title: Positive and negative affect and risk of coronary heart disease: Whitehall II prospective cohort study.
abstract: OBJECTIVE
  To examine the associations between positive and negative affect and subsequent coronary heart disease events independently of established risk factors.
  
  
  METHODS
  Prospective cohort study with follow-up over 12 years.
  
  
  METHODS
  20 civil service departments originally located in London.
  
  
  METHODS
  10,308 civil servants aged 35-55 years at entry into Whitehall II study in 1985.
  
  
  METHODS
  Fatal coronary heart disease, clinically verified incident non-fatal myocardial infarction, and definite angina (n=619, mean follow-up 12.5 years).
  
  
  RESULTS
  In Cox regression analysis adjusted for age, sex, ethnicity, and socioeconomic position, positive affect (hazard ratio=1.01, 95% confidence interval 0.82 to 1.24) and the balance between positive and negative affect, referred to as the affect balance score (hazard ratio=0.89, 0.73 to 1.09), were not associated with coronary heart disease. Further adjustment for behaviour related risk factors (smoking, alcohol consumption, daily fruit and vegetable intake, exercise, body mass index), biological risk factors (hypertension, blood cholesterol, diabetes), and psychological stress at work did not change these results. However, participants in the highest third of negative affect had an increased incidence of coronary events (hazard ratio=1.32, 1.09 to 1.60), and this association remained unchanged after adjustment for multiple confounders.
  
  
  CONCLUSIONS
  Positive affect and affect balance did not seem to be predictive of future coronary heart disease in men and women who were free of diagnosed coronary heart disease at recruitment to the study. A weak positive association between negative affect and coronary heart disease was found and needs to be confirmed in further studies.
authors.affiliation: Department of Epidemiology and Public Health, University College London, London WC1E 6BT. H.Nabi@public-health.ucl.ac.uk
authors.forename: Hermann
authors.initials: H
authors.lastname: Nabi
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimaki
authors.forename: Roberto
authors.initials: R
authors.lastname: De Vogli
authors.forename: Michael G
authors.initials: MG
authors.lastname: Marmot
authors.forename: Archana
authors.initials: A
authors.lastname: Singh-Manoux
mesh_terms: D000328:Adult; D017677:Age Distribution; D003327:Coronary Disease / Q000401:mortality*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution