Marital stress worsens prognosis in women with coronary heart disease - The Stockholm Female Coronary Risk Study

Context Psychosocial stress has been associated with incidence of coronary heart disease (CHD) in men, but the prognostic impact of such stress rarely has been studied in women. Objective To investigate the prognostic impact of psychosocial work stress and marital stress among women with CHD. Design and setting Population-based, prospective follow-up study conducted in the city of Stockholm, Sweden. Participants A total of 292 consecutive female patients aged 30 to 65 years (n = 279 working or cohabiting with a male partner) who were hospitalized for acute myocardial infarction or unstable angina pectoris between Februar y 1991 and February 1994. Patients were followed up from the date of clinic al examination until August 1997 (median, 4.8 years). Main Outcome Measures Recurrent coronary events, including cardiac death, a cute myocardial infarction, and revascularization procedures, by marital st ress (assessed using the Stockholm Marital Stress Scale, a structured inter view) and by work stress (assessed using the ratio of work demand to work c ontrol). Results Among women who were married or cohabiting with a male partner (n = 187), marital stress was associated with a 2.9-fold (95% confidence interv al [CI], 1.3-6.5) increased risk of recurrent events after adjustment for a ge, estrogen status, education level, smoking, diagnosis at index event, di abetes mellitus, systolic blood pressure, smoking, triglyceride level, high -density lipoprotein cholesterol level, and left ventricular dysfunction, A mong working women (n = 200), work stress did not significantly predict rec urrent coronary events (hazard ratio, 1.6; 95% CI, 0.8-3.3). Conclusions Our results indicate that marital stress but not work stress pr edicts poor prognosis in women aged 30 to 65 years with CHD. These findings differ from previous findings in men and suggest that specific preventive measures be tailored to the needs of women with CHD.