title: Psychological and physiological predictors of angina during exercise-induced ischemia in patients with coronary artery disease.
abstract: OBJECTIVE
  This study compares sensory-biological, cognitive-emotional, and cognitive-interpretational factors in predicting angina on an exercise treadmill test (ETT).
  
  
  METHODS
  A total of 163 patients with ETT-induced ischemia and coronary artery disease in the National Heart, Lung, and Blood Institute Psychophysiological Investigations of Myocardial Ischemia study were given an ETT, during which 79 patients reported angina. We assessed the following as potential predictors of self-reported anginal pain: sensory-biological factors (β-endorphin reactivity, hot pain threshold, and maximal ST-segment depression), cognitive-emotional factors (negative affect and symptom perception), and cognitive-interpretational factors (self-reported history of exercise-induced angina). Models were covariate adjusted with predictors examined individually and as part of component blocks.
  
  
  RESULTS
  Logistic regression revealed that history of angina (odds ratio [OR] = 17.41, 95% confidence interval = 7.16-42.34) and negative affect (OR = 1.65, 95% confidence interval = 1.17-2.34), but not maximal ST-segment depression, hot pain threshold, β-endorphin reactivity, or symptom perception, were significant predictors of angina on the ETT. The sensory-biological block was not significantly predictive of anginal pain (χ(2)block = 5.15, p = .741). However, the cognitive-emotional block (χ(2)block = 11.19, p = .004) and history of angina (cognitive-interpretation; χ(2)block = 54.87, p < .001) were predictive of ETT angina. A model including all variables revealed that only history of angina was predictive of ETT pain (OR = 16.39, p < .001), although negative affect approached significance (OR = 1.45, p = .07).
  
  
  CONCLUSIONS
  In patients with ischemia, cognitive-emotional and cognitive-interpretational factors are important predictors of exercise angina.
authors.affiliation: Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
authors.forename: Nadine S
authors.initials: NS
authors.lastname: Bekkouche
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Wawrzyniak
authors.forename: Kerry S
authors.initials: KS
authors.lastname: Whittaker
authors.forename: Mark W
authors.initials: MW
authors.lastname: Ketterer
authors.forename: David S
authors.initials: DS
authors.lastname: Krantz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D001007:Anxiety / Q000150:complications; D015897:Comorbidity; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D003863:Depression / Q000150:complications; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D008959:Models, Neurological; D017288:Pain Threshold; D012008:Recurrence; D012307:Risk Factors; D012649:Self Concept; D057566:Self Report; D001615:beta-Endorphin / Q000097:blood
chemical_list: D001615:beta-Endorphin
keywords: angina; anxiety; depression; treadmill test