Psychosocial factors and risk of ischaemic heart disease and death in women: a twelve-year follow-up of participants in the population study of women in Gothenburg, Sweden.

A community sample of 795 women of the ages 38, 46, 50 and 54 yr was subjected to comprehensive medical and psychiatric examinations and was followed up for 12 yr. The 12-yr incidence of angina pectoris was 3.2% and of electrocardiographic changes indicating ischaemic heart disease 5.8%. The corresponding incidence of myocardial infarction was 1.4% and death rate 4.2%. High initial ratings of passive dependency, neuroticism, experience of strain, grade of mental disorder and severity of major or minor depression were predictive of angina pectoris. A low rating of aggression was predictive of the development of electrocardiographic changes indicating ischaemic heart disease. Low ratings of guilt feelings and neurotic self-assertiveness were predictive of myocardial infarction. Death rate was not related to any of the psychosocial factors studied. These associations remained significant after adjustments for age, social class, marital status or confounding conventional risk factors for ischaemic heart disease. The results show that the different clinical manifestations of ischaemic heart disease are related to different sets of psychosocial predictors.