Background and ObjectivesIncreasing evidence supports that psychological factors may be related to development of coronary artery disease (CAD). Although psychological well-being, ill-being, and control strategy factors may play a significant role in CAD, rarely have these factors been simultaneously examined previously. We assessed comprehensive psychological factors in patients with acute coronary syndrome (ACS).Subjects and MethodsA total of 85 ACS patients (56 unstable angina, 29 acute myocardial infarction; 52.6±10.2 years; M/F=68/17) and 63 healthy controls (48.7±6.7 years, M/F=43/20) were included. Socio-demographic information, levels of psychological maladjustment, such as anxiety, hostility, and job stress, health-related quality of life (HRQoL), and primary and secondary control strategy use were collected through self-report questionnaires.ResultsThere was no significant difference between the ACS group and control group in levels of anxiety, hostility, and job stress. However, ACS patients had significantly lower scores on the general health perception and bodily pain subscales of HRQoL than the control group. The ACS group, as compared with the controls, tended to use primary control strategies more, although not reaching statistical significance by univariate analysis. Multivariate logistic regression analysis after adjusting age and gender identified the physical domain of HRQoL {odds ratio (OR)=0.40}, primary control strategy (OR=1.92), and secondary control strategy (OR=0.53) as independent predictors of ACS.ConclusionPoor HRQoL and primary control strategy, proactive behaviors in achieving ones' goal, may act as risk factors for ACS, while secondary control strategy to conform to current situation may act as a protective factor for ACS.
PurposeDietary and psychological status contributes to the development of coronary artery disease. However, these lifestyle factors may vary depending on ethnic and environmental background, and secondary prevention programs dealing with these factors in a specific population are not well-established. We aimed to assess dietary and psychological characteristics in Korean patients with acute coronary syndrome (ACS) and analyze their interactions as independent risk factors for ACS.MethodsNinety-two patients with ACS (29 acute myocardial infarction and 63 unstable angina) and 69 controls were subjected to dietary and psychological analyses. Dietary intake was assessed by a food frequency questionnaire. Psychological depression and perceived stress were assessed using the Patient Health Questionnaire-9 and the Perceived Stress Scale, respectively. Eight domains of life satisfaction (marital/love relationship, leisure, standard of living, job, health, family life, sex life, and self) were assessed using the Domain Satisfaction Questionnaire (DSQ).ResultsThe ACS group had a higher consumption of sweets and fish/seafood, as well as higher levels of depressive symptoms. Additionally, they had lower DSQ scores in total, and all eight individual domains compared with the control group. In multivariate logistic regression analysis, sweet intake (OR 4.57, 95% CI: 1.94–11.40) and total DSQ scores (OR 0.34, 95% CI: 0.14–0.81) were identified as independent risk factors for ACS. Furthermore, these factors, which displayed a significant inverse correlation (ρ = −0.23, p = 0.01), were determined as having a synergistic contribution to the development of ACS.ConclusionHigh sweet food intake and low life satisfaction can act as risk factors for ACS through a synergistic interaction, which emphasizes a demand for a more comprehensive approach to secondary prevention of ACS. In addition, these data highlight the role of positive psychological wellbeing factors in cardiovascular health.
Introduction: An increasing body of evidence suggests that development of coronary artery disease (CAD) is probably affected by a variety of lifestyle factors. However, most studies have not assessed comprehensive lifestyle factors including well-being psychological factors simultaneously, therefore relative contribution of each factors is obscure. Hypothesis: A variety of lifestyle factors including defect in well-being psychological factors may contribute to development of CAD through interacting muturally. Methods and Results: A case-control, cross-sectional study analyzing comprehensive lifestyle factors of patients with acute coronary syndrome (ACS) and healthy control was conducted. 92 patients with ACS (73 male; 53.2 yr; 30 acute MI, 62 unstable angina) and 69 healthy control (43 male; 48.7yr) were recruited. For dietary analysis, food frequency questionnaire (FFQ) and 2 days of 24 hour dietary recall were used. Anxiety, depression, stress, job stress, and hostility were analyzed to assess psychological ill-being factors. Primary and secondary control strategies, health-related quality of life (HRQoL), and satisfaction degree in 7 life domains such as marriage, leisure, standard of living, job, family, sex life, and self were analyzed to assess well-being factors. Univariate analysis showed that ACS group vs. control group had more current/ex-smoker and exercised less (all, p<0.05). FFQ analysis showed that ACS group vs. control consumed more energy intake, fats, proteins, seafoods, and sweets (all, p<0.05). Psychological analysis showed that the ACS group had more depressive score, less mean satisfaction score in all 7 life domains, and less physical domain of HRQoL especially in the fields of 1) general health perceptrion and 2) bodily pain (all p<0.05). The ACS group vs. control tended to use more primary control strategy, although not reaching statistical signifcance. Logistic regression analysis, after adjustment of age and gender, identified that mean satisfaction score in 7 life domains (OR: 9.66), primary control strategy (OR: 1.92), greater intake of sea foods (OR 6.53) and sweets (OR: 7.40), exercise (OR: 0.26), and smoking (OR:7.53) were determined as significant independent predictors of ACS (all, p<0.05). Conclusions: Defects in well-being psychological factors rather than ill-being factors are closely associated with ACS. A variety of lifestyle factors, especially, poor satisfaction in 7 life domains, use of primary control strategy, greater intake of sea foods and sweets, smoking, and poor exercise are independent predictors of ACS. Therefore preventive intervention trial of ACS should include modification of comprehensive lifestyle factors including defects in well-being factors.
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