title: Psychosocial Factors and Risk of Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis.
abstract: BACKGROUND
  Heart failure (HF) is a major source of morbidity and mortality in the United States. Psychosocial factors have frequently been studied as risk factors for coronary heart disease but not for HF.
  
  
  RESULTS
  We examined the relationship between psychological status and incident HF among 6782 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA). Anger, anxiety, chronic stress, depressive symptoms, and hostility were measured using validated scales, and physician reviewers adjudicated incident HF events. Cox proportional hazards models were used to adjust for relevant demographic, behavioral, and physiological covariates. Interactions by age, race, sex, and self-reported health were examined in exploratory analyses. During a mean follow-up of 9.3 years, 242 participants developed incident HF. There was no association between psychosocial factors and HF hazard ratios (95% confidence interval) for the highest versus lowest quartile: anger=1.14 (0.81-1.60), anxiety=0.74 (0.51-1.07), chronic stress=1.25 (0.90-1.72), depressive symptoms=1.19 (0.76-1.85), and hostility=0.95 (0.62-1.42). In exploratory analysis, among the participants reporting fair/poor health at baseline, those reporting high versus low levels of anxiety, chronic stress, and depressive symptoms had 2-fold higher risk of incident HF, but there was no association for those with good/very good/excellent self-reported health.
  
  
  CONCLUSIONS
  Overall, these psychosocial factors were not significantly associated with incident HF. However, for participants reporting poor health at baseline, there was evidence that anxiety, chronic stress, and depressive symptoms were associated with increased risk of HF. Future research with greater statistical power is necessary to replicate these findings and seek explanations.
authors.affiliation: From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.). ogilv019@umn.edu.
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Ogilvie
authors.affiliation: From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.).
authors.forename: Susan A
authors.initials: SA
authors.lastname: Everson-Rose
authors.affiliation: From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.).
authors.forename: W T
authors.initials: WT
authors.lastname: Longstreth
authors.affiliation: From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.).
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Rodriguez
authors.affiliation: From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.).
authors.forename: Ana V
authors.initials: AV
authors.lastname: Diez-Roux
authors.affiliation: From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.).
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Lutsey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000786:Anger; D001007:Anxiety / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology; D002908:Chronic Disease; D003863:Depression / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology*; D006791:Hostility; D006801:Humans; D015994:Incidence; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: anger; anxiety; depression; epidemiology; heart failure