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Gaffey AE, Spatz ES. Psychological Health and Ischemic Heart Disease in Women: A Review of Current Evidence and Clinical Considerations across the Healthspan. Curr Atheroscler Rep 2024; 26:45-58. [PMID: 38240928 DOI: 10.1007/s11883-023-01185-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/22/2024]
Abstract
PURPOSE OF REVIEW Psychological health encompasses a constellation of negative and positive factors-i.e., psychosocial stress, depression, anxiety, trauma, loneliness and social isolation, anger and hostility, optimism, and a sense of purpose. This narrative review presents current evidence at the intersection of psychological health, risk of ischemic heart disease (IHD), and IHD-related outcomes, with an emphasis on associations in women. RECENT FINDINGS For women, relations between psychological health and IHD reflect important sex and gender differences in biological and psychosocial factors. Although efforts devoted to understanding psychological health and IHD risk have varied by psychological factor-scientific evidence is strongest for psychosocial stress and depression, while anxiety, trauma, and positive psychological factors warrant more investigation-less optimal psychological health is consistently associated with an earlier and greater risk of IHD morbidity and mortality in women. Still, many past prospective studies of psychological factors and IHD risk had a limited representation of women, did not include analyses by sex, or failed to account for other influential, sex-specific factors. Thus, there are multiple pathways for further, rigorous investigation into psychological health-IHD associations, mechanisms, and empirically supported psychological interventions to mitigate IHD risk among women. Given the robust evidence linking psychological health with women's risk for IHD, implementing routine, brief, psychological screening is recommended. Significant life events, developmental milestones specific to women, and IHD diagnoses or events could cue further psychological assessment and referral, efforts which will mutually strengthen the evidence for integrated psychological and IHD care and delivery of such care to this vulnerable group.
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Affiliation(s)
- Allison E Gaffey
- Department of Internal Medicine (Section of Cardiovascular Medicine), Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Erica S Spatz
- Department of Internal Medicine (Section of Cardiovascular Medicine), Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Department of Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
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Zhu C, Dreyer RP, Li F, Spatz ES, Caraballo C, Mahajan S, Raparelli V, Leifheit EC, Lu Y, Krumholz HM, Spertus JA, D’Onofrio G, Pilote L, Lichtman JH. Association of marital/partner status with hospital readmission among young adults with acute myocardial infarction. PLoS One 2024; 19:e0287949. [PMID: 38277368 PMCID: PMC10817183 DOI: 10.1371/journal.pone.0287949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024] Open
Abstract
INTRODUCTION Despite evidence supporting the benefits of marriage on cardiovascular health, the impact of marital/partner status on the long-term readmission of young acute myocardial infarction (AMI) survivors is less clear. We examined the association between marital/partner status and 1-year all-cause readmission and explored sex differences among young AMI survivors. METHODS Data were from the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients), which enrolled young adults aged 18-55 years with AMI (2008-2012). The primary end point was all-cause readmission within 1 year of hospital discharge, obtained from medical records and patient interviews and adjudicated by a physician panel. We performed Cox proportional hazards models with sequential adjustment for demographic, socioeconomic, clinical, and psychosocial factors. Sex-marital/partner status interaction was also tested. RESULTS Of the 2,979 adults with AMI (2002 women [67.2%]; mean age 48 [interquartile range, 44-52] years), unpartnered individuals were more likely to experience all-cause readmissions compared with married/partnered individuals within the first year after hospital discharge (34.6% versus 27.2%, hazard ratio [HR] = 1.31; 95% confidence interval [CI], 1.15-1.49). The association attenuated but remained significant after adjustment for demographic and socioeconomic factors (adjusted HR, 1.16; 95% CI, 1.01-1.34), and it was not significant after further adjusting for clinical factors and psychosocial factors (adjusted HR, 1.10; 95%CI, 0.94-1.28). A sex-marital/partner status interaction was not significant (p = 0.69). Sensitivity analysis using data with multiple imputation and restricting outcomes to cardiac readmission yielded comparable results. CONCLUSIONS In a cohort of young adults aged 18-55 years, unpartnered status was associated with 1.3-fold increased risk of all-cause readmission within 1 year of AMI discharge. Further adjustment for demographic, socioeconomic, clinical, and psychosocial factors attenuated the association, suggesting that these factors may explain disparities in readmission between married/partnered versus unpartnered young adults. Whereas young women experienced more readmission compared to similar-aged men, the association between marital/partner status and 1-year readmission did not vary by sex.
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Affiliation(s)
- Cenjing Zhu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | - Rachel P. Dreyer
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States of America
| | - Fan Li
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States of America
- Center for Methods in Implementation and Preventive Science, Yale University, New Haven, CT, United States of America
| | - Erica S. Spatz
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States of America
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States of America
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States of America
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Erica C. Leifheit
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States of America
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States of America
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States of America
| | - John A. Spertus
- Healthcare Institute for Innovations in Quality, University of Missouri–Kansas City, Kansas City, Missouri, United States of America
- Saint Luke’s Cardiovascular Outcomes Research, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, United States of America
| | - Gail D’Onofrio
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Louise Pilote
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Judith H. Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
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