Psychosocial predictors of long-term mortality among women with suspected myocardial ischemia: the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation

Abstract

This paper evaluated long-term associations between psychosocial factors and premature mortality among women with suspected coronary artery disease (CAD). We tracked total mortality events over a median 9.3 years in a cohort of 517 women [baseline mean age = 58.3 (11.4) years]. Baseline evaluations included coronary angiography, psychosocial testing, and CAD risk factors. Measures included the Spielberger Trait Anxiety Scale, Beck Depression Inventory, self-rated health, and Social Network Index. Cox regression analysis was used to assess relationships. Covariates included age, CAD risk factors, and CAD severity. BDI scores (HR 1.09, 95 % CI 1.02–1.15), STAI scores (HR .86, 95 % CI .78–.93), and very good self-rated health (relative to the poor self-rated health group; HR .33, 95 % CI .12–.96) each independently predicted time to mortality outcomes in the combined model. SNI scores (HR .91, 95 % CI .81–1.06) and other self-rated health categories (i.e., fair, good, and excellent categories) were not significant mortality predictors after adjusting for other psychosocial factors. These results reinforce and extend prior psychosocial research in CAD populations.

Toxic Affect: Are Anger, Anxiety, and Depression Independent Risk Factors for Cardiovascular Disease?

“…Three of the reports also were based on women who were suspected of myocardial ischemia. In one of these, Rutledge et al (2016) reported that low levels of anxiety predicted cardiac mortality, an association remaining even after depression was entered simultaneously. In an earlier study, Rutledge et al (2009) found the risk associated with depression was reduced if patients also scored high in anxiety (Rutledge et al, 2009).…”

Perceived social support and the risk of cardiovascular disease and all-cause mortality in the Women's Health Initiative Observational Study

“…20,21 Social networks or ties have been associated with health 22 and mortality 23 and pertaining to this study, related to CVD risk factors, [24][25][26] incident or prevalent CVD, 27,28 or mortality from CVD. 19,29 Both structural support and functional support have been found to have associations with health outcomes. Functional social support, the type of support used in this research, is generally theorized to affect health by either promoting stress relief by buffering stressful life events 20,[30][31][32] (stress coping perspective) or by affecting self-esteem which can lead to better health behaviors (social constructionist or social cognitive model).…”

Mental Stress and Myocardial Ischemia: Young Women at Risk

“…In the Psychophysiological Investigations of Myocardial Ischemia Study, we found that mental stress–induced ischemia predicted increased risk for all‐cause mortality in patients with obstructive CAD and exercise‐induced ischemia . In a cohort of women with symptoms and signs of ischemic heart disease (mean age 58 years) from the Women's Ischemia Syndrome Evaluation, mostly without obstructive CAD, we found associations between psychosocial factors and premature mortality . Over 9.3 years, the Spielberger Trait Anxiety Index and Beck Depression Inventory scores (hazard ratio 1.09, 95% CI 1.02–1.15, and hazard ratio 0.86, CI 0.78–0.93, respectively) and very good self‐rated health (versus poor self‐rated health, hazard ratio 0.33, CI 0.12–0.96) each independently predicted mortality risk.…”

“…Sex‐specific hormones may be operative, including estrogen, progesterone, or absence of testosterone, and could be differentially modulating perception of stress or cardiovascular vulnerability. The propensity to MSIMI also may be psychosocial in origin, as these factors have been predictive not only of cardiovascular events but also risk factor development in women …”

“…The propensity to MSIMI also may be psychosocial in origin, as these factors have been predictive not only of cardiovascular events but also risk factor development in women. 5,24 Beyond traditional risk factor modification and antianginal therapy, there is no therapeutic silver bullet to treat either MSIMI or coronary microvascular dysfunction. However, identification of MSIMI has potential management implications in high-risk populations, but this requires further study.…”