Document Detail

Psychosocial modulators of angina response to myocardial ischemia.
MedLine Citation:
PMID:  19564560     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Although angina is often caused by atherosclerotic obstruction of the coronary arteries, patients with similar amounts of myocardial ischemia may vary widely in their symptoms. We sought to compare clinical and psychosocial characteristics associated with more frequent angina after adjusting for the amount of inducible ischemia. METHODS AND RESULTS: From 2004 to 2006, 788 consecutive patients undergoing single-photon emission computed tomography stress perfusion imaging at 2 Seattle hospitals were assessed for their frequency of angina over the previous 4 weeks with the Seattle Angina Questionnaire and for a broad range of psychosocial characteristics. Among patients with demonstrable ischemia on single-photon emission computed tomography (summed difference score >or=2; n=191), angina frequency was categorized as none (Seattle Angina Questionnaire score=100; n=68), monthly (score=61 to 99; n=66), and weekly or daily (score=0 to 60; n=57). Using multivariable ordinal logistic regression, increasing angina was significantly associated with a history of coronary revascularization (odds ratio 2.24, 95% confidence interval 1.19 to 4.19), anxiety (odds ratio 4.72, 95% confidence interval 1.91 to 11.66), and depression (odds ratio 3.12, 95% confidence interval 1.45 to 6.69) after adjustment for the amount of inducible ischemia. CONCLUSIONS: Among patients with a similar burden of inducible ischemia, a history of coronary revascularization and current anxiety and depressive symptoms were associated with more frequent angina. These results support the study of angina treatment strategies that aim to reduce psychosocial distress in conjunction with efforts to lessen myocardial ischemia.
Suzanne V Arnold; John A Spertus; Paul S Ciechanowski; Laurie A Soine; Kier Jordan-Keith; James H Caldwell; Mark D Sullivan
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-06-29
Journal Detail:
Title:  Circulation     Volume:  120     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-14     Completed Date:  2009-08-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  126-33     Citation Subset:  AIM; IM    
Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.
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MeSH Terms
Angina Pectoris / etiology*,  psychology*
Anxiety / complications,  psychology
Depression / complications,  psychology
Exercise Test
Health Surveys
Logistic Models
Middle Aged
Myocardial Ischemia / complications*,  psychology*,  therapy
Myocardial Revascularization
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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