Depressive symptoms, social isolation, and progression of coronary artery atherosclerosis: the Stockholm Female Coronary Angiography Study.
BACKGROUND
Although both depressive symptoms and social isolation in relation to coronary heart disease have been studied previously, few have examined their joint effects on coronary atherosclerosis progression in women.


METHODS
Among the women enrolled in the Stockholm Female Coronary Angiography Study, Sweden, between 1991 and 1994, 102 were evaluated for coronary atherosclerosis progression using a computer-assisted standardized assessment, repeated quantitative coronary angiographic documentation, of the mean luminal diameter change over 3 years in 10 predefined coronary segments. Depressive symptoms and social isolation were assessed by standard questionnaires.


RESULTS
Multivariable controlled mixed model ANOVAs revealed that women who were both depressed and socially isolated had the greatest disease progression: their absolute mean luminal diameter decreased by 0.18 mm [95% confidence interval (CI) = 0.11-0.24] and their percent narrowing was 5.5% (95% CI = 3.6-7.4), whereas in women who lacked both psychological risk factors, the mean luminal diameter decrease was 0.04 mm and their percent narrowing was 0.9%. These associations were independent of the baseline luminal diameter and standard risk factors, including age, smoking history, hypertension, and high-density lipoproteins.


CONCLUSIONS
In women with coronary disease, depressive symptoms and social isolation in combination accelerated disease progression, suggesting a direct psychosocial effect on the atherosclerotic process. These findings provide an additional opportunity for therapeutic and preventive efforts against progression of coronary disease in women.
Wang
Hui-Xin
HX
Division of Preventive Medicine, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
Mittleman
Murray A
MA
Leineweber
Constanze
C
Orth-Gomer
Kristina
K
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000453:epidemiology*; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D012720:Severity of Illness Index; D012934:Social Isolation / Q000523:psychology*; D012944:Social Support