Background The relation between psychological variables andclinically evident coronary artery disease has been studiedextensively, although the potential mechanisms of such a relationremain speculative. We studied the relation between multiplepsychological variables and subclinical coronary artery diseaseto assess the possible role of such variables in atherogenesis.
Methods We conducted a prospective study of 630 consecutiveconsenting, active-duty U.S. Army personnel, 39 to 45 yearsof age, without known coronary artery disease. Each participantwas assessed for depression, anxiety, somatization, hostility,and stress. Subclinical coronary artery disease was identifiedby electron-beam computed tomography.
Results The mean (±SD) age of the subjects was 42±2years; 82 percent were male, and 72 percent were white. Theprevalence of coronary-artery calcification was 17.6 percent(mean calcification score, 10±49). The prevalence ofprior or current psychiatric disorders was 12.7 percent. Therewas no correlation between the coronary-calcification scoreand the scores measuring depression (r=–0.07, P=0.08),anxiety (r=–0.07, P=0.10), hostility (r=–0.07, P=0.10),or stress (r=–0.002, P=0.96). Somatization (the numberand severity of durable physical symptoms) was inversely correlatedwith calcification scores (r=–0.12, P=0.003), even afterwe controlled for age and sex. In multivariate logistic-regressionmodels, a somatization score greater than 4 (out of a possible26) was independently associated with the absence of any coronary-arterycalcification (odds ratio, 0.49; 95 percent confidence interval,0.25 to 0.96).
Conclusions Our data suggest that depression, anxiety, hostility,and stress are not related to coronary-artery calcificationand that somatization is associated with the absence of calcification.
Source Information
From the Departments of Medicine (P.G.O., D.L.J., A.J.T.) and Radiology (I.M.F.), Walter Reed Army Medical Center, Washington, D.C.; and the Uniformed Services University of the Health Sciences, Bethesda, Md. (P.G.O., D.L.J., I.M.F., A.J.T.).
Address reprint requests to Dr. O'Malley at the General Internal Medicine Service, Department of Medicine (EDP), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814-4799, or at patrick.omalley{at}na.amedd.army.mil.
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