PSYCHOSOCIAL FACTORS AND RISK OF CORONARY HEART-DISEASE IN WOMEN - ANEPIDEMIOLOGIC PERSPECTIVE

Objective: To review the associations between various psychosocial fac tors and risk of coronary heart disease in women. Design: Review of se lected literature. Setting: Epidemiologic, clinical, and demographic s tudies. Patients: Adult women. Interventions: None. Main Outcome Measu res: Coronary heart disease incidence and mortality rates and elevatio ns in levels of coronary risk factors. Results: Low educational attain ment consistently has been associated with an increased risk of corona ry heart disease in women. This association can be explained only part ially by levels of known coronary risk factors and access to medical c are; other intervening mechanisms remain unknown. Social networks and support have shown inconsistent associations with risk of coronary dis ease in women. Possible associations between greater numbers of childr en, multiple role commitments, and lack of emotional support with hear t disease risk and prognosis are deserving of further study. Working o utside the home has not proven to affect a woman's risk of heart disea se. However, some research indicates that women employed in clerical a nd blue-collar jobs have higher rates of heart disease and higher leve ls of coronary risk factors than women employed in white-collar occupa tions, Higher smoking rates and levels of blood pressure and serum cho lesterol have been related to jobs perceived as stressful. Depression has been related consistently to higher risk of heart disease in studi es of men and women combined; its association among women in particula r is an important area of future inquiry. Conclusion: The research ava ilable at this time suggests a role for several psychosocial factors i n the etiology and natural history of coronary heart disease in women. However, this area is in critical need of rigorous study before firm conclusions can be drawn and preventive interventions contemplated.