Abstract
ObjectiveResearch on psychosocial risk factors in cardiovascular disease (CVD) has identified traumatic stress and attachment style as independent risk factors for the development of CVD and poor prognosis for those with established CVD. Exploring the interrelationships between these variables will inform psychosocial risk factor modeling and potential avenues for intervention. Therefore, the hypothesis that attachment style is related to health outcomes among CR patients and that traumatic stress mediates this relationship was tested.MethodsPatients in a cardiac rehabilitation program (n = 201) completed validated self-report measures of traumatic stress and attachment style at baseline (program intake). Health outcomes were assessed at baseline and 3 months, including anxiety, depression, quality of life, fasting blood glucose, glycated hemoglobin (HbA1c), and cholesterol (HDL ratio). Multivariate structural equation modeling was used to fit the data.ResultsOf the 201 participants, 42 (21%) had trauma scores indicating the probable presence of posttraumatic stress disorder. Via greater levels of traumatic stress, greater attachment anxiety at baseline was indirectly related to greater anxiety, depression, fasting blood glucose, and HbA1c, and poorer physical and mental quality of life. There were no significant indirect effects on HDL ratios.ConclusionGreater attachment anxiety predicted greater traumatic stress; this, in turn, predicted poorer health outcomes. Screening and treatment for these constructs in CVD patients is warranted.
Highlights
Cardiovascular disease (CVD) includes a host of different disorders of the heart and blood vessels, such as coronary artery disease and hypertension, and symptoms typically manifest only after the disease has progressed to an advanced stage (Perk et al, 2012)
Regarding information collected at baseline and 3 months, Hospital Anxiety and Depression Scale (HADS) scores were missing 1 and 23%, respectively, 36-Item Short Form Survey (SF-36) scores were missing 0 and 33%, fasting blood glucose values were missing 2 and 21%, glycated hemoglobin (HbA1c) values were missing 4 and 29%, and high-density lipoprotein (HDL) ratio values were missing 1 and 20%
In the present sample of patients participating in a cardiac rehabilitation program (CR) program, greater attachment anxiety predicted greater traumatic stress; this, in turn, predicted poorer physical and mental health outcomes
Summary
Cardiovascular disease (CVD) includes a host of different disorders of the heart and blood vessels, such as coronary artery disease and hypertension, and symptoms typically manifest only after the disease has progressed to an advanced stage (Perk et al, 2012). The promotion of health behavior change is central to CVD prevention efforts These changes focus on reducing or moderating specific risk factors; these can be behavioral in nature, such as managing weight loss, quitting smoking, or eating healthier (Mozaffarian et al, 2015), they can be physiological, such as targeting specific CVD markers like hypertension, high cholesterol, or lack of exercise (Lee et al, 2012), or, these risk factors can psychological, such as elevated anxiety and depression (Rothenbacher et al, 2007; Whalley et al, 2014; Blumenthal et al, 2016), insecure attachment (Maunder and Hunter, 2001), and lower levels of psychological well-being (Boehm and Kubzansky, 2012). Greater anxiety and depression promote other unhealthy behaviors (e.g., sedentary behavior, smoking) that exacerbate CVD risk
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