title: Behavior in a stressful situation, personality factors, and disease severity in patients with acute myocardial infarction: baseline findings from the prospective cohort study SECAMI (the Secondary Prevention and Compliance following Acute Myocardial Infarction study).
abstract: BACKGROUND
  Psychosocial stress has been identified as a risk factor in association with cardiovascular disease but less attention has been paid to heterogeneity in vulnerability to stress. The serial Color Word Test (CWT) measures adaptation to a stressful situation and it can be used to identify individuals that are vulnerable to stress. Prospective studies have shown that individuals with a maladaptive behavior in this test are exposed to an increased risk of future cardiovascular events. The aim of the present study was to investigate whether maladaptive behavior in the serial CWT alone or in combination with any specific personality dimension was associated with severity of myocardial infarction (MI).
  
  
  METHODS
  MI-patients (n = 147) completed the test and filled in a personality questionnaire in close proximity to the acute event. The results were analyzed in association with four indicators of severity: maximum levels above median of the cardiac biomarkers troponin I and creatine kinase-MB (CKMB), Q-wave infarctions, and a left ventricular ejection fraction (LVEF) ≤ 50%.
  
  
  RESULTS
  Maladaptive behavior in the serial CWT together with low scores on extraversion were associated with maximum levels above median of cardiac troponin I (OR 2.97, CI 1.08-8.20, p = 0.04) and CKMB (OR 3.33, CI 1.12-9.93, p = 0.03). No associations were found between the combination maladaptive behavior and low scores on extraversion and Q-wave infarctions or a decreased LVEF.
  
  
  CONCLUSIONS
  Maladaptive behavior in combination with low scores on extraversion is associated with higher cardiac biomarker levels following an MI. The serial CWT and personality questionnaires could be used to identify individuals vulnerable to the hazardous effects of stress and thereby are exposed to an increased risk of a more severe infarction.
authors.affiliation: Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden. Lena.Andre-Petersson@med.lu.se
authors.forename: Lena
authors.initials: L
authors.lastname: André-Petersson
authors.forename: Mona
authors.initials: M
authors.lastname: Schlyter
authors.forename: Gunnar
authors.initials: G
authors.lastname: Engström
authors.forename: Patrik
authors.initials: P
authors.lastname: Tydén
authors.forename: Bo
authors.initials: B
authors.lastname: Hedblad
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control* / Q000523:psychology*; D009483:Neuropsychological Tests; D010349:Patient Compliance / Q000523:psychology*; D010551:Personality; D011446:Prospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000473:pathology / Q000523:psychology*; D011795:Surveys and Questionnaires