Self-perceived psychological stress and incidence of coronary artery disease in middle-aged men

doi:10.1016/0002-9149(91)90189-R

The American Journal of Cardiology

Volume 68, Issue 11, 1 November 1991, Pages 1171-1175

https://doi.org/10.1016/0002-9149(91)90189-R Get rights and content

Abstract

Self-perceived psychological stress as a risk factor for coronary artery disease (CAD) was evaluated in a general population study comprising 6,935 men aged 47 to 55 years at baseline without previous myocardial infarction. In 1970 to 1973, the men answered a question about psychological stress defined as a feeling of tension, irritability or anxiety, or as having sleeping difficulties as a result of conditions at work or at home. Psychological stress was graded as follows: (1) never experienced stress; (2) ≥1 period of stress; (3) ≥1 period of stress during the last 5 years; (4) several periods of stress during the last 5 years; and (5 to 6) permanent stress during the last year or the last 5 years. After a mean follow-up of 11.8 years, 6% of the men with the lowest 4 stress ratings (n = 5,865) had either developed a nonfatal myocardial infarction or died from CAD, with no increase in risk from grade 1 to 4. The corresponding figure among the men with the highest 2 stress ratings (n = 1,070) was 10%; the odds ratio was 1.5 (95% confidence interval 1.2–1.9) after controlling for age and other risk factors. Similar, independent associations were seen with stroke, and with death from cardiovascular disease and from all causes, but not with death from cancer. With respect to CAD, no decrease in the effect of stress at baseline could be seen over time. No relation between life events and self-perceived psychological stress was found in another sample of 732 fifty-year-old men.

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Results of the present study support the model by showing that conscientiousness is associated with individuals’ general health perception in part through their perception of the levels of experienced stress. Previous research has shown that the experience of stress increased the risk of infectious diseases (Glaser et al., 1987; Stone, Reed, & Neale, 1987), cardiovascular disease, such as stroke (Harmsen, Rosengren, Tsipogianni, & Wilhelmsen, 1990) and coronary artery disease (Rosengren, Tibblin, & Wilhelmsen, 1991). Perceived stress may shape the link between conscientiousness and general health perception in two ways.
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Heart failure (HF) prognosis is negatively influenced by adverse environmental conditions associated with psychological distress and depression. The underlying mechanisms are not well understood because of insufficient experimental control in prior clinical and epidemiological studies. Using a validated animal model we examined whether distress-producing environmental manipulations (social isolation and crowding) increase HF progression following myocardial infarction (MI).
MI was induced using coronary artery ligation in 8-week old male Wistar rats (N = 52) and results were compared to sham surgery (N = 24). Housing conditions were randomly assigned at 5 days post MI or sham surgery (1/cage = isolation, 2/cage = standard reference condition, or 4/cage = crowding) and continued for 17 weeks until the end of observation. The open field test was used to test behavioral responses. Echocardiograms were obtained at weeks 8 and 16, and left ventricular (LV) weight at week 17.
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^☆: This study was supported by the Swedish National Bank Tercentenary Fund, Stockholm, the Swedish National Association Against Heart and Chest Diseases, Stockholm, the Göteborg Medical Society, Göteborg, and the Knut and Alice Wallenberg Foundation, Stockholm.

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Self-perceived psychological stress and incidence of coronary artery disease in middle-aged men☆

Abstract

Lancet

J Chronic Dis

J Chronic Dis

Lancet

J Psychosom Res

J Psychosom Res

Four-year mortality by some socio-economic indicators: the Oslo study

J Epidemiol Community Health

Social isolation and mortality in ischemic heart disease

Acta Med Scand

Job decision latitude, job demands and cardiovascular disease: a prospective study of Swedish men

Am J Public Health

Type of occupation and near-future hospitalization for myocardial infarction and some other diagnoses

Int J Epidemiol