Behavioral Medicine Approaches to Cardiovascular Disease Prevention

By Kristina Orth-Gomér; Neil Schneiderman | Go to book overview

TABLE 10.6
Relative Contribution of Lifestyle and Personality Factors to the Excess Risk for Myocardial Infarction of Subjects With Low Educational Status
OddsPercentage
FactorRatioExplained
Low SES 2.25 -
Controlled for:
Smoking 1.76 39
Vital exhaustion 2.09 13
Hostility 1.87 30
Coffee consumption 2.21 3
All behavioral factors 1.51 59

It is known that the SES-CHD gradient remains to be significant after controlling for smoking. Are personality factors also involved?

My colleague C. Meesters is currently working on a PhD dissertation about hostility as a risk factor for CHD. In his study, he compared 98 men (mean age 55.6 years) who were hospitalized because of a first MI with 168 age-matched healthy neighborhood controls. He observed that a low SES was a risk factor for CHD in his series, the odds ratio being 2.25 (this odds ratio is probably an underestimation of the true difference because he used neighborhood controls). Hence, the risk of MI is increased by 125% in low-SES subjects. Controlling for smoking reduced the odds ratio to 1.76, therefore 39% of the excess risk of low-SES subjects (2.25-1.76/125) is due to smoking. Table 10.6 presents the percentages of the excess risk explained by hostility (assessed by the Buss-Durkee scale), coffee consumption, and VE. The most striking finding presented in Table 10.6 is that hostility explains almost as much of the excess risk as smoking does. Together, the four behavioral factors explain about 60% of the SES-CHD gradient. It is beyond doubt that knowledge of personality factors may contribute to secondary prevention. For example, the Recurrent Coronary Prevention Project has shown that those patients who change their Type A behavior pattern are at decreased risk for a recurrent MI ( 14). The development and implementation of this type of program in health care belongs to the most challenging tasks of behavioral medicine.


REFERENCES
1.
Nerbrand C, Olsson L, Svardsudd K, et al. "Are regional variations in ischemic heart disease related to differences in coronary risk factors?" Eur Heart J 1991; 12: 309-14.
2.
ERICA Research Group. "Prediction of coronary heart disease in Europe. The 2nd report of the WHO-ERICA Project". Eur Heart J 1991; 12: 291-97.
3.
McClelland D. The achieving society. New York: Van Nostrand & Reinhold, 1961.
4.
Appels A. "Coronary heart disease as a cultural disease". Psychotherapy and psychosomatics 1973; 22: 320-24.

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