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Background and rationale

Association of psychosocial risk factors with risk of acute myocardial infarction in 11,119 MI cases and 13,648 controls from 52 countries. The INTERHEART study. Background and rationale. Psychosocial factors have been reported to be independently associated with CHD

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Background and rationale

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  1. Association of psychosocial risk factors with risk of acute myocardial infarction in 11,119 MI cases and 13,648 controls from 52 countries. The INTERHEART study.

  2. Background and rationale Psychosocial factors have been reported to be independently associated with CHD Previous studies have been in mainly North-American or European, populations The INTERHEART study is the first to investigate PS factors in relation to CHD across several regions and ethnic groups

  3. Objective To examine the relation of psychosocial factors to the risk of non-fatal MI in 24,767 subjects from 52 countries representing every inhabited continent of the world.

  4. Psychosocial: Potential pathways by which psychosocial factors influence CHD etiology • Health-related behaviors • Smoking • Diet • Alcohol • Physical activity • Psychosocial • stress factors • External • stressors (life • events, financial • troubles) • Chronic • stressors Depression Clinical CHD Protective factors (income, education, high locus of control Direct pathophysiological mechanisms* *atherosclerosis, plaque stability, coagulation / fibrinolysis ??

  5. Psychosocial stressors • Stress at work • Stress at home • Financial stress • Stressful life events • Depression • Locus of control

  6. Questions How often have you felt stress in the past year? …at home /…at work What level of financial stress do you feel? Have you experienced any of the following in the past year? List of potentially stressful life events. Response options Never/Some periods/Several Periods/Permanent Little-none/Moderate/High-severe Yes/No (0, 1, 2+) Chronic stress

  7. Questions During the past 12 months, was there ever a time when you felt sad, blue or depressed for two weeks or more in a row? + 0 to 7 items* Locus of control: 6 scale items eg I feel what happens in my life is often determined by factors beyond my control Response options Yes/No Strongly agree – strongly disagree Depression & locus of control * Lose interest, tired/low energy, weight loss/gain, sleep trouble, trouble concentrating, think of death, feeling worthless

  8. Overall results

  9. Reported stress during the past year and risk of MI * Odds ratio adjusted for age, sex, region, and smoking

  10. Reported depression during the past year and risk of AMI * Odds ratio adjusted for age, sex, region, and current smoking status

  11. Reported depression items* during the past year and risk of AMI * Lose interest, tired/low energy, weight loss/gain, sleep trouble, trouble concentrating, think of death, feeling worthless * Odds ratio adjusted for age, sex, region, and current smoking status

  12. Risk of AMI by Locus of Control (LOC) Quartile

  13. Odds ratios for combined effects of stress and depression Depression Stress

  14. Odds ratios for combined effects of stress and locus of control Locus of control Stress

  15. Population attributable risk for stress and all psykosocial variables Utilizing several periods of, or permanent work stress and stress at home, financial stress, life events, LoC, and depression in combination, 32.5 % of the population attributable risk for MI is explained.

  16. Data by region and ethnicity

  17. Association of Moderate/Severe General Stress to Risk of MI Overall and by Region % of cases and % of controls are age adjusted. OR are adjusted for region, age, gender, and smoking

  18. Association of Moderate/Severe Gleneral Stress to Risk of MI Overall and by Ethnicity % of cases and % of controls are age adjusted. OR are adjusted for region, age, gender, and smoking

  19. Association of Depression to Risk of MI Overall and by Region % of cases and % of controls are age adjusted. OR are adjusted for region, age, gender, and smoking

  20. Depression Overall and by Ethnicity % of cases and % of controls are age adjusted. OR are adjusted for region, age, gender, and smoking

  21. Summary • The findings of this study, representing patients and controls from all inhabited regions in the world, support the hypothesis that the presence of psychosocial stressors are associated with increased risk of acute myocardial infarction. • Utilizing all measures of psychosocial factors, 32.5 % of the population attributable risk for MI is explained, provided that causality can be established.

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