International Journal of Epidemiology 2002;31:1227-1234
© International Epidemiological Association 2002
Special Theme: Psychosocial |
Psychosocial risk factors for heart disease in France and Northern Ireland: The Prospective Epidemiological Study of Myocardial Infarction (PRIME)
a School of Psychology,
c Department of Epidemiology and Public Health, Queen’s University, Belfast BT7 1NN, Northern Ireland.
b Department of Epidemiology and Public Health, Faculty of Medicine, Strasbourg, France.
d The Toulouse MONICA Project, INSERM U558, Toulouse, France.
e The Lille MONICA Project, INSERM U508, Lille, France.
f The Coordinating Centre, U258 INSERM, Paris, France.
Abstract
Background France has a substantially lower level of premature mortality from cardiovascular diseases (CVD) relative to its comparators. Compared with Northern Ireland, France has one-half the rate, despite having a similar cardiovascular risk profile to Northern Ireland. In this prospective longitudinal study the psychosocial risk hypothesis for CVD was tested.
Method A cohort of 9758 men (7359 in France and 2399 in Northern Ireland) aged 50–59 years who were initially free of any CVD were recruited. At baseline the subjects completed a psychosocial questionnaire, measuring hostility, depression, social support, and the Type A behaviour pattern. At 5-years follow-up their clinical status was determined.
Results Multivariate analysis indicated that, contrary to prediction, France had a substantially more negative psychosocial risk profile than Northern Ireland. The psychosocial risk factors were not successful at predicting at 5-years follow-up the hard clinical endpoint of definite fatal/non-fatal myocardial infarction. In the case of the softer clinical endpoint, angina pectoris/unstable angina, only depression predicted outcome with a small effect size.
Conclusion The findings provide little support for the psychosocial risk hypothesis. The psychosocial risk profile was more negative in France, the opposite of that predicted. The finding of a relationship between depression and angina may reflect a tendency for individuals who respond negatively on mood state to report more cardiac symptoms irrespective of physical disease state.
Keywords Coronary heart disease, depression, hostility, TABP, social support, France, Northern Ireland
Accepted 9 August 2002
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