Psychological factors were associated with a significantly higher risk of MACE in men (HR 1.37; 95% CI 1.27-1.48) compared to women (HR 1.21; 95% CI 1.12-1.30; p=0.017) with ischemic heart disease.
Meta-Analysis (n=549,541)
Are psychological factors associated with a higher risk of MACE in patients with ischemic heart disease, and does this risk differ between men and women?
Psychological factors are associated with an increased risk of MACE in patients with ischemic heart disease, with a slightly but significantly higher risk observed in men compared to women.
Effect estimate: HR 1.37 (men) vs HR 1.21 (women) (95% CI 1.27-1.48 (men) vs 1.12-1.30 (women))
p-value: p=0.017
BACKGROUND: Psychological factors are associated with adverse prognosis in patients with ischemic heart disease (IHD). However, it is unknown whether these risk factors differ between women and men. METHODS: PubMed, EMBASE, and PsycINFO were searched to identify studies assessing the risk of psychological factors for major adverse cardiovascular events (MACE) in samples with IHD. Psychological factors included anger/hostility, anxiety, depression, psychological distress, social support, Type A behavior pattern, Type D personality, and Posttraumatic Stress Disorder (PTSD). RESULTS: A total of 44 articles (64 separate reports) including 227,647 women and 321,894 men reporting confounder-adjusted hazard ratios (HRs) or relative risks (RRs) were included in the primary analysis. Results based on random-effects models showed that the association between psychological factors (all combined) and MACE was stronger in men (n = 321,236; 57 reports; HR = 1.37, 95%CI 1.27-1.48) than in women (n = 226,886; 56 reports; HR = 1.21, 95%CI 1.12-1.30; p = .017). A subset of the studies focusing on women showed significant associations between anger/hostility, depression, and distress with MACE. For men, statistically significant associations were found for anxiety, depression, and distress with MACE. CONCLUSIONS: Psychological factors are associated with MACE in samples with IHD in both women and men, with a small, but significant higher risk for men. Because of the limited number of studies on other psychological factors than depression and anxiety and the current major focus on MACE reflecting lesions in the major coronary arteries which is more typical in men than women, more research is needed to better identify sex and gender differences in IHD.
Smaardijk et al. (Tue,) conducted a meta-analysis in Ischemic heart disease (IHD) (n=549,541). Psychological factors vs. Men vs Women was evaluated on Major adverse cardiovascular events (MACE) (HR 1.37 (men) vs HR 1.21 (women), 95% CI 1.27-1.48 (men) vs 1.12-1.30 (women), p=0.017). Psychological factors were associated with a significantly higher risk of MACE in men (HR 1.37; 95% CI 1.27-1.48) compared to women (HR 1.21; 95% CI 1.12-1.30; p=0.017) with ischemic heart disease.