Psychological job demands increase the risk of ischaemic heart disease: a 14-year cohort study of employed Danish men

AIMS

To test the relationship between job strain and the incidence of ischaemic heart disease (IHD) prospectively in the Danish working population.

METHODS AND RESULTS

In 1986, a clinical examination was undertaken of 659 men, all employed and without known IHD, together with a questionnaire-based evaluation of living conditions and psychosocial factors at work, including items identified in the job strain model. This study was part of the World Health Organization-initiated MONICA II study. In the job strain model, job strain is defined as the combination of high psychological demands and a low degree of control in the work situation. An objective classification of the components in the job strain model was made by imputation by utilizing the participants' job title and the principles guiding the payment of their salaries/wages. In addition, a questionnaire-based subjective classification was undertaken. All participants were followed until the end of 1999 with regard to hospitalization and death as a result of IHD. Stepwise analyses were made, adjusting for age, social class, social network and established behavioural and physiological coronary risk factors. Self-reported job strain was significantly associated with IHD independently of standard coronary risk factors. Of the two components in the job strain model only high demands contributed significantly to this result. The study did not support the job strain hypothesis when an imputed, objective classification of the components in the job strain model was applied. This is in accordance with the majority of other studies in this area. An unexpected finding was that the incidence of IHD was highest among employers and managers.

CONCLUSION

High psychological demands at work are a risk factor for IHD, a fact that should affect the primary and secondary prevention of IHD.

Symptoms of posttraumatic stress disorder in patients who have had a myocardial infarction

Symptoms of posttraumatic stress disorder (PTSD) and risk factors for recurrent ischemia were evaluated in 65 survivors of a myocardial infarction (MI) at baseline and 6 months afterward. PTSD patients had more uncontrolled cardiovascular risk factors at baseline. Patients with PTSD (N=14) were offered trauma-focused cognitive-behavior treatment (CBT) plus a nonspecific intervention to improve adherence to medical recommendations. Adherence to aspirin improved in recipients of the nonspecific intervention (N=8); PTSD symptoms and cardiovascular risk improved in patients who received CBT (N=6). PTSD may be a treatable risk factor for poor post-MI outcome. Further research is needed to evaluate treatment options.

[The influence of psychosocial factors in developments of ischemic heart disease and arterial hypertension in persons with genetic predisposition]

The purpose of the work was to investigate the influence of psychosocial factors on the development of ischemic heart disease and arterial hypertension in persons with genetic predisposition to cardiovascular disease. Three groups of patients were investigated: 72 patients with AH, 175 patients with IHD (74 with angina pectoris and 101 with angina pectoris and myocardial infarction) and 164 patients with IHD and AH. In nearest relation of 283 (69/03%) patients from 410 were found the presence of high arterial hypertension, myocardial infarction, diabetes and obesity. In this persons reliable relationship were found between psychosocial and genetic factors (in persons with genetic predisposition to cardiovascular disease were found high rate of anxiety, frequent stressful situations at work and in family, psychoemotional overloads). On the basis of our investigations it may be concluded that the genetic and psychosocial factors together play important role in the development of IHD and AH, that perhaps caused from influence of genetic factors on capable of to overcome the stress.

[Therapeutic attitude after coronariography in elderly patients with ischemic heart disease]

INTRODUCTION

The incidence of ischemic heart disease in the elderly is high. These patients are increasing referred for coronariography.

OBJECTIVES

Identify factors associated with coronary revascularization in elderly patients.

MATERIAL AND METHODS

Retrospective study of 473 patients > or = 75 years who underwent coronariography in relationship with ischemic heart disease. Their clinical-epidemiological characteristics and treatment adopted were analyzed. A multivariate analysis model was used to identify factors associated with revascularization.

RESULTS

Mean age was 77.6 +/- 2.8 years; 70.4% were men. A total of 36% smoked, 53% were hypertensive, 33% diabetics and 30% dislipidemic. Thirty one % had multivessel disease and 11% involvement of left coronary trunk. There was evidence of anterior descending artery in 68%. Medical treatment was done in 48.4%, percutaneous revascularization in 41.5% and surgical in 10.1%. Patients with lesions of the anterior descending artery were revascularized in greater proportion: 67.7% vs 32.3%; p. 0.001. A logistic regression model was used to identify revascularization predictors, obtaining a direct relationship with the involvement of the anterior descending artery (OR: 4.87; 95% CI: 2.98-7.94; (p < 0.001) and inverse on with the previous revascularization (OR: 0.47; 95% CI: 0.26-0.85; p < 0.02), left ventricular dysfunction (OR: 0.58; 95% CI: 0.39-0.88; p = 0.01) and presence of multivessel disease (OR: 0.51; 95% CI: 0.31-0.84; p < 0.01).

CONCLUSIONS

The elderly subjects with ischemic heart disease who underwent coronariography received revascularizing treatment in somewhat more than 50% of the cases. A direct relationship was found between involvement of the anterior descending artery and performance of revascularizing treatment and an inverse on between previous revascularization, left ventricular dysfunction and presence of multivessel disease.

The impact of screening for asymptomatic myocardial ischemia in individuals with type 2 diabetes

Little is known about factors that contribute to either emotional or behavior outcomes following screening for coronary artery disease (CAD). The purpose of this prospective study was to explore these outcomes, along with potentially contributing factors in individuals enrolled in a screening trial for asymptomatic CAD. Included were 47 subjects with type 2 diabetes. Data were collected at study baseline and 3 and 6 months following entry by self-administered questionnaires and telephone follow-up. Emotional outcomes (quality of life and anxiety) tended to improve in those who underwent more aggressive screening with myocardial perfusion imaging, as well as in those who discussed the results of laboratory tests with their providers. Lower levels of diabetes competence and higher levels of controlled motivation for diet were associated with poorer emotional outcomes. Improvements in CAD risk factor behaviors were not observed.

Mental vulnerability--a risk factor for ischemic heart disease

OBJECTIVE

The purpose of this study is to examine whether mental vulnerability is a risk factor for the development of ischemic heart disease (IHD) after adjustment for well-established risk factors.

METHODS

In three prospective cohort studies in Copenhagen County, Denmark, we recorded the level of mental vulnerability and possible risk factors to IHD at baseline. For follow-up, the sample was linked to relevant registries to identify all cases of fatal and nonfatal IHD. The relationship between mental vulnerability and IHD was examined using both Kaplan-Meir and Cox proportional hazard models adjusting for possible confounding factors.

RESULTS

Mental vulnerability was significantly associated with the risk for IHD (medium mental vulnerability: hazard ratio 1.41, 95% confidence interval 1.04-1.91; and high mental vulnerability: hazard ratio 2.05; 95% confidence interval 1.46-2.88), after adjusting for confounders.

CONCLUSION

Our results imply that mental vulnerability is an independent risk factor for IHD.

[Effect of Lorazepam on emotional status and quality of life of patients with ischemic heart disease]

AIM

To investigate emotional status and quality of life of patients with ischemic heart disease (IHD) with various anxiety and effect of therapy with benzodiazepine anxiolytic lorazepam on these parameters.

MATERIAL AND METHODS

Hospital scale of anxiety and depression, Beck Depression Inventory, and Seattle Questionnaire were used for assessment of anxiety, depression, and quality of life, respectively, in 277 patients with IHD.

RESULTS

Patients with clinically evident level of depression had higher level of vegetative disturbances, worse quality of life and prognosis. Improvement of not only emotional state (lowering of anxiety and depression level) but also of quality of life occurred in patients with clinically pronounced level of depression at the background of treatment with lorazepam.

CONCLUSION

Lorazepam is effective and safe preparation for the treatment of anxiety disorders in patients with IHD. Lorazepam improves not only emotional status of these patients but their quality of life as well.

Improving psychologic adjustment to chronic illness in cardiac patients. The role of depression and anxiety

BACKGROUND

Poor mood adjustment to chronic medical illness is often accompanied by decrements in function.

OBJECTIVE

To evaluate the effectiveness of a telephone-based intervention for psychologic distress and functional impairment in cardiac illness.

DESIGN

Randomized, controlled trial.

METHODS

We recruited survivors of acute coronary syndromes using the Hospital and Anxiety Depression Scale (HADS) with scores indicative of mood disturbances at 1-month postdischarge. Recruited patients were randomized to experimental or control status. Intervention patients received 6 30-minute telephone counseling sessions to identify and address illness-related fears and concerns. Control patients received usual care. Patients' responses to the HADS and the Workplace Social Adjustment Scale (WSAS) were collected at baseline, 2, 3, and 6 months using interactive voice recognition technology. At baseline, the PRIME-MD was used to establish diagnosis of depression. We used mixed effects regression to study changes in outcomes.

RESULTS

We enrolled 100 patients. Mean age was 60; 67% of the patients were male. Findings confirmed that the intervention group had a 27% improvement in depression symptoms (P=.05), 27% in anxiety (P=.02), and a 38% improvement in home limitations (P=.04) compared with controls. Symptom improvement tracked those for WSAS measures of home function (P=.04) but not workplace function.

CONCLUSIONS

The intervention had a moderate effect on patient's emotional and functional outcomes that were observed during a critical period in patients' lives. Patient convenience, ease of delivery, and the effectiveness of the intervention suggest that the counseling can help patients adjust to chronic illness.

[Health-related quality of life in Japanese patients with ischemic heart disease: a multicenter cooperative investigation assessed using SF-36]

OBJECTIVES

To investigate the quality of life (QOL) of Japanese patients with ischemic heart disease.

METHODS

The QOL data of 753 patients with chronic and stable ischemic heart disease was assessed using SF-36 Japanese version 1.2 and compared with Japanese national norms. Physical (PCS) and Mental Component Summary (MCS) scores were calculated to examine the correlation with patient background. Patients were also asked about subjective symptoms during the QOL investigation.

RESULTS

Mean age was 63.6 +/- 7.5 years old and the male/female ratio was 85.7/14.3. About one third (30.7%) of the patients were symptomatic and about half (52.6%) had a history of myocardial infarction. Compared to Japanese national norms, physical functioning, role-physical, social functioning, general health and role-emotional were lower, and body pain, vitality and mental health were higher. PCS was significantly lower and MCS was significantly higher in aged patients than in younger patients (p < 0.0001, p < 0.0001). PCS and MCS were significantly lower in the symptom (+) group than in the symptom (-) group (p = 0.0009, p < 0.0001). PCS decreased as the number of anti-angina medications for the patients increased (p = 0.0002). PCS was significantly lower and MCS was significantly higher in the beta blocker (+) group than in the beta blocker (-) group (p < 0.0001, p < 0.03). Multivariate logistic regression analysis showed that age ( > or = 63 years old), symptom (+), duration of disease (> or = 3 years) and beta blocker (+) influenced the QOL.

CONCLUSIONS

The QOL level of patients with ischemic heart disease was found to depend on the clinical condition and treatment, so the optimal treatment for ischemic heart disease must be established to improve QOL.

[Psychosocial factors at work and ischemic heart disease]

We reviewed the epidemiologic research on the relationship between psychosocial factors at work and ischemic heart disease (IHD). A literature search identified 35 longitudinal English-language studies published in peer-reviewed journals. Nine out of 18 cohort studies and 14 out of 17 case control studies showed a significant association between psychosocial factors at work and IHD. In three of the studies, the results showed the expected association without it being significant, and in nine of the studies no association was found. Twenty-nine of the studies achieved a satisfactory quality score of at least 16 points out of a possible 25. Among these, 19 found a positive association between psychosocial factors at work and IHD. Nineteen of the studies had used the job strain model suggested by Karasek and Theorell as the model of exposure. Eleven of these found a clear association between job strain and IHD, three found a partial association, and five showed negative results. Three of the negative studies had used the ecological method as the measure of exposure. None of the five American studies found any association between job strain and IHD. The 11 positive studies were carried out in the UK, Sweden, the Czech Republic, and Denmark. An imbalance between efforts rendered and rewards, as well as long working hours, was also found to increase the risk of IHD in the six studies which had looked into these exposures. The results of this literature review ought to have consequences for the prevention of IHD and affect the advice offered to IHD patients.

Prevalence and patterns of anxiety and depression in patients undergoing elective percutaneous transluminal coronary angioplasty

BACKGROUND

The use of elective percutaneous transluminal coronary angioplasty (PTCA) as a treatment for coronary heart disease is increasing. Despite this, little is known about the prevalence and patterns of anxiety and depression experienced by patients undergoing and recovering from this procedure. Anxiety and depression are factors known to negatively influence recovery after a cardiac event.

OBJECTIVE

The purpose of this study was to (1) describe the levels of anxiety and depression reported by patients pre- and postelective PTCA, and (2) determine associations evident between anxiety and depression and the sociodemographic and clinical variables of gender, marital status, history of acute myocardial infarction, and attendance at cardiac rehabilitation.

METHODS

In this descriptive, repeated-measures investigation, patients (n = 140) were requested to complete the Spielberger State Trait Anxiety Inventory and Cardiac Depression Scale (CDS) at three time points: 0(1) before admission for elective PTCA (T(1)); (2) 6 to 8 weeks (T(2)) after PTCA; and (3) 6 to 8 months (T(3)) after PTCA.

RESULTS

A typical participant was male (75%), of European ethnicity (90%), aged 62 years (standard deviation = 10.7) with single or double vessel disease, and had attended cardiac rehabilitation in the past. At T(1), 16% of men and 24% of women had state anxiety scores comparable to those experienced by neuropsychiatric patients. Trait anxiety scores remained relatively constant over time; higher scores at T(1) were associated with past acute myocardial infarction. CDS scores at T(2) and T(3) were significantly lower than those at T(1). However, an unexpected increase in CDS scores occurred at T(3), compared with T(2). At T(3), 14% of men and 10% of women were depressed, relative to T(1).

CONCLUSION

The findings lend support for the closer surveillance of emotional status in this population. Specialist nurses have the potential to play a greater role in identifying those at risk of developing anxiety and depression. However, this unmet need will remain unmet until specialist nurses who spend the most face-to-face time with patients are equipped with the skills and resources to systematically identify those "at risk."

[Usefulness of relaxation techniques for patients with ischaemic cardiopathy: intervention in a health district]

OBJECTIVE

To determine the effectiveness of a programme of relaxation used in primary care for patients with ischaemic cardiopathy (IC) through evaluation of the anxiety levels and the quality of life of these patients.

DESIGN

Controlled intervention study without randomisation.

SETTING

Two primary care teams in the city of Sabadell.

PARTICIPANTS

Patients from 15 to 69 years old with IC: intervention group (IG), 57 patients; control group (CG), 47. Interventions. In the IG, conventional treatment and relaxation techniques (RT). In the CG, conventional treatment.

MAIN MEASUREMENTS

Degree of anxiety was measured by means of the STAI scale-questionnaire. Quality of life was measured by means of the SF-36 health questionnaire. Blood pressure and smoking were recorded.

RESULTS

At 12 months, 70% of patients practised relaxation at least for a short time. In the IG, anxiety dropped significantly at 3, 6, and 12 months, especially the anxiety characteristics scale, which was still significant at 12 months (P=.002). Quality of life at 3 and 6 months in the IG showed better scores in most dimensions except body pain. At 12 months, scores continued to be better than at the start (social function P=.012), except in the mental health dimension. No significant changes were found in blood pressure or tobacco consumption.

CONCLUSIONS

Our results suggest that an RT workshop in primary care is beneficial if correctly applied and leads to improved quality of life.

Hostility scores are associated with increased risk of cardiovascular events in women undergoing coronary angiography: a report from the NHLBI-Sponsored WISE Study

OBJECTIVE

To evaluate hostility-related personality traits assessed by the Cook Medley Hostility Inventory and to relate these to the occurrence of adverse cardiac events in women with suspected myocardial ischemia.

METHODS

The cohort included 506 women with suspected coronary artery disease from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. We examined individual components of the Cook Medley Hostility Score (CMHS) measuring cynicism, hostile affect, and aggressive responding, and a total CMHS (sum of these three) and associations with adverse events (defined as hospitalization for angina, nonfatal myocardial infarction, stroke, congestive heart failure (CHF) other vascular events and death) during 3 to 6 years follow-up using Cox proportional hazard modeling.

RESULTS

Women with adverse events had higher total CMHS (10.6 +/- 5.5) than women without any of these events (9.2 +/- 5.1) p = .02. They also had poorer survival by Kaplan-Meier analysis (log-rank p < .05). Unadjusted Cox models showed that the individual scores of cynicism and aggressive responding and the total CMHS were associated with more adverse events (all p < .05). Women with total CMHS above the median had a 35% increase risk of an adverse event in comparison to women with lower scores. In a risk-adjusted Cox model, the hazard ratio for an adverse event was 1.5 (p = .03) for women with total CMHS above the median.

CONCLUSION

In this cohort of women with suspected myocardial ischemia, higher Cook Medley scores reflecting cynicism, hostile affect, and aggressive responding were associated with poorer 3 to 6 year event-free survival and a higher risk of adverse events. After adjusting for risk factors and CAD, the association with risk for adverse events increased.

Baroreflex sensitivity is reduced in depression

OBJECTIVES

Depression is independently associated with increased cardiovascular morbidity and mortality, including sudden cardiac death, and this risk is observed even in patients who have been successfully treated for depression. Recent studies have emphasized the importance of impaired baroreceptor sensitivity (BRS) as a predisposing factor for sudden death in patients with manifest cardiac disease. Our objective was to test the hypothesis that BRS is impaired in subjects with depression in remission and with no other cardiac risk factors.

METHODS

We measured BRS by the sequence method in 36 patients with treated recurrent depression, who were euthymic at the time of study and with no manifest cardiac disease or "conventional" cardiac risk factors, compared with 39 healthy controls. Exclusion criteria included manifest heart disease or any risk factor for IHD (smoking, hypertension, diabetes, hypercholesterolemia, or body mass index >30). Nine subjects were not on any medication, and 22 were taking antidepressants. None of the controls was taking any medication.

RESULTS

BRS was significantly lower in patients than in controls (19.5 [1.78] versus 25.4 [1.69] ms/mm Hg, p = .017). Analysis of covariance, in which age, sex, cholesterol, and body mass index were included, also showed that depression was a significant (p = .027) predictor of BRS. There was no significant difference in BRS adjusted by age and sex between the subjects taking antidepressants compared with those on no medications (p = .40).

CONCLUSIONS

These data indicate that BRS is impaired in otherwise healthy patients with depression and may contribute to their increased cardiac risk.

Anxiety level and responses to stress caused by air raids among patients with ischemic heart disease

BACKGROUND

This study was undertaken to examine the short-term responses of patients with ischemic heart disease to life-threatening events such as war.

METHODS

This retrospective study included 75 persons with ischemic heart disease who were admitted to the Cardiac policlinic for a control check-up immediately after the suspension of air raids. Two-thirds of them were male (average age 62 +/- 10). Data were obtained using a specially conceived questionnaire based on recall.

RESULTS

Almost 40% of patients estimated that they were very anxious the week before the attacks began, but the anxiety decreased after the beginning of the air raids. Frequency of anginal pains increased after the start of the air raids, but the difference was not statisticaly significant. The intensity of pains drastically increased in the first week of war. Consequently, the average number of pain killers consumed increased from the week before the attacks to the first week of the attacks, and it reached the highest value the week after the suspension of the attacks (1.39, 1.87, and 3.02 pain pills per week, respectively). The average weekly number of medications was 3.50 in the week prior to the air raids, increased to 5.05 during the first week of air raids, and rose to 6.06 in the week after the suspension.

CONCLUSION

The adjustment on the psychological level was rapid but physical symptoms increased. This implies that physical adaptation to stress could be slower, or that the stress of the war provoked permanent changes in physical status.

Pharmacologic treatment of depression in patients with heart disease

The relationship between depression and cardiovascular disease is complex and multifaceted. There is a growing body of evidence that depression significantly and adversely affects cardiovascular health. Perhaps the most prominent finding is the documented increase in mortality rate in patients with depression after myocardial infarction. The critical questions of interest to both the clinician and researcher are whether there are safe and effective treatments for depression in patients with heart disease and whether treatment of depression reduces the increased risk of cardiac morbidity and mortality. Although the data are limited and are primarily from open or comparator trials, the tricyclics (TCAs) and selective serotonin reuptake inhibitors (SSRI) are effective for treatment of depression in patients with ischemic heart disease (IHD), and response rates are comparable with those reported in depressed patients without heart disease. In terms of safety, the TCAs are associated with documented adverse cardiovascular effects, including increases in heart rate, orthostatic hypotension, and conduction delays. Use of TCAs in patients with IHD carries a proven increased risk of cardiac morbidity and perhaps of mortality as well. The SSRI appear to be relatively safe and effective in the treatment for depression in patients with comorbid IHD.

Depression, alterations in platelet function, and ischemic heart disease

Platelets, the smallest corpuscular component of human blood, are central to various crucial biologic pathways in the human body. Diminished platelet function is thought to contribute to the increased risk of ischemic heart disease in patients with major depressive disorder, and to the increased morbidity and diminished survival of depressed patients after an index myocardial infarction. We reviewed both recent studies that evaluated platelet function in various patient groups and recent information regarding the potential beneficial effects of selective serotonin reuptake inhibitors on platelet reactivity.

Effects of exercise and stress management training on markers of cardiovascular risk in patients with ischemic heart disease: a randomized controlled trial

CONTEXT

Observational studies have shown that psychosocial factors are associated with increased risk for cardiovascular morbidity and mortality, but the effects of behavioral interventions on psychosocial and medical end points remain uncertain.

OBJECTIVE

To determine the effect of 2 behavioral programs, aerobic exercise training and stress management training, with routine medical care on psychosocial functioning and markers of cardiovascular risk.

DESIGN, SETTING, AND PATIENTS

Randomized controlled trial of 134 patients (92 male and 42 female; aged 40-84 years) with stable ischemic heart disease (IHD) and exercise-induced myocardial ischemia. Conducted from January 1999 to February 2003.

INTERVENTIONS

Routine medical care (usual care); usual care plus supervised aerobic exercise training for 35 minutes 3 times per week for 16 weeks; usual care plus weekly 1.5-hour stress management training for 16 weeks.

MAIN OUTCOME MEASURES

Self-reported measures of general distress (General Health Questionnaire [GHQ]) and depression (Beck Depression Inventory [BDI]); left ventricular ejection fraction (LVEF) and wall motion abnormalities (WMA); flow-mediated dilation; and cardiac autonomic control (heart rate variability during deep breathing and baroreflex sensitivity).

RESULTS

Patients in the exercise and stress management groups had lower mean (SE) BDI scores (exercise: 8.2 [0.6]; stress management: 8.2 [0.6]) vs usual care (10.1 [0.6]; P = .02); reduced distress by GHQ scores (exercise: 56.3 [0.9]; stress management: 56.8 [0.9]) vs usual care (53.6 [0.9]; P = .02); and smaller reductions in LVEF during mental stress testing (exercise: -0.54% [0.44%]; stress management: -0.34% [0.45%]) vs usual care (-1.69% [0.46%]; P = .03). Exercise and stress management were associated with lower mean (SE) WMA rating scores (exercise: 0.20 [0.07]; stress management: 0.10 [0.07]) in a subset of patients with significant stress-induced WMA at baseline vs usual care (0.36 [0.07]; P = .02). Patients in the exercise and stress management groups had greater mean (SE) improvements in flow-mediated dilation (exercise: mean [SD], 5.6% [0.45%]; stress management: 5.2% [0.47%]) vs usual care patients (4.1% [0.48%]; P = .03). In a subgroup, those receiving stress management showed improved mean (SE) baroreflex sensitivity (8.2 [0.8] ms/mm Hg) vs usual care (5.1 [0.9] ms/mm Hg; P = .02) and significant increases in heart rate variability (193.7 [19.6] ms) vs usual care (132.1 [21.5] ms; P = .04).

CONCLUSION

For patients with stable IHD, exercise and stress management training reduced emotional distress and improved markers of cardiovascular risk more than usual medical care alone.

Womenʼs Hearts—Stress Management for Women With Ischemic Heart Disease

PURPOSE

This randomized controlled study aimed to evaluate the effects on psychosocial variables of a 1-year group-based cognitive-behavioral stress management program developed specifically for women with ischemic heart disease.

METHODS

The present explanatory (per protocol) analyses include 80 women who were randomized to a 1-year cognitive-behavioral stress management program and 86 who were randomized to usual care (age = 35-77 years). Data were obtained before randomization and after 1 year, when the intervention group had completed the program.

RESULTS

There were no statistically significant differences between the intervention and usual care groups in the psychosocial endpoints at randomization. Both groups improved in all psychosocial variables during the 1-year study period, but the rate of improvement was significantly greater in the intervention group for self-rated stress behavior (P = .006) and vital exhaustion (P = .03). Although changes were in favor of the treatment group also for depressive mood and quality of life, the rates of improvement between the 2 groups did not reach statistical significance (P = .23 and P = .10, respectively).

CONCLUSION

A 1-year cognitive-behavioral stress management program designed specifically for women improved psychological well-being in some aspects in comparison with usual care.

Personality and mortality from ischemic heart disease and stroke

BACKGROUND

The role of personality in the causation of circulatory diseases has been controversial.

METHODS

From June through August 1990, 41,442 residents of Miyagi Prefecture in northern Japan completed the Japanese version of the short-form Eysenck Personality Questionnaire-Revised and another questionnaire on various health habits. During 11 years of follow-up until March 31, 2001, we identified 90 deaths from ischemic heart disease (IHD) and 131 deaths from stroke. We used Cox regression to estimate the relative risk of IHD and stroke according to the three levels of four personality subscales (extraversion, neuroticism, psychoticism, and lie), with adjustment for sex, age, and other potentially confounding variables.

RESULTS

Multivariate relative risks of IHD for the highest verses the lowest level of personality subscales were 0.7 for extraversion, 1.1 for neuroticism, 1.3 for psychoticism, and 0.8 for lie. Multivariate relative risks of stroke for the highest verses the lowest level of personality subscales were 1.0 for extraversion, 0.9 for neuroticism, 1.2 for psychoticism, and 1.2 for lie.

CONCLUSIONS

This prospective study does not support the hypothesis that personality is a risk factor for mortality from IHD and stroke.

[Effects of therapy with various groups of antianginal agents on life quality of the elderly with coronary heart disease and comorbid depression]

The purpose of the work was to study effects of antianginal agents of various groups on the psychoemotional status and life quality (LQ) of elderly patients with coronary heart disease (CHD) and concomitant depression. The subjects of the study were 70 patients (35 men and 35 women) with stable angina and depression. The subjects were divided into 3 groups. The 20 patients of group I were administered nitrates, the 32 patients of group II--beta-adrenoblockers, and the 18 patients of group III--a Ca antagonist. The control group consisted of 27 patients without anxious depression. The treatment led to significant reduction of weakly attack frequency and weakly sublingual nitroglycerine consumption in all the three groups. Significant reduction of average depression score and personal anxiety was noted in group III; decrease of situational anxiety level was observed in group I. There was no change of the psychoemotional status in group II. Examination of patients with depression showed that their LQ, according to Nottingham Health Profile questionnaire, was significantly lower than that of patients without depression. In spite of more pronounced antianginal effect of beta-adrenoblockers, LQ in this group did not differ significantly from that in other groups. There was significant improvement of LQ in group I and III. The latter demonstrated even more prominent changes, consisting in positive dynamics of the emotional status and improvement of sleep. Despite antianginal agents, LQ of patients with depression remained significantly worse than that of patients who did not have depression prior to the therapy. Thus, correction of concomitant depression will lead not only to improvement of LQ, but perhaps, also to improvement of the prognosis of patients with CHD.