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The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Lijing L. Yan, PhD, MPH; Kiang Liu, PhD; Karen A. Matthews, PhD; Martha L. Daviglus, MD, PhD; T. Freeman Ferguson, MPH, MSPH; Catarina I. Kiefe, MD, PhD

JAMA. 2003;290:2138-2148.

Context  Although psychosocial factors are correlated, previous studies on risk factors for hypertension have typically examined psychosocial factors individually and have yielded inconsistent findings.

Objective  To examine the role of psychosocial factors of time urgency/impatience (TUI), achievement striving/competitiveness (ASC), hostility, depression, and anxiety on long-term risk of hypertension.

Design, Setting, and Study Population  A population-based, prospective, observational study using participant data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. A total of 3308 black and white adults aged 18 to 30 years (when recruited in 1985 and 1986) from 4 US metropolitan areas and followed up through 2000 to 2001.

Main Outcome Measures  Fifteen-year cumulative incidence of hypertension (systolic blood pressure of 140 mm Hg or higher, diastolic blood pressure of 90 mm Hg or higher, or taking antihypertensive medication).

Results  The incidence of hypertension at year 15 was 15% from baseline and 13.6% from year 5. After adjusting for the same set of hypertension risk factors and each of the psychosocial factors of TUI, ASC, hostility, depression, and anxiety in 5 separate logistic regression models, higher TUI and hostility were significantly associated with risk of developing hypertension at 15-year follow-up for the total sample. Compared with the lowest score group, the adjusted odds ratio (OR) for TUI was 1.51 (95% confidence interval [CI], 1.12-2.03) for a score of 1; 1.47 (95% CI, 1.08-2.02) for a score of 2; and 1.84 (95% CI, 1.29-2.62) for a score of 3 to 4 (P for trend = .001). Compared with the lowest quartile group, the adjusted OR for hostility was 1.06 (95% CI, 0.76-1.47) for quartile 2; 1.38 (95% CI, 1.00-1.91) for quartile 3; and 1.84 (95% CI, 1.33-2.54) for quartile 4 (P for trend <.001). No consistent patterns were found for ASC, depression, or anxiety. Race- and sex-specific analyses and multivariable models with simultaneous adjustment for all 5 psychosocial factors and other hypertension risk factors had generally similar results.

Conclusion  Among young adults, TUI and hostility were associated with a dose-response increase in the long-term risk of hypertension.

Author Affiliations: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill (Drs Yan, Liu, and Daviglus); Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pa (Dr Matthews); and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham (Ms Ferguson and Dr Kiefe) and Birmingham Veterans Affairs Medical Center (Dr Kiefe).

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