title: Associations between positive emotional well-being and stress-induced myocardial ischemia: Well-being scores predict exercise-induced ischemia.
abstract: Depressive symptoms have been associated with myocardial ischemia induced by mental (MSIMI) and exercise (ESIMI) stress in clinically stable ischemic heart disease (IHD) patients, but the association between positive emotions and inducible ischemia is less well characterized. The objective of this study was to examine the associations between ratings of well-being and stress-induced ischemia.
  
  
  
  Subjects were adult patients with documented IHD underwent mental and exercise stress testing for the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) trial. The General Well-Being Schedule (GWBS), with higher scores reflecting greater subjective well-being, and the Center for Epidemiologic Studies Depression Scale (CES-D) were obtained from the REMIT participants. Echocardiography was used to measure ischemic responses to mental stress and Bruce protocol treadmill exercise testing. Data were analyzed using logistic regression adjusting for age, sex, resting left-ventricular ejection fraction (LVEF), and resting wall motion score index, as well as health-related behaviors.
  
  
  
  GWBS scores were obtained for 210 individuals, with MSIMI present in 92 (43.8%) and ESIMI present in 64 (30.5%). There was a significant inverse correlation between GWBS-PE (Positive Emotion subscale) scores and probability of ESIMI (OR=0.55 (95%CI 0.36-0.83), p=0.005). This association persisted after additional control for CESD subscales measuring negative and positive emotions and for variables reflecting health-related behaviors. A similar inverse correlation between GWBS-PE and MSIMI was observed, but did not reach statistical significance (OR=0.81 (95%CI 0.54-1.20), p=0.28).
  
  
  
  This is, to our knowledge, the first study demonstrating that greater levels of self-reported positive emotions are associated with a lower likelihood of ESIMI among patients with known IHD. Our results highlight the important interface functions of the central nervous and cardiovascular systems and underscore areas for future investigation.
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, United States; Department of Medicine, Duke University Medical Center, Durham, NC, United States.
authors.forename: Jacob P
authors.initials: JP
authors.lastname: Feigal
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, United States.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Boyle
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, United States.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Samad
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, United States.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, United States.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wilson
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, United States.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Becker
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, United States.
authors.forename: Redford B
authors.initials: RB
authors.lastname: Williams
authors.affiliation: Department of Pharmacology & Cancer Biology, Duke University, Durham, NC, United States.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Kuhn
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, United States.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Ortel
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, United States.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rogers
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, United States.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, United States; Department of Medicine, Duke University Medical Center, Durham, NC, United States. Electronic address: jiang001@mc.duke.edu.
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004452:Echocardiography; D004644:Emotions; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000523:psychology*; D011237:Predictive Value of Tests; D011594:Psychometrics / Q000706:statistics & numerical data*; D011788:Quality of Life / Q000523:psychology*; D013223:Statistics as Topic; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: Coronary heart disease; Exercise induced ischemia; General Well-Being Schedule; General well-being scale; Mental stress induced ischemia; Positive emotions