title: Psychological resources are associated with reduced incidence of coronary heart disease. An 8-year follow-up of a community-based Swedish sample.
abstract: BACKGROUND
  A large number of studies have provided clear evidence for a link between the risk of coronary heart disease and psychological risk factors. Much less attention has been given to the potential protective effect of psychological resources.
  
  
  OBJECTIVE
  The major aim of this study was to investigate the independent association between psychological resources and incidence of coronary heart disease (CHD) in an 8-year follow-up study of a Swedish community-based cohort.
  
  
  METHODS
  The cohort consisted of 484 men and 497 women, aged 45-69 years at baseline. The incidence of first-time major event of CHD was analysed in relation to baseline levels of psychological resources, including mastery, self-esteem, and sense of coherence as well as psychological risk factors including cynicism and hostile affect, vital exhaustion, hopelessness, and depressive symptoms. In Cox proportional hazard models, adjustments were made for age, sex, eight traditional cardiovascular risk factors, and depressive symptoms.
  
  
  RESULTS
  A total of 56 CHD events had occurred after the 8-year follow-up. After adjustment for age, sex, and eight traditional risk factors, a significantly decreased risk of CHD was found for mastery (HR 0.62 per SD, p = 0.003), self-esteem (HR 0.64, p = 0.004), and sense of coherence (HR 0.70, p = 0.031). An increased risk of CHD was found for vital exhaustion (HR 1.46, p = 0.014), hopelessness (HR 1.59, p = 0.003), and depressive symptoms (HR 1.45, p = 0.009). After further adjustment for depressive symptoms, significant associations remained for mastery (HR 0.67, p = 0.034), self-esteem (HR 0.69, p = 0.048), and hopelessness (HR 1.48, p = 0.023).
  
  
  CONCLUSIONS
  The psychological resources, mastery and self-esteem, showed robust protective effects on CHD, also after adjustment for established risk factors as well as depressive symptoms. In parallel, hopelessness was an independent risk factor for CHD. The results may have implications for novel approaches in preventive efforts.
authors.affiliation: Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, 595 83, Sweden, oskar.lundgren@liu.se.
authors.forename: Oskar
authors.initials: O
authors.lastname: Lundgren
authors.forename: Peter
authors.initials: P
authors.lastname: Garvin
authors.forename: Lena
authors.initials: L
authors.lastname: Jonasson
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
authors.forename: Margareta
authors.initials: M
authors.lastname: Kristenson
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology / Q000523:psychology*; D003863:Depression / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006791:Hostility; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012649:Self Concept; D013548:Sweden / Q000453:epidemiology