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Psychological distress, physical illness and risk of myocardial infarction in the Caerphilly study

Published online by Cambridge University Press:  04 April 2007

F. RASUL ,
S. A. STANSFELD ,
G. DAVEY SMITH ,
Y. BEN SHLOMO  and
J. GALLACHER
F. RASUL
Affiliation:
Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London, Queen Mary's School of Medicine and Dentistry, University of London
S. A. STANSFELD*
Affiliation:
Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London, Queen Mary's School of Medicine and Dentistry, University of London
G. DAVEY SMITH
Affiliation:
Department of Social Medicine, University of Bristol
Y. BEN SHLOMO
Affiliation:
Department of Social Medicine, University of Bristol
J. GALLACHER
Affiliation:
Department of Epidemiology and Public Health, University of Wales College of Medicine, Cardiff, UK
*
*Address for correspondence: Professor Stephen A. Stansfeld, Centre for Psychiatry, Barts & The London School of Medicine and Dentistry, Old Anatomy Building, Charterhouse Square, LondonEC1M 6BQ, UK. (Email: [email protected])
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Abstract

Background

Studies have found associations between psychological distress (PD) and increased risk of myocardial infarction (MI). However, it is not clear whether the relationship reflects the subtle influence of pre-existing illness on both PD and MI. This study examines the association between PD and MI in a prospective epidemiological study of 1864 middle-aged men to examine if the association is explained by existing illness.

Method

This study was a prospective cohort study modelling the association between PD, measured using the 30-item General Health Questionnaire (GHQ) and non-fatal myocardial infarction (NFMI) and fatal/non-fatal myocardial infarction (FNFMI).The relationship was modelled in a series of logistic regression models adjusted for age, then cigarette smoking, then social position, and finally for all sociodemographic characteristics, coronary heart disease (CHD) risk factors, and baseline CHD.

Results

PD was associated with a 70% and 68% increased risk of NFMI and FNFMI in fully adjusted analysis. However, PD was not associated with an increased risk of NFMI and FNFMI in analyses excluding those with baseline CHD. Further, being psychologically distressed and physically ill was associated with a greater than twofold risk of NFMI and FNFMI, 2·37 (95% CI 1·33–4·20) and 2·33 (95% CI 1·32–4·12) respectively.

Conclusions

This study suggests that PD is a moderator of the increased risk of MI associated with existing physical illness. PD in men who are physically ill is a marker of an underlying chronic physical illness. The prospective association of PD with MI is not independent of baseline physical illness.

Type
Original Article
Information
Psychological Medicine , Volume 37 , Issue 9 , September 2007 , pp. 1305 - 1313
Copyright
Copyright © Cambridge University Press 2007

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