title: Impact of psychosocial factors on cardiovascular morbimortality: a prospective cohort study.
abstract: BACKGROUND
  Whilst it is well known that psychosocial determinants may contribute to cardiovascular diseases (CVD), data from specific groups are scarce. The present study aims to determine the contribution of psychosocial determinants in increasing the risk of cardiovascular events (myocardial infarction and stroke), and death from CVD, in a high risk adult population.
  
  
  METHODS
  Longitudinal prospective study of 7263 patients (57.5% women), mean age 67.0 (SD 6.2) free from CVD but at high risk, with a median follow-up of 4.8 years (from October 2003 to December 2010). The Hazard Ratios (HRs) of cardiovascular events (myocardial infarction, stroke, and death from cardiovascular causes) related to educational attainment, diagnosed depression (based on medical records), and low social support (number of people living in the household) were estimated by multivariate Cox regression models.
  
  
  RESULTS
  Stroke incidence was associated with low educational level in the whole population (HR: 1.83, 95% CI: 1.09-3.09), and especially in men (HR: 2.11, 95% CI 1.09-4.06). Myocardial infarction and CVD mortality were not associated with any of the psychosocial factors considered.
  
  
  CONCLUSIONS
  Adults with low educational level had a higher risk of stroke. Depression and low social support were not associated with CVD incidence.
  
  
  BACKGROUND
  Clinical trial registration information unique identifier: ISRCTN35739639.
authors.forename: Cília
authors.initials: C
authors.lastname: Mejía-Lancheros
authors.forename: Ramón
authors.initials: R
authors.lastname: Estruch
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Martínez-González
authors.forename: Jordi
authors.initials: J
authors.lastname: Salas-Salvadó
authors.forename: Olga
authors.initials: O
authors.lastname: Castañer
authors.forename: Dolores
authors.initials: D
authors.lastname: Corella
authors.forename: Fernando
authors.initials: F
authors.lastname: Arós
authors.forename: Enrique
authors.initials: E
authors.lastname: Gómez-Gracia
authors.forename: Miquel
authors.initials: M
authors.lastname: Fiol
authors.forename: José
authors.initials: J
authors.lastname: Lapetra
authors.forename: Lluís
authors.initials: L
authors.lastname: Serra-Majem
authors.forename: Xavier
authors.initials: X
authors.lastname: Pintó
authors.forename: Emilio
authors.initials: E
authors.lastname: Ros
authors.forename: Javier
authors.initials: J
authors.lastname: Díez-Espino
authors.forename: Josep
authors.initials: J
authors.lastname: Basora
authors.forename: José-V
authors.initials: JV
authors.lastname: Sorlí
authors.forename: Rosa-Maria
authors.initials: RM
authors.lastname: Lamuela-Raventos
authors.forename: Valentina
authors.initials: V
authors.lastname: Ruiz-Gutiérrez
authors.affiliation: Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain. mamunoz.bcn.ics@gencat.cat.
authors.forename: Miguel-Ángel
authors.initials: MÁ
authors.lastname: Muñoz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003863:Depression / Q000401:mortality / Q000523:psychology; D004522:Educational Status; D005260:Female; D054624:Health Status Disparities; D006798:Housing; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012944:Social Support; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology*; D013997:Time Factors