title: Impaired Health Status, Psychological Distress, and Personality in Women and Men With Nonobstructive Coronary Artery Disease: Sex and Gender Differences: The TWIST (Tweesteden Mild Stenosis) Study.
abstract: Patients with nonobstructive coronary artery disease (NOCAD; wall irregularities, stenosis <60%), and women with NOCAD in particular, remain underinvestigated. We examined sex and gender (S&G) differences in health status, psychological distress, and personality between patients with NOCAD and the general population, as well as S&G differences within the NOCAD population.
  
  
  
  In total, 523 patients with NOCAD (61±9 years, 52% women) were included via coronary angiography and computed tomography as part of the TWIST (Tweesteden Mild Stenosis) study. Generic health status (12-item Short Form physical and mental scales and fatigue), psychological distress (Hospital Anxiety and Depression Scale anxiety and depressive symptoms and Global Mood Scale negative and positive affect), and personality (Type D personality) were compared between patients with NOCAD and an age- and sex-matched group of 1347 people from the general population. Frequency matching was performed to obtain a similar sex distribution in each age-decile group. Both men and women with NOCAD reported impaired health status, more psychological distress, and Type D personality compared with men and women in the reference group. Women reported more psychosocial distress compared with men, but no significant sex-by-group interaction effects were observed. Women with NOCAD reported impaired health status, more anxiety, and less positive affect, but no differences in depressive symptoms, angina, or Type D personality when compared with men with NOCAD. Age, education, employment, partner, and alcohol use explained these S&G differences within the NOCAD group.
  
  
  
  In both men and women, NOCAD was associated with impaired health status, more psychological distress, and Type D personality when compared with a reference population. Factors reflecting S&G differences explained these S&G findings in patient-reported outcomes.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01788241.
authors.affiliation: From the Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands (P.M.C.M., L.A, W.Z., J.W., J.D.); and Department of Cardiology, Elisabeth-Tweesteden Hospital, The Netherlands (J.W., W.A.). P.M.C.Mommersteeg@uvt.nl.
authors.forename: Paula M C
authors.initials: PM
authors.lastname: Mommersteeg
authors.affiliation: From the Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands (P.M.C.M., L.A, W.Z., J.W., J.D.); and Department of Cardiology, Elisabeth-Tweesteden Hospital, The Netherlands (J.W., W.A.).
authors.forename: Lindy
authors.initials: L
authors.lastname: Arts
authors.affiliation: From the Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands (P.M.C.M., L.A, W.Z., J.W., J.D.); and Department of Cardiology, Elisabeth-Tweesteden Hospital, The Netherlands (J.W., W.A.).
authors.forename: Wobbe
authors.initials: W
authors.lastname: Zijlstra
authors.affiliation: From the Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands (P.M.C.M., L.A, W.Z., J.W., J.D.); and Department of Cardiology, Elisabeth-Tweesteden Hospital, The Netherlands (J.W., W.A.).
authors.forename: Jos W
authors.initials: JW
authors.lastname: Widdershoven
authors.affiliation: From the Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands (P.M.C.M., L.A, W.Z., J.W., J.D.); and Department of Cardiology, Elisabeth-Tweesteden Hospital, The Netherlands (J.W., W.A.).
authors.forename: Wilbert
authors.initials: W
authors.lastname: Aarnoudse
authors.affiliation: From the Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands (P.M.C.M., L.A, W.Z., J.W., J.D.); and Department of Cardiology, Elisabeth-Tweesteden Hospital, The Netherlands (J.W., W.A.).
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D016022:Case-Control Studies; D015897:Comorbidity; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000523:psychology*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000523:psychology*; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010551:Personality; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D012737:Sex Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires; D064415:Type D Personality
keywords: Type D personality; anxiety; coronary artery disease; depression; health status; quality of life; sex