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Angina pectoris among 10,000 men

II. Psychosocial and other risk factors as evidenced by a multivariate analysis of a five year incidence study
  • Jack H Medalie
    Correspondence
    Requests for reprints should be addressed to Dr. J. H. Medalie.
    Footnotes
    Affiliations
    Tel Aviv, Israel

    Bethesda, Maryland, USA
    Search for articles by this author
  • Uri Goldbourt
    Footnotes
    Affiliations
    Tel Aviv, Israel

    Bethesda, Maryland, USA
    Search for articles by this author
  • Author Footnotes
    ∗ Present address: Department of Family Medicine, Case-Western Reserve School of Medicine, 2119 Abington Road, Cleveland, Ohio 44106.
    1 From the Department of Family Medicine, Sackler School of Medicine, Tel Aviv University and the Israel Ischemic Heart Disease Study, in collaboration with the National Heart and Lung Institute, Bethesda, Maryland, U.S.A. Research Agreement No. 375106.
    † Present address: Department of Research, Wingate Institute of Physical Education, Netanya, Israel.
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      Abstract

      The major independent role played by anxiety and severe psychosocial problems (especially family ones) is demonstrated by this multivariate analysis of a five year prospective study of the development of new angina pectoris among almost 10,000 adult men (average annual incidence = Math Eq).
      The independent effect of these two variables is considerably augmented by the other significant risk factors of age, total serum cholesterol, systolic or diastolic blood pressure, certain electrocardiographic abnormalities and diabetes mellitus. The presence of all seven risk factors (at a high level) increases the probability of angina pectoris developing within five years to Math Eq from Math Eq, when these factors are low or absent.
      The wife's love and support is an important balancing factor, which apparently reduces the risk of angina pectoris even in the presence of high risk factors. The implications of these findings to the pathophysiology and prevention of angina are stressed.
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      References

        • Medalie JH
        • Snyder M
        • Groen JJ
        • et al.
        Angina pectoris among 10,000 men: 5 year incidence and univariate analysis.
        Am J Med. 1973; 55: 583
        • Groen JJ
        • Medalie JH
        • Neufeld HN
        • et al.
        An epidemiologic investigation of hypertension and ischemic heart disease within a defined segment of the adult male population of Israel.
        Isr J Med Sci. 1968; 4: 177
        • Medalie JH
        • Kahn HA
        • Neufeld HN
        • et al.
        Myocardial infarction among 10,000 adult males over a 5 year period. I. Prevalence, incidence and mortality experience.
        J Chron Dis. 1973; 26: 63
      1. Hypertension and coronary heart disease: classification and criteria for epidemiological studies.
        WHO Technical Report Series 168. 1959; (Geneva)
        • Medalie JH
        • Riss E
        • Neufeld HN
        • et al.
        Some practical problems of observer variation in a large survey.
        in: Eliakim M Neufeld HN Cardiology—Current Topics and Progress. Academic Press, New York1970: 100
        • Anderson JT
        • Keys A
        Cholesterol in serum and lipoprotein fraction.
        Clin Chem. 1956; 21: 145
      2. WHO Technical Report Series 231. 1962; (Geneva): 5
        • Medalie JH
        • Papier C
        • Herman JB
        • et al.
        Diabetes mellitus among 10,000 adult men. I. Five year incidence and associated variables.
        Isr J Med Sci. 1974; 10: 681
        • Cox DR
        The regression analysis of binary sequences.
        JR Stat Soc. 1958; B20: 215
        • Cornfield J
        • Gordon T
        • Smith WW
        Quartal response curves for experimentally uncontrolled variables.
        Bull Int Inst Stat. 1961; 38: 97
        • Walker SH
        • Duncan DB
        Estimation of the probability of an event as a function of several independent variables.
        Biometrika. 1967; 54: 167
        • Goldbourt U
        • Medalie JH
        Weight-height indices. Choice of the most suitable index and its association with selected variables among 10,000 adult males of heterogeneous origin.
        Br J Prev Soc Med. 1974; 28: 116
        • Kannel WB
        • Dawber TR
        • Kagan A
        • et al.
        Factors of risk in the development of coronary heart disease.
        Ann Intern Med. 1961; 55: 33
        • Epstein FH
        The epidemiology of coronary heart disease.
        J Chron Dis. 1965; 18: 735
        • Morris JN
        • Gardner MJ
        Epidemiology of ischemic heart disease.
        JAMA. 1969; 46: 674
        • Medalie JH
        • Kahn HA
        • Neufeld HN
        • et al.
        Five-year myocardial infarction incidence. II. Association of single variables with age and birthplace.
        J Chron Dis. 1973; 26: 329
        • Goldbourt U
        • Medalie JH
        • Neufeld HN
        Clinical myocardial infarction over a five-year period. III. A multivariate analysis of incidence.
        J Chron Dis. 1975; 28: 217
        • Rosenman RH
        • Friedman M
        • Straus R
        • et al.
        Coronary heart disease in Western Collaborative Group Study.
        J. Chron Dis. 1970; 23: 173
        • Rosenman RH
        • Friedman M
        • Straus R
        • et al.
        A predictive study of coronary heart disease.
        JAMA. 1964; 189: 15
        • Jenkins CD
        Psychologic and social precursors of coronary disease.
        N Engl J Med. 1971; 284: 244
        • Jenkins CD
        Psychologic and social precursors of coronary disease.
        N Engl J Med. 1971; 284: 307
        • Ostfeld AM
        • Lebovits BZ
        • Shekelle RB
        • et al.
        A prospective study of the relationship between personality and coronary heart disease.
        J Chron Dis. 1964; 17: 265
        • Bakker CB
        Psychological factors in angina pectoris.
        Psychosomatics. 1967; 8: 43
        • Frank CW
        • Weinblatt E
        • Shapiro S
        Angina pectoris in men: prognostic significance of selected medical factors.
        Circulation. 1973; 47: 509
        • Gordon T
        • Garcia-Palmieri MB
        • Kagan A
        • et al.
        Differences in coronary heart disease in Framingham, Honolulu and Puerto Rico.
        J Chron Dis. 1974; 29: 329
        • Lynn TN
        • Duncan R
        • Naughton J
        • et al.
        Prevalence of evidence of prior myocardial infarction, hypertension, diabetes, and obesity in three neighboring communities in Pennsylvania.
        Am J Med Sci. 1967; 254: 385
        • Bruhn JG
        • Chandler B
        • Miller MC
        • et al.
        Social aspects of coronary heart disease in two adjacent, ethnically different communities.
        Am J Pub Health. 1966; 56: 1493
        • Tyroler HA
        • Cassel J
        Health consequences of culture change. II. The effect of urbanization on coronary heart mortality in rural residents.
        J Chron Dis. 1964; 17: 167
        • Cassel J
        Appraisal and implications for theoretical development. Social factors and cardiovascular disease. Factors involving socio-cultural incongruity and change.
        Milbank Mem Fund Quart. 1967; 45 (suppl): 41
        • Christenson WN
        • Hinkle Jr, LE
        Differences in illness and prognostic signs in two groups of young men.
        JAMA. 1961; 177: 247
        • Gordon T
        Mortality experiences among the Japanese in the U.S., Hawaii and Japan.
        Publ Health Rep. 1957; 72: 543
      3. Coronary heart disease in seven countries. Circulation. 42. 1970: 4 (suppl 1)
        • Stamler J
        • Schoenberger JA
        • Shekelle RB
        • et al.
        Hypertension: The Problem and The Challenge.
        in: The Hypertension Handbook. Merck, West Point, Pa1974: 3
        • Kleinbaum DG
        • Kupper LL
        • Cassel JC
        • et al.
        Multivariate analysis of risk of coronary heart disease in Evans County, Georgia.
        Arch Intern Med. 1971; 128: 943
        • Mechanic D
        Social psychological factors affecting the presentation of bodily complaints.
        N Engl J Med. 1972; 286: 1132
        • Zborowski M
        Cultural components in responses to pain.
        J Soc Issues. 1952; 8: 16
        • Balint M
        The Doctor, His Patient and the Illness.
        Pitman, London1964
        • Abramson JH
        • Epstein LM
        • Kark SL
        • et al.
        The contribution of a health survey to a family practice.
        Scand J Soc Med. 1973; 1: 33
        • Mann KJ
        • Medalie JH
        • Lieber E
        • et al.
        Visits to Doctors.
        Academic Press, Jerusalem1970
        • Asch AJ
        • Rabin DL
        • Hurwitz A
        • et al.
        Bronchial asthma in an Isreal community.
        Isr J Med Sci. 1973; 9: 1014
        • Medalie JH
        • Birnbaum D
        • Goldbourt U
        • et al.
        Peptic ulcer history among 10,000 adult males. I. Prevalence and incidence.
        Isr J Med Sci. 1972; 8: 1673
        • Yodfat Y
        A population study of peptic ulcer.
        Isr J Med Sci. 1972; 8: 1680
        • Epstein LM
        Validity of a questionnaire for diagnosis of peptic ulcer in an ethnically heterogeneous population.
        J Chron Dis. 1969; 22: 49
        • Adler E
        • Abramson JH
        The use of questions as an indication of active rheumatoid arthritis.
        Isr J Med Sci. 1968; 4: 210
        • Abramson JH
        • Terespolsky L
        • Brook JG
        • et al.
        Cornell Medical Index as a health measure in epidemiological studies: a test of validity of a health questionnaire.
        Br J Prev Soc Med. 1965; 19: 103
        • Sive PH
        • Medalie JH
        • Kahn HA
        • et al.
        Distribution and multiple regression analysis of blood pressure in 10,000 Israeli men.
        Am J Epidemiol. 1971; 93: 317
        • Lazarus RS
        The concepts of stress and disease.
        in: Society Stress and Disease. vol. I. Oxford University Press, London1971: 53
        • Groen JJ
        Social change and psychosomatic disease.
        in: Society Stress and Disease. vol. I. Oxford University Press, London1971: 91
        • Scott R
        • Howard A
        Models of stress.
        in: Levine S Scotch NA Social Stress. Aldine, Chicago1970: 259
        • Cassel J
        Physical illness in response to stress.
        in: Levine S Scotch NA Social Stress. Aldine, Chicago1970: 189
        • Granville-Grossman K
        Recent Advances in Clinical Psychiatry.
        in: Churchill, London1971: 135
        • Lazarus RS
        Cognitive and personality factors underlying threat and coping.
        in: Levine S Scotch NA Social Stress. Aldine, Chicago1970: 143
        • Dohrenwend BP
        The social psychological nature of stress: a framework for causal inquiry.
        J Abn Soc Psychol. 1961; 62: 294
        • Pichot P
        Quantification of psychological stress responses.
        in: Society Stress and Disease. vol. I. Oxford University Press, London1971: 49
        • Stouffer SA
        • Guttman L
        • Suchman EA
        • et al.
        Measurement and Prediction.
        Princeton University Press, Princeton, NJ1950
        • Selye H
        The evolution of the stress concept: stress and cardiovascular disease.
        in: Society Stress and Disease. vol. I. Oxford University Press, London1971: 299
        • Pitts FN
        • McClure JN
        Lactate metabolism in anxiety neurosis.
        N Engl J Med. 1967; 277: 1329
        • Axelrod J
        • Weinshilboum R
        Catecholamines.
        N Engl J Med. 1972; 287: 237
        • Fröberg J
        • Karlsson CG
        • Levi L
        • et al.
        Physiological and biochemical stress reactions induced by psychosocial stimuli.
        in: Society Stress and Disease. vol. I. Oxford University Press, London1971: 280
        • Raab W
        Cardiotonic biochemical effects of emotional-environmental stressors: fundamentals of psychocardiology.
        in: Society Stress and Disease. vol. I. Oxford University Press, London1971: 331
        • Raab W
        The sympathogenic biochemical trigger mechanisms of angina pectoris.
        Am J Cardiol. 1962; 9: 576
        • Levi L
        Neuroendocrinology of anxiety.
        Br J Psychiat, Special Publication No. 3. 1969;
        • Frankenhaeuser M
        Experimental approaches to the study of human behavior as related to neuroendocrine functions.
        in: Society Stress and Disease. vol. I. Oxford University Press, London1971: 22
        • Wolff HG
        Stress and Disease.
        in: Charles C Thomas, Springfield, Illinois1953: 72
        • Holmes Th
        • Rahe RH
        The social readjustment rating scale.
        J Psychosom Res. 1967; 11: 213
        • Rahe RH
        • Lundberg M
        • Bennett L
        • et al.
        The social readjustment rating scale.
        J Psychosom Res. 1971; 15: 241
        • Rahe RH
        Multi-cultural correlations of life change scaling: America, Japan, Denmark and Sweden.
        J Psychosom Res. 1969; 13: 191
        • Dwyer Jr, EM
        • Wiener L
        • Cox JW
        Angina pectoris in patients with normal and abnormal coronary arteriograms.
        Am J Cardiol. 1969; 23: 639
        • Kemp Jr, HG
        Left ventricular function in patients with the anginal syndrome and normal coronary arteriograms.
        Am J Cardiol. 1973; 32: 375
        • James TN
        Angina without coronary disease (sic).
        Circulation. 1970; 42: 189
        • Mustard JF
        • Packham MA
        Platelet function and myocardial infarction.
        in: Research on Acute Myocardial Infarction. American Heart Association Monograph No. 27. 1969: 20 (New York)
        • Wolf S
        Psychosocial forces in myocardial infarction and sudden death.
        in: Levi L Society Stress and Disease. Oxford University Press, London1971: 324
        • Lapin BA
        • Cherkovich GM
        Environmental changes causing the development of neuroses and corticovisceral pathology in monkeys.
        in: Levi L Society Stress and Disease. Oxford University Press, London1971: 266
        • Melville KI
        • Bloom B
        • Shister HE
        • et al.
        Cardiac ischemic changes in arrhythmias induced by hypothalamic stimulation.
        Am J Cardiol. 1963; 12: 781
        • Greenhoot JH
        • Reichenback DD
        Cardiac injury and subarachnoid haemorrhage—a clinical, pathological and physiological correlation.
        J Neurosurg. 1969; 30: 521
      4. Cold and the heart.
        Br Med J. 1974; 3 (Editorial): 430
        • Kahn HA
        • Medalie JH
        • Neufeld HN
        • et al.
        The screening efficiency of two variable cross-classifications compared to discriminant functions.
        in: Eliakim M Neufeld HN Cardiology: Current Topics and Progress. Academic Press, New York1970: 96