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Social Network and Coronary Artery Calcification in Asymptomatic Individuals

Kop, Willem J. PhD; Berman, Daniel S. MD; Gransar, Heidi MS; Wong, Nathan D. PhD; Miranda-Peats, Romalisa NP; White, Maria D. NP; Shin, Magnolia NP; Bruce, Melissa NP; Krantz, David S. PhD; Rozanski, Alan MD

doi: 10.1097/01.psy.0000161201.45643.8d
Original Articles

Background: Psychosocial factors are associated with the development of coronary artery disease. However, studies examining psychosocial factors as risk indicators for coronary artery calcification (CAC) have been inconclusive.

Methods: Seven hundred eighty-three participants (mean age 57.4 ± 9.3 years, 47% female) underwent CAC imaging using electron beam tomography. Psychosocial measures included social network (number of people in the household, marital status), socioeconomic status (education, income, and work status), history of depression, and current depressive symptoms as assessed with the Center for Epidemiologic Studies Depression (CES-D) scale. Assessments were also made for lipid profile, blood glucose, blood pressure, and health behaviors (smoking status, exercise, and diet).

Results: Calcification was present in 351 (44.8%) participants (CAC score range 0–3022; mean 111.5 ± 307.2). Indicators of social isolation (being single or widowed) were independently associated with elevated risk for the presence of CAC, even after adjustment for age, sex, systolic blood pressure, blood glucose, and low-density lipoprotein (adjusted odds ratios 1.80, 95% confidence interval [CI] = 1.05–3.10, and 2.48, 95% CI = 1.02–6.03, respectively). By contrast, health behaviors, socioeconomic status, and depressive symptoms were not related to CAC.

Conclusions: Social network indices such as being single or widowed are associated with CAC, independent of age and coronary risk factors. Because coronary calcification has been identified as a potential marker of early atherosclerosis, these findings may partially explain the predictive value of limited social networks for future adverse cardiovascular health outcomes.

BMI = body mass index; CAC = coronary artery calcification; CAD = coronary artery disease; CES-D = Center for Epidemiologic Studies Depression; CI = confidence interval; DBP = diastolic blood pressure; HDL = high-density lipoprotein; LDL = low-density lipoprotein; OR = odds ratio; SBP = systolic blood pressure.

From the Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD (W.J.K., D.S.K.); and the Department of Imaging and Division of Nuclear Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (D.S.B., H.G., N.D.W., R.M.-P., M.D.W., M.S., M.B., A.R.).

Address correspondence and reprint requests to Willem J. Kop, PhD, Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814. E-mail:

Received for publication June 21, 2004; revision received November 17, 2004.

The study was supported by a grant from the Eisner Foundation, Los Angeles, CA.

The opinions and assertions expressed herein are those of the authors and are not to be construed as reflecting the views of the USUHS or the U.S. Department of Defense.

Copyright © 2005 by American Psychosomatic Society
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