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Psychosocial Predictors of Coronary Artery Calcification Progression in Postmenopausal Women

Low, Carissa A. PhD; Matthews, Karen A. PhD; Kuller, Lewis H. MD, DrPH; Edmundowicz, Daniel MD

doi: 10.1097/PSY.0b013e318236b68a
Original Articles

Objective: Coronary artery calcification (CAC) has been associated with psychosocial factors in some but not all cross-sectional analyses. The goal of this study was to determine whether positive and negative psychosocial factors prospectively predict CAC progression in postmenopausal women.

Methods: Participants from the Healthy Women Study who also participated in the Pittsburgh Mind-Body Center protocol (n = 149) completed self-report psychosocial measures before two electron beam computed tomographic scans of CAC separated by an average of 3.3 years. Results of exploratory factor analysis were used to create aggregate psychosocial indices: psychological risk (depressive symptoms, perceived stress, cynicism, and anger-in) and psychosocial resources (optimism, purpose in life, mastery, self-esteem, and social support).

Results: The psychological risk index predicted significantly greater CAC progression over 3 years (β = 0.16, p = .035, ΔR2 = 0.03), whereas the psychosocial resources index was not predictive of CAC progression (β = −0.08, p = .30, ΔR2 = 0.01). On individual scales, higher scores on cynicism emerged as a significant predictor of CAC progression, along with a trend linking anger-in to atherosclerosis progression. A post hoc analysis showed a significant interaction between cynicism and anger-in (β = 0.20, p = .01, ΔR2 = 0.03), such that women reporting high levels of both cynicism and anger suppression exhibited the most CAC progression.

Conclusions: These findings highlight psychosocial risk factors that may accelerate the progression of subclinical atherosclerosis in older women, suggest the potential importance of examining combinations of psychosocial risk factors, and identify potential targets for psychological interventions to reduce cardiovascular risk.

CAC = coronary artery calcification; CVD = cardiovascular disease; EBCT = electron beam computed tomography; HWS = Healthy Women Study; IMT = intima-media thickness; PMBC = Pittsburgh Mind-Body Center

From the Departments of Psychiatry (C.A.L., K.A.M.), Epidemiology (L.H.K.), and Medicine (D.E.), University of Pittsburgh, Pittsburgh, Pennsylvania.

Address correspondence and reprint requests to Carissa A. Low, PhD, 3811 O'Hara St, Pittsburgh, PA 15213. E-mail:

This research was supported in part by the National Institutes of Health (Grants HL007560 and HL28266).

Received for publication February 24, 2011; revision received August 12, 2011.

Copyright © 2011 by American Psychosomatic Society
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