Rasul F, Stansfeld S A, Smith G Davey, Shlomo Y Ben, Gallacher J
Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London, Queen Mary's School of Medicine and Dentistry, University of London.
Psychol Med. 2007 Sep;37(9):1305-13. doi: 10.1017/S0033291707000402. Epub 2007 Apr 4.
Studies have found associations between psychological distress (PD) and increased risk of myocardial infarction (MI). However, it is not clear whether the relationship reflects the subtle influence of pre-existing illness on both PD and MI. This study examines the association between PD and MI in a prospective epidemiological study of 1864 middle-aged men to examine if the association is explained by existing illness.
This study was a prospective cohort study modelling the association between PD, measured using the 30-item General Health Questionnaire (GHQ) and non-fatal myocardial infarction (NFMI) and fatal/non-fatal myocardial infarction (FNFMI). The relationship was modelled in a series of logistic regression models adjusted for age, then cigarette smoking, then social position, and finally for all sociodemographic characteristics, coronary heart disease (CHD) risk factors, and baseline CHD.
PD was associated with a 70% and 68% increased risk of NFMI and FNFMI in fully adjusted analysis. However, PD was not associated with an increased risk of NFMI and FNFMI in analyses excluding those with baseline CHD. Further, being psychologically distressed and physically ill was associated with a greater than twofold risk of NFMI and FNFMI, 2.37 (95% CI 1.33-4.20) and 2.33 (95% CI 1.32-4.12) respectively.
This study suggests that PD is a moderator of the increased risk of MI associated with existing physical illness. PD in men who are physically ill is a marker of an underlying chronic physical illness. The prospective association of PD with MI is not independent of baseline physical illness.
研究发现心理困扰（PD）与心肌梗死（MI）风险增加之间存在关联。然而，尚不清楚这种关系是否反映了既往疾病对PD和MI的微妙影响。本研究在一项对1864名中年男性进行的前瞻性流行病学研究中，考察PD与MI之间的关联，以检验这种关联是否可由现有疾病解释。
本研究是一项前瞻性队列研究，模拟使用30项一般健康问卷（GHQ）测量的PD与非致命性心肌梗死（NFMI）以及致命性/非致命性心肌梗死（FNFMI）之间的关联。这种关系在一系列逻辑回归模型中进行建模，先对年龄进行调整，然后对吸烟情况进行调整，接着对社会地位进行调整，最后对所有社会人口学特征、冠心病（CHD）危险因素和基线CHD进行调整。
在完全调整分析中，PD与NFMI和FNFMI风险分别增加70%和68%相关。然而，在排除有基线CHD的受试者的分析中，PD与NFMI和FNFMI风险增加无关。此外，心理困扰且身体患病与NFMI和FNFMI风险增加两倍以上相关，分别为2.37（95%CI 1.33 - 4.20）和2.33（95%CI 1.32 - 4.12）。
本研究表明，PD是与现有身体疾病相关的MI风险增加的调节因素。身体患病男性中的PD是潜在慢性身体疾病的一个标志。PD与MI的前瞻性关联并非独立于基线身体疾病。
