László Krisztina D, Janszky Imre, Ahnve Staffan
Preventive Medicine, Department of Public Health Sciences, Karolinska University Hospital, Norrbacka 6th floor, Stockholm, 17176, Sweden.
Eur J Epidemiol. 2008;23(10):669-80. doi: 10.1007/s10654-008-9285-8. Epub 2008 Sep 18.
Strong evidence supports the existence of a social gradient in poor prognosis in patients with coronary heart disease (CHD). However, knowledge regarding what factors may explain this relationship is limited. We aimed to analyze in women CHD patients the association between personal income and recurrent events and to determine whether lifestyle, biological and psychosocial factors contribute to the explanation of this relationship. Altogether 188 women hospitalized for a cardiac event were assessed for personal income, demographic factors, lipids, inflammatory markers, cortisol, creatinine, lifestyle and psychosocial factors, i.e. alcohol consumption, smoking habits, body-mass index, depressive symptoms, anxiety, vital exhaustion, availability of social interaction, hostility and anger-related characteristics and were followed for cardiovascular death and recurrent acute myocardial infarction (AMI). During the 6-year follow-up 18 patients deceased and 31 experienced cardiovascular death or non-fatal AMI. After adjustment for confounders, patients with medium and high income had lower risk for recurrent events relative to those with low income (HR (95% CI): 0.38 (0.15-0.97) and 0.39 (0.17-0.93), respectively). Controlling for smoking reduced by 12.8% the risk for recurrent events associated with high versus low income, while adjusting for depression decreased the risk for middle versus low income by 13.5%. Anger symptoms explained 16.7% of the risk for recurrent events associated with middle versus low income and 10.2% of the risk for high versus low income. We suggest that in women with CHD low income is associated with recurrent events and that smoking, depressive symptomatology and anger symptoms may contribute to the explanation of this relationship.
有力证据支持冠心病（CHD）患者预后不良存在社会梯度。然而，关于哪些因素可能解释这种关系的知识有限。我们旨在分析女性冠心病患者个人收入与复发事件之间的关联，并确定生活方式、生物学和心理社会因素是否有助于解释这种关系。总共对188名因心脏事件住院的女性进行了个人收入、人口统计学因素、血脂、炎症标志物、皮质醇、肌酐、生活方式和心理社会因素评估，即饮酒、吸烟习惯、体重指数、抑郁症状、焦虑、极度疲劳、社交互动的可及性、敌意和愤怒相关特征，并对心血管死亡和复发性急性心肌梗死（AMI）进行随访。在6年随访期间，18名患者死亡，31名经历了心血管死亡或非致命性AMI。在对混杂因素进行调整后，中等收入和高收入患者复发事件的风险相对于低收入患者较低（HR（95%CI）：分别为0.38（0.15 - 0.97）和0.39（0.17 - 0.93））。控制吸烟使高收入与低收入相关的复发事件风险降低了12.8%，而调整抑郁因素使中等收入与低收入相关的风险降低了13.5%。愤怒症状解释了中等收入与低收入相关的复发事件风险的16.7%以及高收入与低收入相关风险的10.2%。我们认为，在患有冠心病的女性中，低收入与复发事件相关，吸烟、抑郁症状和愤怒症状可能有助于解释这种关系。
