title: Coronary heart disease and risk factors as predictors of trajectories of psychological distress from midlife to old age.
abstract: To examine coronary heart disease (CHD) and its risk factors as predictors of long-term trajectories of psychological distress from midlife to old age.
  
  
  
  In the Whitehall II cohort study, 6890 participants (4814 men, 2076 women; mean age 49.5 years) had up to seven repeat assessments of psychological distress over 21 years (mean follow-up 19 years). CHD and its risk factors (lifestyle-related risk factors, diabetes, hypertension and cholesterol) were assessed at baseline. Group-based trajectory modelling was used to identify clusters of individuals with a similar pattern of psychological distress over time.
  
  
  
  We identified four trajectories of psychological distress over the follow-up: 'persistently low' (69% of the participants), 'persistently intermediate' (13%), 'intermediate to low' (12%) and 'persistently high' (7%). The corresponding proportions were 60%, 16%, 13% and 11% among participants with CHD; 63%, 15%, 12% and 10% among smokers and 63%, 16%, 12% and 10% among obese participants. In multivariable adjusted multinomial regression analyses comparing other trajectories to persistently low trajectory, prevalent CHD was associated with intermediate to low (OR 1.70, 95% CI 1.08 to 2.68) and persistently high (OR 1.92, 95% CI 1.16 to 3.19) trajectories. Smoking (OR 1.33, 95% CI 1.07 to 1.64; OR 1.55, 95% CI 1.19 to 2.04) and obesity (OR 1.33, 95% CI 1.04 to 1.70; OR 1.47, 95% CI 1.07 to 2.01) were associated with persistently intermediate and persistently high trajectories, respectively.
  
  
  
  CHD, smoking and obesity may have a role in the development of long-lasting psychological distress from midlife to old age.
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Marianna
authors.initials: M
authors.lastname: Virtanen
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.|Institute of Behavioral Sciences, University of Helsinki, Finland.
authors.forename: Marko
authors.initials: M
authors.lastname: Elovainio
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Kim
authors.initials: K
authors.lastname: Josefsson
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: G David
authors.initials: GD
authors.lastname: Batty
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.|Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
authors.forename: Archana
authors.initials: A
authors.lastname: Singh-Manoux
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland.|Department of Epidemiology and Public Health, University College London, London, UK.|Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
mesh_terms: D000328:Adult; D000367:Age Factors; D000375:Aging / Q000502:physiology*; D015897:Comorbidity; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008019:Life Style; D008131:London / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017711:Nonlinear Dynamics; D009765:Obesity / Q000453:epidemiology / Q000523:psychology; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology / Q000523:psychology; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires; D013997:Time Factors