Psychosocial factors in the epidemiology of coronary heart disease in women.

Although the study of coronary heart disease has provided a fruitful area of research for the psychosocial risk factors for disease, the amount of information among women is limited. Many of the psychological concepts tested in women have been developed from studies of men. The assumption that these psychological constructs (such as type A behavior) are pertinent to the psychology of women must be questioned. When women are included in studies of any disease, the questions asked of them must be applicable to their environment, behaviors, and psychological milieu. Because of the limited amount of data on women, it is difficult to draw conclusions regarding the relationships of psychosocial variables and the development of CHD. Several studies have indicated, however, that the change from a positive to an inverse relationship of SES to CHD in men has not been observed in women. Across various time periods and in different populations low SES is related to the occurrence of CHD in women. The reason for this is not known, and this is clearly an area for future investigations. Several measures of low social support have been found to be related to increase risk of CHD mortality and morbidity in women. A problem with this research is that each study demonstrated a different measure of social support to be the detrimental factor. This may be due to true differences between populations or may be a result of bias introduced from studying different age groups and different populations. It seems to be fairly clear that type A behavior, as measured in Framingham, is not related to definite CHD in women. The fact, however, that type A is related to anginal pain should not be minimized. These men and women are suffering from chest pain and are at increased risk to develop subsequent acute coronary events. For the most part, other personality variables, such as emotional lability, anxiety, depression, and neuroticism, have not been shown to be related to coronary disease in women. This may also be due to a true lack of effect or may be the result of not being able to separate the various manifestations of CHD and perhaps to limited sample sizes of women, which leads to a lack of power to detect at true effect. In the field of coronary heart disease epidemiology, as more studies include women and ask questions that are meaningful to them, a clearer understanding of the possible psychosocial etiology of disease will be possible.(ABSTRACT TRUNCATED AT 400 WORDS)