Clinical implications of the Women's Ischemia Syndrome Evaluation: Inter-relationships between symptoms, psychosocial factors and cardiovascular outcomes

• Type of Material: Article
• Authors: Eileen M. Handberg, University of Florida; Jo-Ann Eastwood, University of California, Los Angeles; Wafia Eteiba, University of Pittsburgh; B. Delia Johnson, University of Pittsburgh; David S. Krantz, Uniformed Services University of the Health Sciences; Diane V. Thompson, Allegheny General Hospital; Viola Vaccarino, Emory University; Vera Bittner, University of Alabama Birmingham; George Sopko, National Heart, Lung, and Blood Institute; Carl J. Pepine, University of Florida; Noel Bairey Merz, Cedars-Sinai Medical Center; Thomas R. Rutledge, VA San Diego Healthcare System
• Language: English
• Date: 2013-09-01
• Publisher: SAGE Publications (UK and US): Open Access Titles
• Publication Version: Final Published Version
• Copyright Statement: © 2013 Future Medicine Ltd.
• Final Published Version (URL): http://dx.doi.org/10.2217/whe.13.50
• Title of Journal or Parent Work: Women's Health
• ISSN: 1745-5057
• Volume: 9
• Issue: 5
• Start Page: 479
• End Page: 490
• Grant/Funding Information: This work was supported by contracts from the National Heart, Lung and Blood Institutes nos. N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164; grants U0164829, U01 HL649141, U01 HL649241, T32HL69751, R01-HL090957; NIH and NCRR CTSA grant UL1 TR000064, 1R03AG032631 from the National Institute on Aging; GCRC grant MO1-RR000425 from the National Center for Research Resources; and grants from the Gustavus and Louis Pfeiffer Research Foundation, Danville, NJ; The Women’s Guild of Cedars-Sinai Medical Center, Los Angeles, CA; The Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, PA; and QMED, Inc., Laurence Harbor, NJ, the Edythe L. Broad Women’s Heart Research Fellowship; Cedars-Sinai Medical Center, Los Angeles, California; the Barbra Streisand Women’s Cardiovascular Research and Education Program, Cedars-Sinai Medical Center, Los Angeles; and The Society for Women’s Health Research (SWHR), Washington, D.C.
• Keywords: Syndrome; Chest Pain; Risk; Quality of Life; Aged; Socioeconomic Factors; Coronary Artery Disease; Mental Health; Women's Health; Anxiety; Myocardial Ischemia; Cardiovascular Diseases; Comorbidity; Depression; Health Services; Humans; Middle Aged; Costs and Cost Analysis
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery

Abstract

Cardiovascular disease remains the leading cause of death in the USA and is associated with several modifiable (hypertension, diabetes, high cholesterol, tobacco use, physical inactivity, obesity and unhealthy diet) and nonmodifiable (age, gender and family history) risk factors. The role of psychosocial risk factors in the development of cardiovascular disease has a growing body of literature, and differences in men and women have been identified. The Women's Ischemia Syndrome Evaluation provides insight into psychosocial risk factors in a cohort of women presenting with chest pain who had a comprehensive battery of psychosocial assessments and long-term follow-up. This review focuses on symptom presentation for chest pain and its relationship to cardiovascular disease morbidity and mortality, quality of life, healthcare costs and psychosocial predictor variables, including anxiety, depression, hostility and social networks. In the Women's Ischemia Syndrome Evaluation, persistent chest pain was associated with an increased rate of adverse events and relatively high rates of depression and anxiety, with reduced functional capacity and impaired quality of life, over a median of 6 years of follow-up. More research is needed to better understand the relationships between symptoms and negative emotions and to determine whether psychological (pharmacologic and/or cognitive) interventions might impact both psychological and cardiovascular outcomes.