Department of Internal Medicine (Section of Cardiovascular Medicine), Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.
Curr Atheroscler Rep. 2024 Mar;26(3):45-58. doi: 10.1007/s11883-023-01185-0. Epub 2024 Jan 19.
Psychological health encompasses a constellation of negative and positive factors-i.e., psychosocial stress, depression, anxiety, trauma, loneliness and social isolation, anger and hostility, optimism, and a sense of purpose. This narrative review presents current evidence at the intersection of psychological health, risk of ischemic heart disease (IHD), and IHD-related outcomes, with an emphasis on associations in women.
For women, relations between psychological health and IHD reflect important sex and gender differences in biological and psychosocial factors. Although efforts devoted to understanding psychological health and IHD risk have varied by psychological factor-scientific evidence is strongest for psychosocial stress and depression, while anxiety, trauma, and positive psychological factors warrant more investigation-less optimal psychological health is consistently associated with an earlier and greater risk of IHD morbidity and mortality in women. Still, many past prospective studies of psychological factors and IHD risk had a limited representation of women, did not include analyses by sex, or failed to account for other influential, sex-specific factors. Thus, there are multiple pathways for further, rigorous investigation into psychological health-IHD associations, mechanisms, and empirically supported psychological interventions to mitigate IHD risk among women. Given the robust evidence linking psychological health with women's risk for IHD, implementing routine, brief, psychological screening is recommended. Significant life events, developmental milestones specific to women, and IHD diagnoses or events could cue further psychological assessment and referral, efforts which will mutually strengthen the evidence for integrated psychological and IHD care and delivery of such care to this vulnerable group.
心理健康包括一系列的负面和积极因素，即心理社会压力、抑郁、焦虑、创伤、孤独和社会隔离、愤怒和敌意、乐观和目标感。本综述介绍了当前心理健康、缺血性心脏病（IHD）风险和与 IHD 相关结局之间的交叉点的证据，重点关注女性中的关联。
对于女性来说，心理健康与 IHD 之间的关系反映了生物和心理社会因素中重要的性别差异。尽管人们致力于理解心理健康和 IHD 风险的努力因心理因素而异——心理社会压力和抑郁的科学证据最强，而焦虑、创伤和积极的心理因素需要更多的研究——但较差的心理健康与女性更早和更大的 IHD 发病率和死亡率风险始终相关。尽管如此，许多过去关于心理因素和 IHD 风险的前瞻性研究对女性的代表性有限，没有按性别进行分析，或没有考虑到其他有影响力的特定于性别的因素。因此，有多种途径可以进一步深入研究心理健康与 IHD 之间的关联、机制以及经过实证支持的心理干预措施，以降低女性的 IHD 风险。鉴于心理健康与女性 IHD 风险之间的强有力证据，建议实施常规、简短的心理筛查。重大生活事件、女性特有的发展里程碑以及 IHD 诊断或事件可能提示进一步的心理评估和转介，这些努力将相互加强综合心理和 IHD 护理的证据，并为这一弱势群体提供此类护理。
