their blood pressure.
c. losing weight is likely to lower their blood pressure.
d. drastic weight loss is likely to be dangerous.
82. The role of the health psychologist in cardiac rehabilitation is MOST likely to include
a. assisting in surgery.
b. implementing the exercise component of the program.
c. helping patients make and sustain lifestyle changes to lower risk.
d. designing and implementing dietary changes.
83. Treating depression among cardiac patients is important, but difficult. A recent cognitive
behavioral intervention showed improvements in survival among
a. African American men and women only.
b. European American men only.
c. European American men and women only.
d. all ethnic groups.
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214
84. All of the following factors predict development of cardiovascular disease and also
failure to adhere to rehabilitation after a cardiac event EXCEPT:
a. being depressed
b. being a smoker
c. being overweight
d. being anxious
85. Cardiac patients experience a number of psychological problems following heart surgery.
The most common of these are
a. paranoia and delusions.
b. anxiety and depression.
c. anxiety and decreased self-esteem.
d. anger and sleep disturbances.
86. In comparison with heart attack patients who do not participate in a cardiac rehabilitation
program, those who do
a. have lower death rates from cardiovascular disease.
b. have an increased rate of nonfatal heart attacks.
c. have an increased rate of fatal heart attacks.
d. tend to have lower death rates from heart disease but higher death rates from
stroke.
87. Which of these strategies would NOT ordinarily be recommended to heart patients?
a. resumption of sexual activities
b. high protein diet
c. physical activity
d. reduction of calories from fat
88. Dean Ornish and his colleagues have found that coronary artery damage
a. can be reversed by following the American Heart Association’s guidelines that no
more than 30% of calories come from fat.
b. can be reversed by following a diet with considerably less fat than that
recommended by the American Heart Association.
c. can be reversed by cognitive-behavioral group therapy.
d. cannot be reversed by any known treatment.
89. When Dean Ornish placed cardiac patients on a diet that allowed only 10% of calories
from fat, he found
a. a higher mortality rate among those participants than among a control group.
b. lower mortality rates for the experimental group, but no regression in coronary
artery plaque.
c. that most patients in the experimental group reduced the amount of plaque in their
coronary arteries.
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215
d. drugs were more effective than diet in reducing coronary artery plaque.
90. Dean Ornish believes that the dietary recommendations of the American Heart
Association
a. may be sufficient to prevent coronary artery disease.
b. are not sufficient to reverse coronary artery disease.
c. both a and b
d. neither a nor b
91. If you wish to lower your risk for cardiovascular disease, the BEST course of action
would be to
a. ignore inherent risks because you can’t change them anyway.
b. concentrate mostly on inherent risks because you may be able to change them
with effort.
c. stop drinking alcohol.
d. carefully monitor your blood pressure and take measures to lower it if it is at the
prehypertension level or higher.
True/False Questions
1. The term cardiovascular disease includes stroke.
2. Coronary arteries supply blood to the heart.
3. Loss of elasticity of the arteries is called atherosclerosis.
4. Restriction of blood flow to the heart is called ischemia.
5. The medical term for heart attack is myocardial infarction.
6. Hypertension is a predictor of heart attack but not stroke.
7. Arteriosclerosis is when the arteries have “hardened” and atherosclerosis is the formation of
plaques.
8. Presently, deaths from cardiovascular disease in the United States are increasing.
Behavioral Factors in Cardiovascular Disease
9. Twice as many men as women die of cardiovascular disease.
10. People who follow a cardiac rehabilitation program substantially lower their risk for a second
heart attack.
11. Heart disease and stroke are only a leading cause of death in industrialized countries, but not
a concern in developing and underdeveloped countries.
12. Inherent risk factors can easily be modified through diet and exercise.
13. Modifying behavioral risk factors does not significantly reduce one’s chance of having a
myocardial infarction.
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217
Essay Questions
1. Discuss the relationship between changes in lifestyle and decline in cardiovascular disease
in the United States and other industrialized nations.
2. Discuss the behavioral contributions to the physiological conditions of hypertension and
serum cholesterol and how these physiological conditions relate to the development of
cardiovascular disease.
3. Evaluate the Type A behavior pattern, including its success and shortcomings in predicting
coronary heart disease.
Behavioral Factors in Cardiovascular Disease
4. What behaviors can alter the risk for cardiovascular disease?
5. What is the role of health psychology in cardiac rehabilitation?