Interactions of psychological factors and family history in relation to coronary artery disease.

BACKGROUND

Psychological factors including hostility, depression and stress have been associated with severity of coronary artery disease (CAD). However, few studies have examined interactions between such factors and typical CAD risk factors. Investigating interactive effects simulates their co-occurrence and complex effects in illness, as well as helping to identify groups of patients at greatest risk of morbidity. This study examined the interactive effects of hostility, hopelessness and daily hassles with family history of CAD in relation to CAD severity.

DESIGN

Correlation design.

METHODS

Seventy-three patients were assessed for hostility, hopelessness and daily hassles before undergoing coronary artery angiography. Severity of CAD was assessed by a cardiologist who was blind to patients' psychological data, with a scale considering type and proximity of occluded artery: the Ilia-score.

RESULTS

Hostility significantly interacted with family history in relation to CAD severity. Hostility was positively correlated with CAD severity when family history was positive (r = 0.43, P< 0.05), but not when family history was absent (r = -0.10, NS). No other interaction effects were found. Interestingly, patients with family history of CAD had significantly lower hostility scores (14.4) compared to patients without such history (19.2; P= 0.002). No background or typical-risk factor correlated with CAD severity.

CONCLUSION

Hostility synergistically interacted with family history of CAD in relation to CAD severity. The mechanisms of this interaction need to be explored in future studies. Hostility-reduction interventions provided to high-hostile patients with a genetic predisposition to CAD may be relevant for primary and secondary CAD prevention.