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Wallert J, Gustavson E, Held C, Madison G, Norlund F, Von Essen L, Olsson E. P5407Predicting adherence to internet-delivered cognitive behaviour therapy for comorbid symptoms of depression and anxiety after myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J Wallert
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
| | - E Gustavson
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
| | - C Held
- Uppsala Clinical Research Center, Department of Medical Sciences: Cardiology, Uppsala, Sweden
| | - G Madison
- Umeå University, Department of Psychology, Umeå, Sweden
| | - F Norlund
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
| | - L Von Essen
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
| | - E Olsson
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
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Hagström E, Norlund F, Stebbins A, Armstrong PW, Chiswell K, Granger CB, López-Sendón J, Pella D, Soffer J, Sy R, Wallentin L, White HD, Stewart RAH, Held C. Psychosocial stress and major cardiovascular events in patients with stable coronary heart disease. J Intern Med 2018; 283:83-92. [PMID: 28960596 DOI: 10.1111/joim.12692] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Assess the risk of ischaemic events associated with psychosocial stress in patients with stable coronary heart disease (CHD). METHODS Psychosocial stress was assessed by a questionnaire in 14 577 patients (median age 65.0, IQR 59, 71; 81.6% males) with stable CHD on optimal secondary preventive therapy in the prospective randomized STABILITY clinical trial. Adjusted Cox regression models were used to assess associations between individual stressors, baseline cardiovascular risk factors and outcomes. RESULTS After 3.7 years of follow-up, depressive symptoms, loss of interest and financial stress were associated with increased risk (hazard ratio, 95% confidence interval) of CV death (1.21, 1.09-1.34; 1.15, 1.05-1.27; and 1.19, 1.08-1.30, respectively) and the primary composite end-point of CV death, nonfatal MI or nonfatal stroke (1.21, 1.13-1.30; 1.19, 1.11-1.27; and 1.17, 1.10-1.24, respectively). Living alone was related to higher risk of CV death (1.68, 1.38-2.05) and the primary composite end-point (1.28, 1.11-1.48), whereas being married as compared with being widowed, was associated with lower risk of CV death (0.64, 0.49-0.82) and the primary composite end-point (0.81, 0.67-0.97). CONCLUSIONS Psychosocial stress, such as depressive symptoms, loss of interest, living alone and financial stress, were associated with increased CV mortality in patients with stable CHD despite optimal medical secondary prevention treatment. Secondary prevention of CHD should therefore focus also on psychosocial issues both in clinical management and in future clinical trials.
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Affiliation(s)
- E Hagström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - F Norlund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - A Stebbins
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | | | - K Chiswell
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - C B Granger
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - J López-Sendón
- Hospital Universitario La Paz, Instituto de investigacion IdiPaz, Paseo de la Castellana, Madrid, Spain
| | - D Pella
- Department of Medicine, PJ Safarik University, Kosice, Slovakia
| | - J Soffer
- Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, Collegeville, PA, USA
| | - R Sy
- Department of Internal Medicine, College of Medicine, University of the Philippines-Manila, Manila, Philippines
| | - L Wallentin
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - H D White
- Green Lane Cardiovascular Service, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
| | - R A H Stewart
- Green Lane Cardiovascular Service, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
| | - C Held
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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