Use of a significant other in assessing psychosocial/emotional distress in males may confer greater accuracy, and therefore predictive power for clinical endpoints.

The present study uses early diagnosis of ischaemic coronary heart disease (ICHD) as a proxy for disease malignancy in testing the statistical strength of association, and uniqueness/confounding, of several psychometric scales that have previously been found to prospectively predict death in cardiac samples (Beck Depression Inventory, Crown–Crisp Phobic Anxiety Scale, Type D Scale & Ketterer Stress Symptom Frequency Checklist). Eighty-three patients (no. of females=35) with documented ICHD were assessed for traditional and psychometric risk factors. The psychometric risk factors were moderately to strongly intercorrelated, and strongly confounded in their relationship to age at initial diagnosis. In a stepwise multiple regression, only the AIAI (aggravation, irritation, anger and impatience) scale of the Ketterer Stress Symptom Frequency Checklist (KSSFC) survived as a predictor of age at initial diagnosis (P=0.016). In a subgroup of the sample for whom the Spouse/Friend Version of the KSSFC was received (n=58, or 70%), spouse/friend reported AIAI survived as the only predictor (P=0.010). While present results need replication in a prospective study of diagnosed ICHD patients for all important clinical outcomes, only one psychometric screening instrument may be necessary to identify patients in need of treatment.

Background Psychosocial/ emotional distress has been repeatedly found to be a correlate of the onset/aggravation of ischaemic heart disease.Methods Eighty-three patients (63 men and 20 women)~ith known coronary artery disease who entered an aggressive lifestyle modification programme were adminis~ered a clini?all demographic history and the Symptom Checklist 90 -Revised at baseline. Several measures of social isolation/alienation (shyness/self-consciousness, feeling lonely, feeling abused and overall) were derived from the the Symptom Checklist 90 -Revised.Results Univariate tests of the association of known cardiovascular risk factors and the Symptom Checklist 90 -Revised scales with age at initial diagnosis yielded several significant results for history of hypercholesterolaemia (p= 0.018), history of hypertension (p= 0.030), somatization (p= 0.007), obsessive-compulsive (P= 0.009), depression (P= 0.006), anxiety (P= 0.021), hostility (P= 0.003), paranoia (P=0.050), psychoticism (P=0.029), the Global Severity Index (P= 0.007), the Positive Symptom Distress Index (P= 0.005), the Positive Symptom Total Score (P= 0.003) and feeling abused (P= 0.037). Only history of hypertension, history of hypercholesterolaemia and the hostility scale (overall F= 6.08 and P= 0.0009) emerged as unique correlates of age at initial diagnosis in a multiple regression using only the significant univariate predictors.Conclusions Psychosocial factors are sufficiently confounded with one another that they lose their predictive value once one is entered in the equation. High scores on the hostility scale were associated with a 5.7 year differential in age at initial diagnosis. The younger a patient is at initial diagnosis, the more likely he/she is to have high levels of emotional distress.J Cardiovasc Risk 7:409-413

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Treatment of psychosocial/emotional distress as a strategy for diminishing chest pain in such patients remains entirely unutilized in standard care. Sixty-three patients with known or suspected CAD were entered in an aggressive lifestyle modification program. Patients completed the Symptom Checklist 90-Revised (SCL90R) at the diagnostic interview session, at 3 and at 12 months. Statistically significant drops were observed on multiple scales of the SCL90R at both 3 and 12 months. An item from the SCL90R was used as a proxy for angina. Multiple measures of emotional distress at baseline were found to correlate with chest pain at baseline, but not a number of traditional cardiovascular risk factors. The chest pain item displayed improvement at both 3 and 12 months. Improvement on all scales of the SCL90R correlated with improvement in chest pain. It may be possible to control chest pain in some CAD patients with psychosocial interventions.