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The Stockholm Female Coronary Risk Study

Kristina Orth-Gomér, MD, PhD; Sarah P. Wamala, PhD; Myriam Horsten, PhD; Karin Schenck-Gustafsson, MD, PhD; Neil Schneiderman, PhD; Murray A. Mittleman, MD, DrPH

JAMA. 2000;284:3008-3014.

Context  Psychosocial stress has been associated with incidence of coronary heart disease (CHD) in men, but the prognostic impact of such stress rarely has been studied in women.

Objective  To investigate the prognostic impact of psychosocial work stress and marital stress among women with CHD.

Design and Setting  Population-based, prospective follow-up study conducted in the city of Stockholm, Sweden.

Participants  A total of 292 consecutive female patients aged 30 to 65 years (n = 279 working or cohabiting with a male partner) who were hospitalized for acute myocardial infarction or unstable angina pectoris between February 1991 and February 1994. Patients were followed up from the date of clinical examination until August 1997 (median, 4.8 years).

Main Outcome Measures  Recurrent coronary events, including cardiac death, acute myocardial infarction, and revascularization procedures, by marital stress (assessed using the Stockholm Marital Stress Scale, a structured interview) and by work stress (assessed using the ratio of work demand to work control).

Results  Among women who were married or cohabiting with a male partner (n = 187), marital stress was associated with a 2.9-fold (95% confidence interval [CI], 1.3-6.5) increased risk of recurrent events after adjustment for age, estrogen status, education level, smoking, diagnosis at index event, diabetes mellitus, systolic blood pressure, smoking, triglyceride level, high-density lipoprotein cholesterol level, and left ventricular dysfunction. Among working women (n = 200), work stress did not significantly predict recurrent coronary events (hazard ratio, 1.6; 95% CI, 0.8-3.3).

Conclusions  Our results indicate that marital stress but not work stress predicts poor prognosis in women aged 30 to 65 years with CHD. These findings differ from previous findings in men and suggest that specific preventive measures be tailored to the needs of women with CHD.

Author Affiliations: Department of Public Health Sciences, Division of Preventive Medicine, Karolinska Institutet, Stockholm, Sweden (Drs Orth-Gomér, Wamala and Horsten); Department of Medicine, Division of Cardiology, Karolinska Hospital, Stockholm, Sweden (Dr Schenck-Gustafsson); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Miami, Fla (Dr Schneiderman); and Cardiovascular Division, Beth Israel Deaconess Medical Center and Department of Epidemiology, Harvard School of Public Health, Boston, Mass (Dr Mittleman).

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