Am Fam Physician. 2001 Jun 1;63(11):2259-2260.
It has been suggested that some psychologic conditions, including hostility, anxiety and depression, contribute to coronary disease and are associated with adverse outcomes in patients with acute coronary events. Various theories have been proposed to explain the underlying mechanism, ranging from increased platelet reactivity to poor adherence to medications. O'Malley and colleagues performed a study to assess the effect that multiple psychologic variables might have on underlying atherosclerosis.
Research subjects enrolled in the study were active-duty military personnel 39 to 45 years of age who were seen for an Army-mandated physical examination. They were subjected to an extensive evaluation of their medical and family histories and underwent a thorough physical examination. Primary exclusion criteria included a history of angina pectoris or coronary artery disease. Subjects underwent computed tomographic (CT) scanning of their coronary arteries to determine the amount of subclinical coronary atherosclerosis. Based on the CT scans, a scoring system for coronary artery calcification involving the four major epicardial coronary arteries was determined. For the psychologic assessment, subjects completed an extensive questionnaire that addressed functional status, stress, hostility, and identified depression, anxiety and somatoform disorders, based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV).
The study included 630 research subjects, 82 percent of whom were men. The mean age was 42 years. Twenty-three percent had a history of hypertension, 22 percent had a family history of heart disease and 11 percent were smokers. Based on the Framingham Risk Index, the five-year predicted risk of coronary heart disease among the group was 1.6 percent. Coronary artery calcifications were present in 21 percent of the men and 4 percent of the women. The presence of calcifications was significantly related to the presence of hypertension, total cholesterol and low-density lipoprotein cholesterol levels, and high body-mass index. These same factors were also identified as independent correlates of coronary artery calcification. However, depression, anxiety, stress and hostility were not associated with coronary calcification. The degree of somatization actually had an inverse correlation with the presence of coronary artery calcifications.
The authors conclude that there is no positive association between psychologic variables and the presence of coronary artery calcification. Moreover, somatization appears to be a marker for the absence of coronary atherosclerosis.
O'Malley PG, et al. Lack of correlation between psychological factors and subclinical coronary artery disease. N Engl J Med. November 2, 2000;343:1298–304.
Copyright © 2001 by the American Academy of Family Physicians.
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