title: Do psychological factors affect inflammation and incident coronary heart disease: the Whitehall II Study.
abstract: OBJECTIVE
  The purpose of this study was to test whether psychological factors affect inflammation processes to an extent that increases the risk of coronary heart disease (CHD).
  
  
  RESULTS
  We used data from 6396 civil servants (4453 men, 1943 women) from the Whitehall II Study, aged 35 to 55 years and free from clinically validated CHD at the start of the follow-up period. Two psychological factors were assessed at phase 1 (1985 to 1988) and phase 2 (1989 to 1990): negative affect and psychological distress. Inflammatory biomarkers (fibrinogen, high-sensitivity C-reactive- protein, interleukin-6) and 12 baseline covariates including biological and behavioral CHD risk factors, sociodemographic variables, and work stress were measured at phase 3 (1991 to 1993). Follow-up for CHD death, first nonfatal myocardial infarction, or definite angina occurring between phase 3 and phase 7 (2003 to 2004) was based on clinical records. Higher levels of inflammatory markers were associated with higher CHD incidence, with hazard ratios (HR) ranging from 1.31 to 2.37 in age-and sex-adjusted models. Higher levels of negative affectivity and psychological distress were not associated with greater concentrations of inflammatory markers. Negative affectivity (relative index of inequality=1.68, 95% confidence interval [CI] 1.20 to 2.36) and higher psychological distress exposure (HR=1.66, 95% CI 1.28 to 2.14) were associated with higher CHD incidence and these associations remained unchanged after adjustment for inflammatory markers.
  
  
  CONCLUSIONS
  Our findings suggest that psychological factors do not affect inflammation although they predict incident CHD.
authors.affiliation: Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK. H.Nabi@public-health.ucl.ac.uk
authors.forename: Hermann
authors.initials: H
authors.lastname: Nabi
authors.forename: Archana
authors.initials: A
authors.lastname: Singh-Manoux
authors.forename: Martin
authors.initials: M
authors.lastname: Shipley
authors.forename: David
authors.initials: D
authors.lastname: Gimeno
authors.forename: Michael G
authors.initials: MG
authors.lastname: Marmot
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimaki
mesh_terms: D000328:Adult; D000339:Affect; D015415:Biomarkers / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000097:blood / Q000453:epidemiology / Q000523:psychology*; D018836:Inflammation Mediators / Q000097:blood; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D013315:Stress, Psychological / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators