Life changes and myocardial infarction. How useful are life change measurements?

Although statistically significant, the relation between certain life changes and imminent myocardial infarction appears to be quantitatively weak. Of particular importance are events connected with employment. However, the summation of life changes has not proved to be of use in the prediction of imminent myocardial infarction. For patients with ischemic heart disease, variations in life change measures have proved to be of use in the prediction of changes in catecholamine output and in prognosis. When genetic factors are held constant, as in monozygotic twin pairs vulnerable to ischemic heart disease, more life changes in one partner may indicate a greater risk of unexpected sudden cardiac death in this partner than in the other twin. The self-rating of the severity of each experienced event has proved more useful than "standard weights" in the retrospective discrimination of myocardial infarction patients. Further clinical and epidemiological studies are needed in this field. For the future, the following recommendations are made: The studies should be prospective. The individual's habitual level and actual level of the change should be recorded. The severity of events should be self-rated. Risk variables, known to be of importance to the development of MI should be recorded. They are for instance smoking habits, blood pressure, serum lipids and genetic predisposition. Psychological variables should be mentioned separately in this connection.