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Coronary artery disease
Original article
Coronary heart disease and risk factors as predictors of trajectories of psychological distress from midlife to old age
  1. Marianna Virtanen1,
  2. Marko Elovainio2,3,
  3. Kim Josefsson2,
  4. G David Batty4,
  5. Archana Singh-Manoux4,5,
  6. Mika Kivimäki1,4,6
  1. 1Finnish Institute of Occupational Health, Helsinki, Finland
  2. 2National Institute for Health and Welfare, Helsinki, Finland
  3. 3Institute of Behavioral Sciences, University of Helsinki, Finland
  4. 4Department of Epidemiology and Public Health, University College London, London, UK
  5. 5Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
  6. 6Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
  1. Correspondence to Professor Marianna Virtanen, Finnish Institute of Occupational Health, P.O. Box 40, Helsinki FI-00251, Finland; marianna.virtanen{at}ttl.fi

Abstract

Objective To examine coronary heart disease (CHD) and its risk factors as predictors of long-term trajectories of psychological distress from midlife to old age.

Methods In the Whitehall II cohort study, 6890 participants (4814 men, 2076 women; mean age 49.5 years) had up to seven repeat assessments of psychological distress over 21 years (mean follow-up 19 years). CHD and its risk factors (lifestyle-related risk factors, diabetes, hypertension and cholesterol) were assessed at baseline. Group-based trajectory modelling was used to identify clusters of individuals with a similar pattern of psychological distress over time.

Results We identified four trajectories of psychological distress over the follow-up: ‘persistently low’ (69% of the participants), ‘persistently intermediate’ (13%), ‘intermediate to low’ (12%) and ‘persistently high’ (7%). The corresponding proportions were 60%, 16%, 13% and 11% among participants with CHD; 63%, 15%, 12% and 10% among smokers and 63%, 16%, 12% and 10% among obese participants. In multivariable adjusted multinomial regression analyses comparing other trajectories to persistently low trajectory, prevalent CHD was associated with intermediate to low (OR 1.70, 95% CI 1.08 to 2.68) and persistently high (OR 1.92, 95% CI 1.16 to 3.19) trajectories. Smoking (OR 1.33, 95% CI 1.07 to 1.64; OR 1.55, 95% CI 1.19 to 2.04) and obesity (OR 1.33, 95% CI 1.04 to 1.70; OR 1.47, 95% CI 1.07 to 2.01) were associated with persistently intermediate and persistently high trajectories, respectively.

Conclusion CHD, smoking and obesity may have a role in the development of long-lasting psychological distress from midlife to old age.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/heartjnl-2016-310207

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    Footnotes

    • Contributors MV is responsible for the overall content as a guarantor, contributed to the conception and design of the work, data analysis and drafting the manuscript; ME contributed to the conception and design of the work, data analysis and revising the manuscript critically for important intellectual content; KJ contributed to the design of the work, data analysis and revising the manuscript; GDB and AS-M contributed to the design of the work, interpretation of data and revising the manuscript; MK contributed to the conception and design of the work, interpretation of data and revising the manuscript. All authors approved the final version to be published and have agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The Whitehall II Study is supported by grants from the Medical Research Council (K013351), the British Heart Foundation, the National Heart Blood and Lung Institute, National Institutes of Health (NIH) (R01HL036310) and the National Institute of Aging, NIH (R01AG013196 and R01AG034454). MV is supported by the Academy of Finland (258598, 92824), ME by the Academy of Finland (265977) and MK by the UK Medical Research Council (K013351), NordForsk, the Nordic Council of Ministers (grant 75021) and Finnish Work Environment Foundation.

    • Competing interests None.

    • Ethics approval The University College London Medical School and the NHS London-Harrow Health Research Authority committees on the ethics of human research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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