Anxiety and anger immediately prior to myocardial infarction and long-term mortality: Characteristics of high-risk patients

作者：Smeijers Loes; Mostofsky Elizabeth; Tofler Geoffrey H; Muller James E; Kop Willem J; Mittleman Murray A^*

来源：Journal of Psychosomatic Research, 2017, 93: 19-27.

DOI：10.1016/j.jpsychores.2016.12.001

• Myocardial infarction
• Mortality
• Risk factors
• Anxiety
• Anger
• Acute stress

Objective: Acute high levels of anger and anxiety are associated with an elevated risk of myocardial infarction (MI) in the following two hours. Mls preceded by these acute negative emotions may also have a poor long-term prognosis, but information about high-risk patients is lacking. We examined whether young age and female sex are associated with Mls that are preceded by negative emotions and whether age and sex moderate the subsequent increased mortality risk following MI preceded by negative emotions.
Methods: We conducted a secondary analysis of the Determinants of Myocardial Infarction Onset Study (N = 2176, mean age = 60.1 +/- 12.3 years, 29.2% women). Anxiety and anger immediately prior to (0 - 2 h) MI and the day before (24-26 h) MI were assessed using a structured interview. Subsequent 10-year all-cause mortality was determined using the US National Death Index.
Results: Anxiety during the 0-2 h pre-MI period was associated with younger age (OR = 0.98,95% Cl = 0.96-0.99 per year) and female sex (OR = 1.50,95% Cl = 1.11-2.02). Anger in the 0-2 h pre-MI period was also associated with younger age (OR = 0.95,95% Cl = 0.94-0.96) but not with sex (OR = 0.93,95% Cl = 0.67-1.28). During follow-up, 580 (26.7%) patients died. Mortality rate was higher if MI occurred immediately after high anxiety, particularly in patients >= 65 years (HR = 1.80,95% CI = 128-2.54) vs. younger patients (HR = 0.87,95% Cl = 0.551.40; p-interaction = 0.015). Other interactions with sex or anger were not significant.
Conclusions: Patients with high anxiety or anger levels in the critical 2-hour period prior to MI are younger than those without such emotional precipitants. In addition, pre-MI anxiety is associated with an elevated 10-year mortality risk in patients aged 65 years.

• 出版日期2017-2