Author + information
- Received March 19, 2012
- Revision received June 6, 2012
- Accepted June 12, 2012
- Published online October 30, 2012.
- Suzanne V. Arnold, MD, MHA⁎ (, )
- Kim G. Smolderen, PhD,
- Donna M. Buchanan, PhD,
- Yan Li, PhD and
- John A. Spertus, MD, MPH
- ↵⁎Reprint requests and correspondence:
Dr. Suzanne V. Arnold, St. Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, Missouri 64111
Objectives This study sought to determine the association of chronic stress with long-term adverse outcomes after acute myocardial infarction (AMI).
Background Chronic stress has been shown to be associated with the development of cardiovascular disease and, in the case of particular types of stress such as job and marital strain, with recurrent adverse events after AMI. Little is known, however, about the association of chronic stress with mortality and adverse health status outcomes in a general AMI population.
Methods In a cohort of 4,204 AMI patients from 24 U.S. hospitals completing the Perceived Stress Scale-4 (sum scores ranging from 0 to 16) during hospitalization, moderate/high stress over the previous month was defined as scores in the top 2 quintiles (scores of 6 to 16). Detailed data on sociodemographics, psychosocial status, and clinical characteristics were collected at baseline. Outcomes included patients' 1-year health status, assessed with the Seattle Angina Questionnaire, Short Form-12, and EuroQol Visual Analog Scale, and 2-year mortality.
Results AMI patients with moderate/high stress had increased 2-year mortality compared with those having low levels of stress (12.9% vs. 8.6%; p < 0.001). This association persisted after adjusting for sociodemographics, clinical factors (including depressive symptoms), revascularization status, and GRACE (Global Registry of Acute Coronary Events) discharge risk scores (hazard ratio: 1.42: 95% confidence interval: 1.15 to 1.76). Furthermore, moderate/high stress was independently associated with poor 1-year health status, including a greater likelihood of angina, worse disease-specific and generic health status, and worse perceived health (p < 0.01 for all).
Conclusions Moderate/high perceived stress at the time of an AMI is associated with adverse long-term outcomes, even after adjustment for important confounding factors. Future studies need to examine whether stress mediates observed racial and socioeconomic disparities and whether novel interventions targeting chronic stress and coping skills can improve post-AMI outcomes.
TRIUMPH was sponsored by a grant from the National Institutes of Health (National Heart, Lung, and Blood Institute): Washington University School of Medicine SCCOR grant P50HL077113-01. The funding organization did not play a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. Drs. Arnold and Smolderen are supported by an award from the American Heart Association Pharmaceutical Roundtable and David and Stevie Spina. Dr. Smolderen is also supported by the Netherlands Organization for Scientific Research [VENI grant no.: 916.11.179]; and received a research grant from W.L. Gore & Associates. Dr. Spertus owns the copyright to the Seattle Angina Questionnaire; received partial support from a Clinical and Translational Science Award (1UL1RR033179); received a research grant from Lilly; and is a consultant for United Healthcare. Drs. Buchanan and Li have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 19, 2012.
- Revision received June 6, 2012.
- Accepted June 12, 2012.
- American College of Cardiology Foundation