title: Combining psychosocial data to improve prediction of cardiovascular disease risk factors and events: The National Heart, Lung, and Blood Institute--sponsored Women's Ischemia Syndrome Evaluation study.
abstract: BACKGROUND
  There is overlap among psychosocial predictors of cardiovascular disease (CVD). The usefulness of combining psychosocial variables as risk markers for CVD needs investigation.
  
  
  METHODS
  Participants were 493 women in the NHLBI WISE study. Multivariate combination of Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Social Network Index (SNI), and Cook-Medley hostility subscales was evaluated, and principal components analysis also conducted. Relationships of composite psychosocial risk markers to CVD events and risk factors were assessed.
  
  
  RESULTS
  The multivariate block of SNI, Cook-Medley Hostile Affect subscale, STAI, and BDI predicted CVD events (χ(2) = 27.8, df = 6, p < .001). Scalewise factor analysis revealed 2 factors: negative affectivity (NA) and hostility (explained variance, 45.6% and 17.1%, respectively). NA was associated with BMI (β [SE] = 0.18 [0.09], p = .04), hostility with metabolic syndrome (exp(β) = 0.60 [0.28], p = .04). Both factors were associated with blood pressure (BP): NA with SBP (β = 2.53 [1.04], p = .02) and DBP (β = 1.66 [0.60], p = .02); hostility with SBP (β = 2.72 [1.13], p = .02) and DBP (β = 1.83 [0.65], p = .005). Neither factor predicted CVD events. Original scales predicted CVD events: lower SNI (HR = 0.74, CI = 0.57-0.96), lower Hostile Affect (HR = 0.80, CI = 0.56-1.03), and higher BDI (HR = 1.33, CI = 1.08-1.74).
  
  
  CONCLUSIONS
  In women with suspected ischemia, multivariate combination of psychosocial risk markers predicts CVD events; derived psychosocial factors were associated with CVD risk factors but not events. Measuring common variance among psychosocial variables may be a useful research strategy.
authors.affiliation: Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda 20814, USA.
authors.forename: Kerry S
authors.initials: KS
authors.lastname: Whittaker
authors.forename: David S
authors.initials: DS
authors.lastname: Krantz
authors.forename: Thomas
authors.initials: T
authors.lastname: Rutledge
authors.forename: B Delia
authors.initials: BD
authors.lastname: Johnson
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Wawrzyniak
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
authors.forename: Jo-Ann
authors.initials: JA
authors.lastname: Eastwood
authors.forename: Wafia
authors.initials: W
authors.lastname: Eteiba
authors.forename: Carol E
authors.initials: CE
authors.lastname: Cornell
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
authors.forename: Diane A
authors.initials: DA
authors.lastname: Vido
authors.forename: Eileen
authors.initials: E
authors.lastname: Handberg
authors.forename: C Noel Bairey
authors.initials: CN
authors.lastname: Merz
mesh_terms: D000786:Anger; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000523:psychology*; D017023:Coronary Angiography; D003627:Data Interpretation, Statistical; D004812:Epidemiologic Methods; D005260:Female; D006791:Hostility; D006801:Humans; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology; D054555:National Heart, Lung, and Blood Institute (U.S.); D010552:Personality Assessment / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012944:Social Support; D013315:Stress, Psychological / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D016387:Women's Health / Q000706:statistics & numerical data*