Abstract
BackgroundA large number of studies have provided clear evidence for a link between the risk of coronary heart disease and psychological risk factors. Much less attention has been given to the potential protective effect of psychological resources.PurposeThe major aim of this study was to investigate the independent association between psychological resources and incidence of coronary heart disease (CHD) in an 8-year follow-up study of a Swedish community-based cohort.MethodsThe cohort consisted of 484 men and 497 women, aged 45–69 years at baseline. The incidence of first-time major event of CHD was analysed in relation to baseline levels of psychological resources, including mastery, self-esteem, and sense of coherence as well as psychological risk factors including cynicism and hostile affect, vital exhaustion, hopelessness, and depressive symptoms. In Cox proportional hazard models, adjustments were made for age, sex, eight traditional cardiovascular risk factors, and depressive symptoms.ResultsA total of 56 CHD events had occurred after the 8-year follow-up. After adjustment for age, sex, and eight traditional risk factors, a significantly decreased risk of CHD was found for mastery (HR 0.62 per SD, p = 0.003), self-esteem (HR 0.64, p = 0.004), and sense of coherence (HR 0.70, p = 0.031). An increased risk of CHD was found for vital exhaustion (HR 1.46, p = 0.014), hopelessness (HR 1.59, p = 0.003), and depressive symptoms (HR 1.45, p = 0.009). After further adjustment for depressive symptoms, significant associations remained for mastery (HR 0.67, p = 0.034), self-esteem (HR 0.69, p = 0.048), and hopelessness (HR 1.48, p = 0.023).ConclusionsThe psychological resources, mastery and self-esteem, showed robust protective effects on CHD, also after adjustment for established risk factors as well as depressive symptoms. In parallel, hopelessness was an independent risk factor for CHD. The results may have implications for novel approaches in preventive efforts.
Highlights
Since the 1940s, a continually growing interest in the relationship between cardiovascular disease and psychological distress has generated a rich amount of scientific data [1], with solid evidence for significant associations between risk of coronary heart disease (CHD) and psychological risk factors like perceived stress [2, 3], anxiety [3], hostile affect [3, 4], vital exhaustion [5], hopelessness [6], and depression [3, 7]
Fifty-six new cases of CHD were identified over 7,502 person years (n=981)
The main finding in this study was that mastery, self-esteem, and sense of coherence were significantly associated with a reduced risk of CHD, in a model adjusted for age, sex, and eight cardiovascular risk factors
Summary
Since the 1940s, a continually growing interest in the relationship between cardiovascular disease and psychological distress has generated a rich amount of scientific data [1], with solid evidence for significant associations between risk of coronary heart disease (CHD) and psychological risk factors like perceived stress [2, 3], anxiety [3], hostile affect [3, 4], vital exhaustion [5], hopelessness [6], and depression [3, 7]. Much less attention has been given to the potential protective effect of psychological. A handful of prospective studies have reported a protective effect of mastery, sense of coherence [11], and optimism [12] on coronary heart mortality. A large number of studies have provided clear evidence for a link between the risk of coronary heart disease and psychological risk factors. Much less attention has been given to the potential protective effect of psychological resources. Purpose The major aim of this study was to investigate the independent association between psychological resources and incidence of coronary heart disease (CHD) in an 8-year follow-up study of a Swedish community-based cohort
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