Beyond traditional cardiovascular risk: psychological vulnerability and lifestyle patterns in a tertiary cardiology sample
F Doria, F Galli, M Scalzeri, A Mastrangelo, L Grancini, G Monizzi, E Conte, V Mallia, L P Alberti, G Fusco, M Campolo, M Sabato, D AndreiniAbstract
Background
Cardiovascular care has historically prioritized biological risk markers and procedural outcomes, often underestimating the relevance of psychological and social determinants. Emerging evidence and guidelines recommend integrating systematic biopsychosocial assessment into routine cardiovascular care rather than considering psychological vulnerability a secondary issue.
Purpose
To provide preliminary biopsychosocial risk data from routine clinical activity and describe the coexistence of medical and psychological risk factors in a cardiovascular sample.
Methods
We conducted a cross-sectional analysis of 31 patients consecutively admitted to our Unit. Traditional biomedical data were collected together with validated self-administered questionnaires, including State-Trait Anxiety Inventory form Y-2 (trait anxiety), Patient Health Questionnaire-9 (depressive symptoms), UCLA Loneliness Scale (perceived loneliness), Traumatic Experiences Checklist (exposure to traumatic experiences), Insomnia Severity Index (sleep disorders), Fagerström test for nicotine dependence, Alcohol Use Disorders Identification Test, and Health Promoting Lifestyle Profile II subscales for physical activity and nutrition. Where available, established cut-offs were applied; otherwise, the sample was described using standard descriptive statistics and sample-specific quartiles.
Results
The sample (M=60.6 ± 9.4 years; 87.1% male) showed heterogeneous diagnoses, with chronic ischemic heart disease (29.0%) being the most represented. Marked polypharmacy (mean 6.59 ± 4.08 medications) coexisted with a median of 3 risk factors; hypertension (64.5%) and dyslipidemia (58.1%) were most prevalent, followed by previous smoking (51.6%) and overweight/obesity (38.7%). Clinically relevant depressive symptoms were present in 19.4%, and moderate insomnia in 6.5%. High nicotine and alcohol consumption were infrequent (6.5% and 3.2%). Trait anxiety had a mean score of 37.68 ± 10.75 (median 35; IQR 29–46), with 25.8% of patients in the highest quartile; while loneliness averaged 37.81 ± 11.36 (median 36; IQR 28–45.5); 25.8% were in the upper quartile. Perceived stress averaged 59.39 ± 15.35 (median 54; IQR 47–73.5), and traumatic experience exposure 14.81 ± 12.09 (median 12; IQR 6–20.5); in both cases, 25.8% fell within the highest quartile. Physical activity levels were modest, whereas nutritional behaviors were more evenly distributed.
Conclusions
Patients exhibited substantial clinical burden, characterized by multiple biomedical and psychosocial risk factors. These findings suggest that psychological vulnerability and behavioral factors add complexity to tertiary cardiovascular prevention. Integrating structured biopsychosocial screening into routine cardiology care is clinically relevant, supporting targeted psychological interventions for patients who may benefit. Prospective studies should evaluate its impact on long-term outcomes.Biopsychosocial risk profile