Author + information
- Received October 30, 1991
- Revision received July 6, 1992
- Accepted July 13, 1992
- Published online February 1, 1993.
- Richard F. Davies, MD, PhD, FRCPC, FACC∗,
- Wolfgang Linden, PhD,
- Habibullah Habibi, MD,
- W.Peter Klinke, MD, FRCPC, FACC,
- Claude Nadeau, MD, FRCPC,
- Denis C. Phaneuf, MD, FRCPC, FACC,
- Serge Lepage, MD, FRCPC,
- Pierre Dessain, MD,
- Jennifer A. Buttars, BSc,
- Canadian Amlodipine/Atenolol in Silent Ischemia Study (CASIS) Investigators∗
- ↵∗Address for correspondence: Richard F. Davies, MD, PhD, FRCPC, University of Ottawa Heart Institute, 1053 Carling Avenue, Ottawa, Ontario KIY 4E9, Canada.
Objectives. This study was conducted to compare the influence of psychologic traits versus ischemia severity on the occurrence of angina during treadmill exercise.
Background. Some studies suggest that angina is associated with certain psychologic traits, whereas others show an association with more severe ischemia. The relative influence of these two factors and the extent to which they interact are not known.
Methods. Off-drug treadmill exercise testing and a battery of psychologic tests were performed on 122 patients with known coronary artery disease. Psychologic tests measured sensitivity to physical symptoms, denial and deception, type A behavior, anger, hostility, depression, marital adjustment and amount of external stress. Stepwise logistic regression was used to determine the Independent association of psychologic traits, ischemic threshold and exercise tolerance with the occurrence of angina.
Results. Angina during treadmill exercise was reported by 66 of 122 patients. On univariate testing, angina was positively associated with sensitivity to physical symptoms (p < 0.001), type A behavior (p = 0.021) and depression (p = 0.032) and was negatively associated with exercise tolerance (p < 0.001) and work load threshold for ischemia (p < 0.01). Multivariate analysis revealed independent and additive associations of angina with sensitivity to physical symptoms (p = 0.003), exercise capacity (p = 0.003) and work load threshold for ischemia (p = 0.018). Once these were included in a logistic model, depression and type A behavior were no longer significant. Other psychologic traits showed no association with angina.
Conclusions. Sensitivity to physical symptoms, ischemic threshold and exercise tolerance are independently associated with angina, with sensitivity to physical symptoms having the stronger influence. The physiologic and psychologic mechanisms underlying symptom perception have an influence on angina that is independent of and addition to the severity of underlying ischemia.
↵∗ A list of contributing investigators and participating centers appears in the Appendix.
☆ This study was supported by a grant from the Heart and Stroke Foundation of British Columbia and Yukon, Vancouver, British Columbia and Pfizer Canada Inc, kirkland, Quebec, Canada.
- Received October 30, 1991.
- Revision received July 6, 1992.
- Accepted July 13, 1992.