Abstract 10850: Is Psychosocial Stress an Independent Predictor of Mortality in Patients with Stable Coronary Heart Disease?
Background: In many coronary heart disease (CHD) cohorts, depression, anxiety and hostility are associated with a worse prognosis. We examined the relationship between total psychosocial stress and mortality in a cohort with stable CHD.
Patients and Methods: We studied 538 patients with CHD following major CHD events. Using validated questionnaires(Kellner Symptom Questionnaire), stress was measured in three domains: depression, anxiety, and hostility. The number of positive stress sources as a categorical variable was aggregated into a psychosocial stress score from 0 to 3, and the raw scores for each domain were also added to determine a composite of total stress. Subjects at the four levels were analyzed by total mortality over 3-year follow-up by National Death Index.
Results: During 3-year follow-up (Figure - Kaplan Meier Survival Curve for different levels of stress, as defined by the number of sources [anxiety, depression, hostility]; see text for p-values), mortality was highest in those individuals with the highest stress score of 3 (n = 8; 37.5%); mortality was lower at 10.3% (n = 29), 4.9% (n = 41) and 3.5% (n = 460) for scores 2,1 and 0, respectively (p values are <0.0001, <0.0001, 0.011 respectively). The group with the second level of stress (score of 2) had a significantly increased mortality risk compared with the group with stress score of 0 ( p=0.04). Mortality was significantly higher in the 90th percentile of total stress raw score compared with other patients (13.7% vs 3.5%; p<0.0001). In multiple logistic regression analysis, after adjusting for age, gender, ejection fraction and peak exercise oxygen consumption, psychosocial stress score was an independent predictor of higher overall mortality (OR 1.89; CI 1.03-3.44).
Conclusion: Psychosocial stress is an independent predictor of mortality in stable CHD patients. Greater emphasis directed at psychosocial stress and intervention is needed in primary and secondary CHD prevention.
- © 2011 by American Heart Association, Inc.