Association of psychological risk factors and acute myocardial infarction in China: the INTER-HEART China study

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Author:
XU Tao(Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100037,China)
LI Wei(Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100037,China)
Koon Teo(The Population Health Research Institute and McMaster University, Hamilton, ON,Canada)
WANG Xing-yu(Beijing Hypertension League Institute, Beijing 100037, China)
LIU Li-sheng(Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100037,China)
Salim Yusuf(The Population Health Research Institute and McMaster University, Hamilton, ON,Canada)
Journal Title:
CHINESE MEDICAL JOURNAL
Issue:
Volume 124, Issue 14, 2011
DOI:
10.3760/cma.j.issn.0366-6999.2011.14.001
Key Word:
acute myocardial infarction;psychological factors;stress;depression;negative life event;China

Abstract: Background Most data about psychological factors relating to acute myocardial infarction (AMI) were obtained from studies carried out in western countries. Results from small descriptive cross-sectional studies in China were inconclusive. The aim of this study was to explore possible associations between psychological risk factors and AMI among the Chinese population with a large-scale case-control study.Methods This study was part of the INTER-HEART China study, itself part of the large international INTER-HEART study of cardiovascular risk factors. In this case-control study, 2909 cases and 2947 controls were recruited from 17 cities.Psychological stress, negative life events, depression and controllability of life circumstances were assessed.Results Cases reported more psychological stress at home or work and odds ratios (ORs) were 3.2 (95% CI 2.1-4.9)for permanent stress and 2.1 (95% CI 1.5-2.8) for several periods of stress respectively. More cases experienced depression compared with controls (19.6% vs. 9.3%) and ORs were 2.2 (95% CI 1.9-2.6). Subjects with 1, 2 and 3 or more depressive symptoms had increased risk of AMI by 2.1, 2.2 and 2.6 fold, respectively, i.e., more depressive symptoms were associated with higher risks of AMI (P for trend <0.0001). Women had a greater risk of AMI from depression (OR 3.0, 95% CI 2.2-4.0) compared to men (OR 2.0, 95% CI 1.6-2.4), P for interaction =0.0364. Negative life events in subjects were associated with increased risk of AMI, OR 1.7 (95% CI 1.4-2.0) for one event and 1.8 (95% CI 1.3-2.4) for two or more events. High levels of controllability of life circumstances reduced the risk for AMI (OR 0.8, 95%CI 0.7-1 .0).Conclusions Several psychological factors were closely associated with increased AMI risk among Chinese population.Psychological stress had a greater AMI risk in men but depression was more significant among women.

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