title: Relative importance of psychologic traits and severity of ischemia in causing angina during treadmill exercise. Canadian Amlodipine/Atenolol in Silent Ischemia Study (CASIS) Investigators.
abstract: OBJECTIVE
  This study was conducted to compare the influence of psychologic traits versus ischemia severity on the occurrence of angina during treadmill exercise.
  
  
  BACKGROUND
  Some studies suggest that angina is associated with certain psychologic traits, whereas others show an association with more severe ischemia. The relative influence of these two factors and the extent to which they interact are not known.
  
  
  METHODS
  Off-drug treadmill exercise testing and a battery of psychologic tests were performed on 122 patients with known coronary artery disease. Psychologic tests measured sensitivity to physical symptoms, denial and deception, type A behavior, anger, hostility, depression, marital adjustment and amount of external stress. Stepwise logistic regression was used to determine the independent association of psychologic traits, ischemic threshold and exercise tolerance with the occurrence of angina.
  
  
  RESULTS
  Angina during treadmill exercise was reported by 66 of 122 patients. On univariate testing, angina was positively associated with sensitivity to physical symptoms (p < 0.001), type A behavior (p = 0.021) and depression (p = 0.032) and was negatively associated with exercise tolerance (p < 0.001) and work load threshold for ischemia (p < 0.01). Multivariate analysis revealed independent and additive associations of angina with sensitivity to physical symptoms (p = 0.003), exercise capacity (p = 0.003) and work load threshold for ischemia (p = 0.018). Once these were included in a logistic model, depression and type A behavior were no longer significant. Other psychologic traits showed no association with angina.
  
  
  CONCLUSIONS
  Sensitivity to physical symptoms, ischemic threshold and exercise tolerance are independently associated with angina, with sensitivity to physical symptoms having the stronger influence. The physiologic and psychologic mechanisms underlying symptom perception have an influence on angina that is independent of and additive to the severity of underlying ischemia.
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada.
authors.forename: R F
authors.initials: RF
authors.lastname: Davies
authors.forename: W
authors.initials: W
authors.lastname: Linden
authors.forename: H
authors.initials: H
authors.lastname: Habibi
authors.forename: W P
authors.initials: WP
authors.lastname: Klinke
authors.forename: C
authors.initials: C
authors.lastname: Nadeau
authors.forename: D C
authors.initials: DC
authors.lastname: Phaneuf
authors.forename: S
authors.initials: S
authors.lastname: Lepage
authors.forename: P
authors.initials: P
authors.lastname: Dessain
authors.forename: J A
authors.initials: JA
authors.lastname: Buttars
mesh_terms: D017311:Amlodipine / Q000627:therapeutic use; D000787:Angina Pectoris / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D001262:Atenolol / Q000627:therapeutic use; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000188:drug therapy; D011581:Psychological Tests; D012044:Regression Analysis
chemical_list: D017311:Amlodipine; D001262:Atenolol