title: Association of psychological risk factors and acute myocardial infarction in China: the INTER-HEART China study.
abstract: BACKGROUND
  Most data about psychological factors relating to acute myocardial infarction (AMI) were obtained from studies carried out in western countries. Results from small descriptive cross-sectional studies in China were inconclusive. The aim of this study was to explore possible associations between psychological risk factors and AMI among the Chinese population with a large-scale case-control study.
  
  
  METHODS
  This study was part of the INTER-HEART China study, itself part of the large international INTER-HEART study of cardiovascular risk factors. In this case-control study, 2909 cases and 2947 controls were recruited from 17 cities. Psychological stress, negative life events, depression and controllability of life circumstances were assessed.
  
  
  RESULTS
  Cases reported more psychological stress at home or work and odds ratios (ORs) were 3.2 (95%CI 2.1 - 4.9) for permanent stress and 2.1 (95%CI 1.5 - 2.8) for several periods of stress respectively. More cases experienced depression compared with controls (19.6% vs. 9.3%) and ORs were 2.2 (95%CI 1.9 - 2.6). Subjects with 1, 2 and 3 or more depressive symptoms had increased risk of AMI by 2.1, 2.2 and 2.6 fold, respectively, i.e., more depressive symptoms were associated with higher risks of AMI (P for trend < 0.0001). Women had a greater risk of AMI from depression (OR 3.0, 95%CI 2.2 - 4.0) compared to men (OR 2.0, 95%CI 1.6 - 2.4), P for interaction = 0.0364. Negative life events in subjects were associated with increased risk of AMI, OR 1.7 (95%CI 1.4 - 2.0) for one event and 1.8 (95%CI 1.3 - 2.4) for two or more events. High levels of controllability of life circumstances reduced the risk for AMI (OR 0.8, 95%CI 0.7 - 1.0).
  
  
  CONCLUSIONS
  Several psychological factors were closely associated with increased AMI risk among Chinese population. Psychological stress had a greater AMI risk in men but depression was more significant among women.
authors.affiliation: Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Xu
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Koon
authors.initials: K
authors.lastname: Teo
authors.forename: Xing-yu
authors.initials: XY
authors.lastname: Wang
authors.forename: Li-sheng
authors.initials: LS
authors.lastname: Liu
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002681:China; D003863:Depression / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology