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Behavioral factors predict all-cause mortality in female coronary patients and healthy controls over 26 years – a prospective secondary analysis of the Stockholm Female Coronary Risk Study
Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.ORCID iD: 0000-0001-8433-2405
Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.ORCID iD: 0000-0001-7457-7302
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Number of Authors: 62022 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 12, article id e0277028Article in journal (Refereed) Published
Abstract [en]

Objective

The prognosis of coronary artery disease (CAD) is related to its severity and cardiovascular risk factors in both sexes. In women, social isolation, marital stress, sedentary lifestyle and depression predicted CAD progression and outcome within 3 to 5 years. We hypothesised that these behavioral factors would still be associated with all-cause mortality in female patients after 26 years.

Methods

We examined 292 patients with CAD and 300 healthy controls (mean age of 56 ± 7 y) within the Fem-Cor-Risk-Study at baseline. Their cardiac, behavioral, and psychosocial risk profiles, exercise, smoking, and dietary habits were assessed using standardized procedures. Physiological characteristics included a full lipid profile, the coagulation cascade and autonomic dysfunction (heart rate variability, HRV). A new exploratory analysis using machine-learning algorithms compared the effects of social and behavioral mechanisms with standard risk factors. Results: All-cause mortality records were completed in 286 (97.9%) patients and 299 (99.7%) healthy women. During a median follow-up of 26 years, 158 (55.2%) patients and 101 (33.9%) matched healthy controls died. The annualized mortality rate was 2.1% and 1.3%, respectively. After controlling for all available confounders, behavioral predictors of survival in patients were social integration (HR 0.99, 95% CI 0.99–1.0) and physical activity (HR 0.54, 95% CI 0.37–0.79). Smoking acted as a predictor of all-cause mortality (HR 1.56, 95% CI 1.03–2.36). Among healthy women, moderate physical activity (HR 0.42, 95% CI 0.24–0.74) and complete HRV recordings (≥50%) were found to be significant predictors of survival.

Conclusions

CAD patients with adequate social integration, who do not smoke and are physically active, have a favorable long-term prognosis. The exact survival times confirm that behavioral risk factors are associated with all-cause mortality in female CAD patients and healthy controls.

Place, publisher, year, edition, pages
2022. Vol. 17, no 12, article id e0277028
National Category
Public Health, Global Health, Social Medicine and Epidemiology
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URN: urn:nbn:se:su:diva-215180DOI: 10.1371/journal.pone.0277028ISI: 000925063300015PubMedID: 36477657Scopus ID: 2-s2.0-85143561541OAI: oai:DiVA.org:su-215180DiVA, id: diva2:1740612
Available from: 2023-03-01 Created: 2023-03-01 Last updated: 2024-05-31Bibliographically approved

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Leineweber, ConstanzeKecklund, Göran

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