I själ och hjärta - Psykosociala faktorer och hjärt-kärlhälsa

Abstract

Cardiovascular disease (CVD) is the leading cause of death in Sweden and worldwide. Although the prevalence is declining in the Western world there are signs of rising prevalence among the young. The overall aim of the thesis was to investigate the associations between negative and positive psychosocial factors, as well as negative emotional states, on the one hand, and clinical as well as subclinical CVD on the other, in two cohorts; one of them including younger age groups. Research on the associations of positive psychosocial factors with subclinical stages of CVD is still quite scarce. The three included studies investigate associations of negative emotional states and negative life events with CVD (study I), but also of positive psychosocial factors, i.e., life satisfaction (study II) and optimism (study III), in two large population-based samples. Study I used prospective data from the InterGene cohort, comprising 3614 randomly selected men and women aged 25-75 (participation rate 42%). At baseline, self-rated depression, anxiety, and life stress, along with information on covariates, were assessed with questionnaires; blood samples were taken and physiological parameters were assessed. Cox regression was used to predict incident CVD, CVD mortality, as well as all-cause mortality. Depressiveness, anxiety and negative life events were associated with increased risk of CVD in a dose-response manner. Such associations mostly persisted in the fully adjusted models. Study II and III used cross-sectional data from the SCAPIS Malmö cohort, comprising 6251 men and women aged 50-64 years (participation rate 53%). Optimism and life satisfaction were assessed with questionnaire, while data on covariates was collected through questionnaire, physiological measurements, and blood samples. Arterial health was assessed in terms of coronary artery calcium score (CACS), aortic augmentation index (AIx) and ankle-brachial index (ABI). Associations were investigated with multiple linear and logistic regression analyses. Optimism and higher life satisfaction were associated with better arterial health. There was a dose-response relationship between higher life satisfaction and lower CACS in all investigated coronary artery regions. In conclusion, negative emotional states and positive as well as negative psychosocial factors are associated with cardiovascular health and warrants further consideration in public health efforts.