Impaired Health Status, Psychological Distress, and Personality in Women and Men With Nonobstructive Coronary Artery Disease

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Abstract

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Abstract

Background—

Patients with nonobstructive coronary artery disease (NOCAD; wall irregularities, stenosis <60%), and women with NOCAD in particular, remain underinvestigated. We examined sex and gender (S&G) differences in health status, psychological distress, and personality between patients with NOCAD and the general population, as well as S&G differences within the NOCAD population.

Methods and Results—

In total, 523 patients with NOCAD (61±9 years, 52% women) were included via coronary angiography and computed tomography as part of the TWIST (Tweesteden Mild Stenosis) study. Generic health status (12-item Short Form physical and mental scales and fatigue), psychological distress (Hospital Anxiety and Depression Scale anxiety and depressive symptoms and Global Mood Scale negative and positive affect), and personality (Type D personality) were compared between patients with NOCAD and an age- and sex-matched group of 1347 people from the general population. Frequency matching was performed to obtain a similar sex distribution in each age–decile group. Both men and women with NOCAD reported impaired health status, more psychological distress, and Type D personality compared with men and women in the reference group. Women reported more psychosocial distress compared with men, but no significant sex-by-group interaction effects were observed. Women with NOCAD reported impaired health status, more anxiety, and less positive affect, but no differences in depressive symptoms, angina, or Type D personality when compared with men with NOCAD. Age, education, employment, partner, and alcohol use explained these S&G differences within the NOCAD group.

Conclusions—

In both men and women, NOCAD was associated with impaired health status, more psychological distress, and Type D personality when compared with a reference population. Factors reflecting S&G differences explained these S&G findings in patient-reported outcomes.

Clinical Trial Registration—

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01788241.

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Most cited references 34

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DS14: standard assessment of negative affectivity, social inhibition, and Type D personality.

Johan Denollet (2005)

Type D personality-a joint tendency toward negative affectivity (NA) and social inhibition (SI)-is related to poor cardiac prognosis, but there is no standard for assessing Type D. This study reports on the Type D Scale-14 (DS14) as a standard measure of NA, SI, and Type D. The study included 3813 participants (2508 from the general population, 573 cardiac patients, 732 hypertension patients). They all filled out the DS14, containing 7-item NA and SI subscales; 275 subjects also completed the NEO-FFI, and 121 patients filled out the DS14 twice. Factor analysis of the DS14 yielded 2 dominant traits; all of the NA and SI items loaded between 0.62 to 0.82 on their corresponding factor (N = 3678). The NA scale covered dysphoria, worry, and irritability; the SI scale covered discomfort in social interactions, reticence, and lack of social poise. The NA and SI scales were internally consistent (alpha = 0.88/0.86; N = 3678), stable over a 3-month period (test-retest r = 0.72/0.82) and not dependent on mood and health status (N = 121). NA correlated positively with neuroticism (r = 0.68); SI correlated negatively with extraversion (r = -0.59/-0.65). Scale-level factor analysis confirmed the construct validity of the DS14 against the NEO-FFI. Using a cutoff of 10 (NA > or =10 and SI > or =10), 1027 subjects (28%) were classified as Type D, 21% in the general population versus 28% in coronary heart disease and 53% in hypertension (p < or = .001). Age, sex, and Type D (odds ratio, 3.98; 95% confidence interval, 3.2-4.6; p <.0001) were independently associated with cardiovascular morbidity. The DS14 is a brief, psychometrically sound measure of negative affectivity and social inhibition that could readily be incorporated in epidemiologic and clinical research.

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Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events.

Lasse Jespersen, Anders Hvelplund, Steen Abildstrøm … (2012)

Patients with chest pain and no obstructive coronary artery disease (CAD) are considered at low risk for cardiovascular events but evidence supporting this is scarce. We investigated the prognostic implications of stable angina pectoris in relation to the presence and degree of CAD with no obstructive CAD in focus. We identified 11 223 patients referred for coronary angiography (CAG) in 1998-2009 with stable angina pectoris as indication and 5705 participants from the Copenhagen City Heart Study for comparison. Main outcome measures were major adverse cardiovascular events (MACE), defined as cardiovascular death, myocardial infarction, stroke or heart failure, and all-cause mortality. Significantly more women (65%) than men (32%) had no obstructive CAD (P< 0.001). In Cox's models adjusted for age, body mass index, diabetes, smoking, and use of lipid-lowering or antihypertensive medication, hazard ratios (HRs) associated with no obstructive CAD were similar in men and women. In the pooled analysis, the risk of MACE increased with increasing degrees of CAD with multivariable-adjusted HRs of 1.52 (95% confidence interval, 1.27-1.83) for patients with normal coronary arteries and 1.85 (1.51-2.28) for patients with diffuse non-obstructive CAD compared with the reference population. For all-cause mortality, normal coronary arteries and diffuse non-obstructive CAD were associated with HRs of 1.29 (1.07-1.56) and 1.52 (1.24-1.88), respectively. Patients with stable angina and normal coronary arteries or diffuse non-obstructive CAD have elevated risks of MACE and all-cause mortality compared with a reference population without ischaemic heart disease.

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Anxiety and risk of incident coronary heart disease: a meta-analysis.

Annelieke M Roest, Elisabeth J Martens, Peter de Jonge … (2010)

The purpose of this study was to assess the association between anxiety and risk of coronary heart disease (CHD). Less research has focused on the association of anxiety with incident CHD in contrast to other negative emotions, such as depression. A meta-analysis of references derived from PubMed, EMBASE, and PsycINFO (1980 to May 2009) was performed without language restrictions. End points were cardiac death, myocardial infarction (MI), and cardiac events. The authors selected prospective studies of (nonpsychiatric) cohorts of initially healthy persons in which anxiety was assessed at baseline. Twenty studies reporting on incident CHD comprised 249,846 persons with a mean follow-up period of 11.2 years. Anxious persons were at risk of CHD (hazard ratio [HR] random: 1.26; 95% confidence interval [CI]: 1.15 to 1.38; p < 0.0001) and cardiac death (HR: 1.48; 95% CI: 1.14 to 1.92; p = 0.003), independent of demographic variables, biological risk factors, and health behaviors. There was a nonsignificant trend for an association between anxiety and nonfatal MI (HR: 1.43; 95% CI: 0.85 to 2.40; p = 0.180). Subgroup analyses did not show any significant differences regarding study characteristics, with significant associations for different types of anxiety, short- and long-term follow-up, and both men and women. Anxiety seemed to be an independent risk factor for incident CHD and cardiac mortality. Future research should examine the association between anxiety and CHD with valid and reliable anxiety measures and focus on the mechanisms through which anxiety might affect CHD. Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): Circ Cardiovasc Qual Outcomes

Journal ID (iso-abbrev): Circ Cardiovasc Qual Outcomes

Journal ID (publisher-id): HCQ

Title: Circulation. Cardiovascular Quality and Outcomes

Publisher: Lippincott Williams & Wilkins

ISSN (Print): 1941-7713

ISSN (Electronic): 1941-7705

Publication date (Print): February 2017

Publication date (Electronic): 21 February 2017

Volume: 10

Issue: 2

Page: e003387

Affiliations

From the Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands (P.M.C.M., L.A, W.Z., J.W., J.D.); and Department of Cardiology, Elisabeth-Tweesteden Hospital, The Netherlands (J.W., W.A.).

Author notes

Correspondence to Paula M.C. Mommersteeg, Department of Medical and Clinical Psychology, CoRPS, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE Tilburg, The Netherlands. E-mail P.M.C.Mommersteeg@ 123456uvt.nl

Article

Accession ID: 00005

DOI: 10.1161/CIRCOUTCOMES.116.003387

PMC ID: 5333724

PubMed ID: 28228453

SO-VID: 3d0fde02-4a07-428e-9276-f3dab7c6477d

License:

Circulation: Cardiovascular Quality and Outcomes is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDervis License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.

History

Date received : 1 November 2016

Date accepted : 20 January 2017

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Keywords: anxiety,coronary artery disease,depression,health status,quality of life,sex,type d personality

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Keywords: anxiety, coronary artery disease, depression, health status, quality of life, sex, type d personality

Impaired Health Status, Psychological Distress, and Personality in Women and Men With Nonobstructive Coronary Artery Disease : Sex and Gender Differences: The TWIST (Tweesteden Mild Stenosis) Study

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Abstract

Abstract

Background—

Methods and Results—

Conclusions—

Clinical Trial Registration—

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Cardiovascular Innovations and Applications

Most cited references 34

DS14: standard assessment of negative affectivity, social inhibition, and Type D personality.

Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events.

Anxiety and risk of incident coronary heart disease: a meta-analysis.

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