TY - JOUR
T1 - Sex and gender-stratified risks of psychological factors for adverse clinical outcomes in patients with ischemic heart disease
T2 - A systematic review and meta-analysis
AU - Smaardijk, Veerle R
AU - Maas, Angela H E M
AU - Lodder, Paul
AU - Kop, Willem J
AU - Mommersteeg, Paula M C
N1 - This work was supported by ZonMw and the Dutch Heart Foundation (De Hartstichting) ‘Gender and Health’ program to Dr. Mommersteeg [Grant number #849100001].
PY - 2020
Y1 - 2020
N2 - Background: Psychological factors are associated with adverse prognosis in patients with ischemic heart disease (IHD). However, it is unknown whether these risk factors differ between women and men.Methods: PubMed, EMBASE, and PsycINFO were searched to identify studies assessing the risk of psychological factors for major adverse cardiovascular events (MACE) in samples with IHD. Psychological factors included anger/hostility, anxiety, depression, psychological distress, social support, Type A behavior pattern, Type D personality, and Posttraumatic Stress Disorder (PTSD).Results: A total of 44 articles (64 separate reports) including 227,647 women and 321,894 men reporting confounder-adjusted hazard ratios (HRs) or relative risks (RRs) were included in the primary analysis. Results based on random-effects models showed that the association between psychological factors (all combined) and MACE was stronger in men (n = 321,236; 57 reports; HR = 1.37, 95%CI 1.27-1.48) than in women (n = 226,886; 56 reports; HR = 1.21, 95%CI 1.12-1.30; p = .017). A subset of the studies focusing on women showed significant associations between anger/hostility, depression, and distress with MACE. For men, statistically significant associations were found for anxiety, depression, and distress with MACE.Conclusions: Psychological factors are associated with MACE in samples with IHD in both women and men, with a small, but significant higher risk for men. Because of the limited number of studies on other psychological factors than depression and anxiety and the current major focus on MACE reflecting lesions in the major coronary arteries which is more typical in men than women, more research is needed to better identify sex and gender differences in IHD.
AB - Background: Psychological factors are associated with adverse prognosis in patients with ischemic heart disease (IHD). However, it is unknown whether these risk factors differ between women and men.Methods: PubMed, EMBASE, and PsycINFO were searched to identify studies assessing the risk of psychological factors for major adverse cardiovascular events (MACE) in samples with IHD. Psychological factors included anger/hostility, anxiety, depression, psychological distress, social support, Type A behavior pattern, Type D personality, and Posttraumatic Stress Disorder (PTSD).Results: A total of 44 articles (64 separate reports) including 227,647 women and 321,894 men reporting confounder-adjusted hazard ratios (HRs) or relative risks (RRs) were included in the primary analysis. Results based on random-effects models showed that the association between psychological factors (all combined) and MACE was stronger in men (n = 321,236; 57 reports; HR = 1.37, 95%CI 1.27-1.48) than in women (n = 226,886; 56 reports; HR = 1.21, 95%CI 1.12-1.30; p = .017). A subset of the studies focusing on women showed significant associations between anger/hostility, depression, and distress with MACE. For men, statistically significant associations were found for anxiety, depression, and distress with MACE.Conclusions: Psychological factors are associated with MACE in samples with IHD in both women and men, with a small, but significant higher risk for men. Because of the limited number of studies on other psychological factors than depression and anxiety and the current major focus on MACE reflecting lesions in the major coronary arteries which is more typical in men than women, more research is needed to better identify sex and gender differences in IHD.
KW - ANXIETY
KW - ASSOCIATION
KW - CORONARY-ARTERY-DISEASE
KW - DEPRESSIVE SYMPTOMS
KW - EVENTS
KW - Gender
KW - Ischemic heart disease
KW - MANAGEMENT
KW - MORTALITY
KW - MYOCARDIAL-INFARCTION
KW - Major adverse cardiovascular events
KW - Psychological factors
KW - Sex
KW - WOMEN
KW - Women
UR - http://www.scopus.com/inward/record.url?scp=85077677607&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2019.12.014
DO - 10.1016/j.ijcard.2019.12.014
M3 - Article
C2 - 31937453
SN - 0167-5273
VL - 302
SP - 21
EP - 29
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -