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Perceived control as a predictor of cardiovascular disease mortality in Poland. The HAPIEE study
Magdalena Kozela1, Agnieszka Doryńska, Urszula Stepaniak
1Department of Epidemiology and Population Studies, Institute of Public Health, Faculty of Health Sciences, Jagiellonian Univer sity Medical College, Krakow, Poland. mkozela@cm-uj.krakow.pl.
Insights
Low perceived control significantly increases the risk of cardiovascular disease (CVD) mortality in Poland. This psychosocial factor is an independent predictor, highlighting its importance beyond traditional risk factors.
Area of Science:
- Cardiology
- Psychosocial Medicine
- Public Health
Background:
- Cardiovascular disease (CVD) mortality trends in Poland are not fully explained by treatment advances or changes in classic risk factors.
- Psychosocial factors are increasingly considered influential in CVD outcomes.
- This study investigates the role of perceived control in CVD mortality within the Polish population.
Purpose of the Study:
- To determine the association between perceived control and the prevalence of established CVD risk factors.
- To evaluate the relationship between perceived control and the risk of all-cause and CVD-specific mortality.
- To identify perceived control as a potential CVD risk factor in urban Poland.
Main Methods:
- A 5-year prospective cohort study involving 10,728 residents of Krakow (aged 45-69).
- Perceived control assessed using an 11-item scale, with participants categorized into quartiles (very high to low).
- Cox proportional hazards models used to analyze the independent effect of perceived control on mortality, with data from local registers and death certificates.
Main Results:
- Low perceived control was independently associated with significantly higher CVD mortality in both men and women (HR 2.68-5.18).
- Individuals with low perceived control exhibited the highest risk of all-cause mortality, even after age adjustment.
- Further adjustments for covariates partially attenuated, but did not eliminate, the observed associations.
Conclusions:
- Perceived control is a robust, independent predictor of cardiovascular disease mortality.
- The findings suggest perceived control should be recognized as a significant CVD risk factor in the Polish urban population.
- Addressing psychosocial factors like perceived control may offer new avenues for CVD prevention strategies.
Background:
Neither the development in methods of treatment of coronary heart disease nor the changes in exposure to main cardiovascular disease (CVD) risk factors do not fully explain the trends in CVD mortality in Poland. An influence of psychosocial factors is considered. The aims of the study were: (1) to assess the relationship between perceived control and the prevalence of classic CVD risk factors; (2) to assess the relationship between perceived control and the risk of death from all causes and from CVD.
Methods:
A cohort study with 5-year follow-up was conducted. Random sample of 10,728 permanent residents of Krakow aged 45-69 was examined. Perceived control was measured using a standard 11-item scale. The studied group was divided into four subgroups of people with very high, high, moderate, and low perceived control according to quartile values. Data on deaths and causes were obtained from the local register, death certificates and participants' families. An independent effect of perceived control on CVD mortality was assessed using Cox proportional hazards models.
Results:
Low perceived control was strongly associated with a higher CVD mortality, independently of age, education, marital status, history of CVD, hypertension, hypercholesterolemia, smoking, body mass index, physical activity or diabetes in both men and women (HR 2.68, 95% CI 1.36-5.31 and HR 5.18, 95% CI 1.17-22.96, respectively). After adjustment for age, both in men and women, the highest risk of death from all causes was observed in persons with low perceived control. Further adjustment for covariates attenuated the relationship.
Conclusions:
Perceived control is a strong independent predictor of CVD mortality and may be considered a CVD risk factor in the Polish urban population.
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