title: Clinical implications of the Women's Ischemia Syndrome Evaluation: inter-relationships between symptoms, psychosocial factors and cardiovascular outcomes.
abstract: Cardiovascular disease remains the leading cause of death in the USA and is associated with several modifiable (hypertension, diabetes, high cholesterol, tobacco use, physical inactivity, obesity and unhealthy diet) and nonmodifiable (age, gender and family history) risk factors. The role of psychosocial risk factors in the development of cardiovascular disease has a growing body of literature, and differences in men and women have been identified. The Women's Ischemia Syndrome Evaluation provides insight into psychosocial risk factors in a cohort of women presenting with chest pain who had a comprehensive battery of psychosocial assessments and long-term follow-up. This review focuses on symptom presentation for chest pain and its relationship to cardiovascular disease morbidity and mortality, quality of life, healthcare costs and psychosocial predictor variables, including anxiety, depression, hostility and social networks. In the Women's Ischemia Syndrome Evaluation, persistent chest pain was associated with an increased rate of adverse events and relatively high rates of depression and anxiety, with reduced functional capacity and impaired quality of life, over a median of 6 years of follow-up. More research is needed to better understand the relationships between symptoms and negative emotions and to determine whether psychological (pharmacologic and/or cognitive) interventions might impact both psychological and cardiovascular outcomes.
authors.affiliation: Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA. eileen.handberg@medicine.ufl.edu
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Handberg
authors.forename: Jo-Ann
authors.initials: JA
authors.lastname: Eastwood
authors.forename: Wafia
authors.initials: W
authors.lastname: Eteiba
authors.forename: B Delia
authors.initials: BD
authors.lastname: Johnson
authors.forename: David S
authors.initials: DS
authors.lastname: Krantz
authors.forename: Diane V
authors.initials: DV
authors.lastname: Thompson
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
authors.forename: Noel Bairey
authors.initials: NB
authors.lastname: Merz
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Rutledge
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000523:psychology; D002637:Chest Pain / Q000523:psychology*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D003365:Costs and Cost Analysis; D003863:Depression / Q000453:epidemiology; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008603:Mental Health; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D011788:Quality of Life; D012306:Risk; D012959:Socioeconomic Factors; D013577:Syndrome; D016387:Women's Health