Do psychological risk factors predict the presence of coronary atherosclerosis?
OBJECTIVE
To assess how clinical and psychological variables compare in their ability to predict coronary artery calcium (CAC) in a broad spectrum of subjects. Although prior studies reported contradictory findings on the association between psychological risk factors and CAC, psychological risk factors have not yet been compared with concurrent clinical coronary risk factors for their association to CAC measurements.


METHODS
We performed research CAC scans in three cohorts: 1,111 healthy volunteers; 138 asymptomatic patients; and 600 symptomatic patients. All subjects completed questionnaires designed to assess clinical and psychological coronary artery disease (CAD) risk factors, including measurements of depression, hostility, social support, perceived stress, job strain, and optimism. A serum sample was obtained to assess lipid parameters and glucose. All variables were compared for their correlation to CAC scores.


RESULTS
We observed a marked lack of association between psychosocial risk factors and CAC scores in each cohort. For symptomatic patients only, there was a modest negative correlation between depression and CAC scores (r = -.19, p < .001). Most CAD risk factors were also not associated with CAC. Once age and gender were considered as multivariable predictors of CAC, neither psychological nor CAD risk factors added to prediction of CAC.


CONCLUSIONS
Both psychological and clinical risk factors are poorly correlated with concurrent measurements of CAC. Given our findings and previously established associations of these risk factors to cardiac events, further assessment of the relationship between chronicity of these risk factors and coronary atherosclerosis could be of interest. Our findings cast doubt on the use of CAC scanning as a surrogate means for assessing the clinical significance of both concurrently measured psychological and clinical risk factors.
Division of Cardiology and Department of Medicine, Cardiovascular Fellowship Training Program, St. Luke's Roosevelt Hospital Center, New York, NY 10025, USA. arozanski@chpnet.org
Alan
A
Rozanski
Heidi
H
Gransar
Laura D
LD
Kubzansky
Nathan
N
Wong
Leslee
L
Shaw
Romalisa
R
Miranda-Peats
Louise E
LE
Thomson
Sean W
SW
Hayes
John D
JD
Friedman
Daniel S
DS
Berman
D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging; D002908:Chronic Disease; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D003863:Depression / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data; D011379:Prognosis; D012307:Risk Factors; D012944:Social Support; D013315:Stress, Psychological / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D011795:Surveys and Questionnaires