Type A behaviour and coronary atherosclerosis

Psychosocial factors and plasma lipids in black and white young adults: the Coronary Artery Risk Development in Young Adults Study data

These analyses examined the relationship between fasting plasma lipids and several psychosocial factors in a healthy cohort of 5115 black and white men and women between the ages of 18 and 30. Primary analyses were performed within race/gender subgroups and were supplemented with analyses examining consistency of associations across these groups. After controlling for age, high density lipoprotein (HDL) decreased, triglycerides increased, low density lipoprotein (LDL) increased, and the total cholesterol/HDL cholesterol ratio increased with increasing level of education in black men. This pattern is, in general, opposite to that found in other groups, particularly white women, whose lipid profile was found to be less atherogenic the higher the education. These associations were strongly confounded with health behaviors. There was also a positive association between hostility and triglycerides in women but not in men. No significant association with any plasma lipid for either race or gender was found for Type A behavior, social support, or life events. Despite a narrow plasma lipid range in these young adults, these data support the conclusion that increasing education is associated with a less atherogenic plasma lipid profile, except in black men, for whom education is associated with a less favorable plasma lipid profile. Among other psychosocial factors, the only consistent finding was an inverse association between hostility and triglycerides in women.

Gender, psychological well-being and somatic cardiovascular risk factors

The purpose of this study is to determine associations between cardiovascular risk factors and subjective experience of psychological general well-being with special reference to gender related differences. One-hundred fifty white-collar workers in a car manufacturing plant in Sweden participated in a health care screening program. Subjective experience of psychological well-being was significantly correlated with cardiovascular risk factors among both men and women. There were, however, marked differences between the genders. For men, the following specific psychological variables were correlated with different cardiovascular risk factors: estimation of general health and psychological well-being, anxiety, depression, self-control and vitality. For women, more complex significant relationships between the two sets of variables were found. Moreover, the direction of the correlations differed between the genders. For example, men with cardiovascular risk factors, such as increased waist-hip-ratio, age and cholesterol, reported significantly more positive estimation of their self-control and vitality. For women the relation was the opposite with a significantly positive correlation (p=3D0.008) between experience of good health and a low risk factor profile indicating the concordance between physiological and psychological parameters. Possible reasons for these sex differences are discussed.

Patient selection factors in angiographic studies: a conceptual formulation and empirical test

Studies using coronary angiography patients as the study population to assess etiologic relationships are vulnerable to bias produced by patient selection factors, but the direction and magnitude of the bias in any particular study are uncertain. Partly for this reason, some authors have questioned the use of angiography data for studies of etiology. Nevertheless, this type of data continues to be used in etiologic studies. Therefore, in this paper a conceptual framework is described to quantify the degree of bias under different assumptions about the process whereby patients are selected for angiography. The direction and degree of bias depend on the pattern of patient selection, as well as the measure of association used (e.g., the risk ratio or odds ratio). One method is then described, based on assessing how physicians refer patients to angiography, which estimates the degree of bias produced by selection factors. This study is limited to the situation of a two-level risk factor (e.g., type A/B behavior) in relation to a two-level outcome measure (e.g., significant coronary artery occlusion versus no significant coronary artery occlusion). While type A/B behavior is used as an example in this paper, the concepts apply to any behavioral or nonbehavioral predictor variable.