Author + information
- Received June 6, 1995
- Revision received September 26, 1995
- Accepted October 11, 1995
- Published online March 1, 1996.
- Frances H. Gabbay, PhDa,
- David S. Krantz, PhDa,∗,
- Willem J. Kop, PhDa,
- Susan M. Hedges, PhDa,
- Jacob Klein, MD∗,
- John S. Gottdiener, MD, FACC† and
- Alan Rozanski, MD, FACC‡
- ↵∗Address for correspondence: Dr. David S. Krantz, Department of Medical and Clinical Psychology, Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814-4799.
Objectives. This study assessed the potency of physical and mental activities and emotions (anger and anxiety) and smoking and other substance use as proximate triggers of ischemia in patients with coronary artery disease during daily life.
Background. Myocardial ischemia occurs during a wide variety of activities in patients with coronary artery disease, but frequency and relative potency of physical and mental activities, smoking and use of caffeine and alcohol as triggers of ischemia during daily life have not been established.
Methods. Patients (n = 63) with coronary artery disease and evidence of out-of-hospital ischemia kept a validated structured diary of physical and mental activities and psychologic states while undergoing ambulatory electrocardiographic monitoring for 24 to 48 h.
Results. Ischemia occurred most frequently during moderately intense physical and mental activities. Patients spent the largest proportion of time engaged in low intensity physical and mental activities (p < 0.05), but the likelihood of ischemia was greatest during intense physical (p < 0.0001) and stressful mental activities (p < 0.03). The percentage of time in ischemia was elevated and approximately equivalent for high intensity physical and high intensity mental activities (5%) compared with 0.2% when patients were engaged in low intensity activities. Strenuous physical activity (e.g., effortful walking, p < 0.05) and the experience of intense anger were potent ischemic triggers, and heart rates at onset of ischemia increased with the intensity of physical and mental activity and with anger. Among smokers, ischemia was more than five times as likely when patients smoked than when they did not (during 27% vs. 5% of diary entries, p < 0.0001). Coffee and alcohol consumption were also related to ischemia (p < 0.05), but this association disappeared after controlling for concurrent cigarette smoking.
Conclusions. Triggers of ischemia in patients with coronary artery disease during daily life include not only strenuous exercise, but also activities involving low levels of exertion, such as anger and smoking. Mental activities appear to be as potent as physical activities in triggering daily life ischemia. Coffee and alcohol consumption are related to ischemia only by virtue of their associations with smoking.
☆ This study was supported by Grant HL47337 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland: by the John D. and Catherine T. MacArthur Foundation, Chicago, Illinois: and by Grant RO7233 from the Uniformed Services University of the Health Sciences, Bethesda, Maryland. The opinions and assertions expressed herein are those of the authors and are not to be constructed as reflecting the views of the Uniformed Services University of the Health Sciences or the U.S. Department of Defense.
- Received June 6, 1995.
- Revision received September 26, 1995.
- Accepted October 11, 1995.