教育程度、愤怒与触发心肌梗死发作的风险。心肌梗死发作决定因素研究调查人员。

Educational attainment, anger, and the risk of triggering myocardial infarction onset. The Determinants of Myocardial Infarction Onset Study Investigators.

作者信息

Mittleman M A, Maclure M, Nachnani M, Sherwood J B, Muller J E

机构信息

Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, USA.

出版信息

Arch Intern Med. 1997 Apr 14;157(7):769-75.

PMID:9125009

Abstract

BACKGROUND

While it has recently been shown that anger may trigger the onset of acute myocardial infarction, there has been no study of the role of socioeconomic factors in such triggering. Socioeconomic factors, such as educational attainment, may modulate the risk of triggering because of their influence on individual reactivity to external stressors and on the prevalence of traditional cardiac risk factors.

OBJECTIVE

To evaluate the influence of educational attainment on the relative risk of myocardial infarction onset following episodes of anger.

METHODS

We interviewed 1623 patients (501 women) an average of 4 days following a myocardial infarction. Data were collected on standard demographic variables as well as risk factors for coronary artery disease. Educational attainment was categorized into 3 levels: less than high school, completed high school, and at least some college. Anger was assessed by the Onset Anger Scale, a single-item, 7-level, self-report scale. Occurrence of anger in the 2 hours preceding the onset of myocardial infarction was compared with its expected frequency using self-matched control data based on the case-crossover study design.

RESULTS

The risk of having a myocardial infarction triggered by isolated episodes of anger declined consistently and significantly with increasing levels of educational attainment (P = .03). The relative risk was twice as high among those with less than high school education (relative risk, 3.3; 95% confidence interval, 2.0-5.4) compared with patients with at least some college education (relative risk, 1.6; 95% confidence interval, 0.9-2.9).

CONCLUSIONS

These findings indicate that socioeconomic factors are potent modulators of the risk of triggering acute cardiovascular disease onset. A better understanding of the physiological mechanisms underlying this association may lead to novel approaches to prevent acute cardiovascular events.

摘要

背景

虽然最近有研究表明愤怒可能引发急性心肌梗死，但尚未有关于社会经济因素在这种触发过程中作用的研究。社会经济因素，如教育程度，可能会调节触发风险，因为它们会影响个体对外界压力源的反应以及传统心脏危险因素的患病率。

目的

评估教育程度对愤怒发作后心肌梗死发病相对风险的影响。

方法

我们在心肌梗死后平均4天对1623名患者（501名女性）进行了访谈。收集了标准人口统计学变量以及冠状动脉疾病危险因素的数据。教育程度分为3个水平：高中以下、高中毕业、至少上过一些大学。愤怒程度通过发作性愤怒量表进行评估，这是一个单项、7级的自我报告量表。根据病例交叉研究设计，使用自我匹配对照数据，将心肌梗死发作前2小时内愤怒的发生情况与其预期频率进行比较。