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Psychological characteristics and fatal ischaemic heart disease
A Haines1, J Cooper, T W Meade
1Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Rowland Hill Street, London NW3 2PF, UK. andy.haines@lshtm.ac.uk
Insights
Psychological traits like obsessionality and somatic complaints are linked to fatal ischaemic heart disease (IHD). These findings suggest psychological factors are independent risk factors for IHD events.
Area of Science:
- Cardiology and Psychology
- Psychosomatic Medicine
- Epidemiology
Background:
- Psychological characteristics are increasingly recognized as potential contributors to cardiovascular disease.
- Previous research suggests links between certain psychological states and ischaemic heart disease (IHD).
Purpose of the Study:
- To investigate the relationship between specific psychological traits and the incidence of fatal ischaemic heart disease (IHD) events.
- To determine if psychological factors predict fatal IHD independently of established cardiovascular risk factors.
Main Methods:
- A prospective study of 1408 white men aged 40-64 without prior myocardial infarction, recruited between 1972-1978.
- Participants completed the Crown-Crisp experiential index (CCEI) assessing psychological characteristics.
- Follow-up for fatal IHD events occurred until 1997.
Main Results:
- Increased scores on the obsessionality/obsessional neurosis subscale and the functional somatic complaint subscale were associated with a 1.08 relative risk of fatal IHD per point increase.
- A 10-point increase in the total CCEI score correlated with a 1.28 relative risk of fatal IHD.
- These associations remained significant and independent of age, social class, and traditional cardiovascular risk factors.
Conclusions:
- Scores on specific CCEI subscales (obsessionality, somatic complaints) and the total score are significantly associated with long-term risk of fatal IHD.
- Psychological characteristics identified by the CCEI represent independent predictors of fatal ischaemic heart disease.
- The findings underscore the importance of considering psychological factors in cardiovascular risk assessment.
Objective:
To determine the relation between psychological characteristics and subsequent fatal ischaemic heart disease (IHD) events.
Design:
Prospective study of participants in the Northwick Park heart study (NPHS) recruited between 1972 and 1978 and followed up for fatal events until 1997.
Setting:
Three occupational groups in north west London.
Subjects:
1408 white men without a history of myocardial infarction aged 40-64 years at entry who completed a Crown-Crisp experiential index form (CCEI).
Main Outcome Measure:
Fatal IHD during follow up.
Results:
A one point increase in the score on the obsessionality/obsessional neurosis subscale was associated with a relative risk of fatal IHD of 1.08 (95% confidence interval (CI) 1.02 to 1.15). For the functional somatic complaint subscale the relative risk was also 1.08 (95% CI 1.02 to 1.15). In the case of the total score the relative risk of fatal IHD was 1.28 (95% CI 1.09 to 1.50) for a 10 point increase. The associations were independent of age, social class, and known cardiovascular risk factors. In the case of phobic anxiety, which had previously been found to be associated with fatal IHD in NPHS, the association was evident in the first 10 years of follow up but overall the relative risk was only 1.07 (95% CI 0.99 to 1.15) for a one point increase in the score.
Conclusion:
Scores on two of the subscales of the CCEI and the total score are significantly associated with fatal IHD on long term follow up independently of other known risk factors.