Changes in life-style in men under sixty years of age before and after acute myocardial infarction: a case-control study.

A case-control study was conducted to examine the presence of psychosocial factors before, during, and after acute myocardial infarction (AMI) in Dutch men under sixty years of age. The study included 42 AMI patients and 48 individuals in an age-adjusted sampled control group. The psychological factors included high level of psychological stress, of social isolation, type A1 and A2 behavior, and mental depression. They were assessed by means of the Health Insurance Questionnaire of Greater New York. Univariate analysis indicated that the presence of psychological factors was common at the onset of the myocardial infarction (MI). It clearly diminished, however, after the MI had taken place. In a stepwise logistic regression analysis after adjustment for the independent variables hypertension, cholesterol, and smoking, the following three characteristics were independently related to the risk of MI: no talking (item of social isolation, P = 0.008), need to excel (item of type A1 behavior, P = 0.04), and blue feeling (item of mental depression, P = 0.09). The authors conclude that in men under 60 with AMI, the presence of psychosocial characteristics is common and that this group is going to change its life-style soon after the MI, even without any psychosocial rehabilitation therapy. Follow-up studies investigating the influence of psychological factors on survival and reinfarction should be adjusted for these changes in life-style.