Holiday Angst? Family Stress Linked to Angina

Family stress linked to angina

Shelley Wood

December 28, 2010

December 28, 2010 (Copenhagen, Denmark) — In what may not come as a shock to families coming together over the festive season, newly published research suggests that family ties can both help and harm the heart [1].

In an interview-based study of 4573 randomly selected, middle-aged men and women in Denmark, Dr Rikke Lund (University of Copenhagen, Denmark) and colleagues found that the demands of intimate family ties and the worries that arise between family members can increase the risk of self-reported angina over a six-year period.

"It has been shown before that supportive social relations are protective against incident ischemic heart disease and [that] supportive social relations seem to protect against relapse of disease," Lund told heartwire . "However, few have studied the negative sides of social relations, which we all know are there. Our study suggests that high degree of demands and worries is a risk factor for incident angina pectoris and in a clear dose-response pattern--ie, the more demands/worries, the higher the risk of angina six years later."

Lund et al's paper appears as an early online publication in the Journal of Epidemiology and Community Health.

Over the course of the study, 9% of participants developed new-onset angina (all were free of heart disease at baseline). After adjustment for age, gender, social class, cohabitation status, and mental health, increased worries (about future unknowns) or "excessive demands" (taking place in the present) were associated with increased risk of angina, the authors report. When the source of these worries/demands was a spouse or partner, the angina risk was increased more than threefold, while for children it was more than twofold. Other family members nearly doubled angina risk. By contrast, excessive demands or worries caused by more distant family relations or from friends and neighbors were associated with little or no risk.

Conflicts between family members did not exert as strong an effect on angina risk.

Just how important are these kinds of familial stressors? "You can of course always discuss how strong an effect should be to be called a risk factor," Lund said. "But on the other hand, if an exposure such as demands/worries are common, a lot of people will be affected by the possible effects, and thereby it becomes an 'interesting factor.' I am not a psychologist, but I am sure there exist techniques to help people resolve or work with feelings of serious worries, not to mention that helping people solve the problems that give rise to the worries/demands could be helpful, although not a cardiologist's job."

Angina was self-reported in the study, and Lund and colleagues acknowledge that some degree of misclassification of symptoms likely occurred as a result. However, Lund told heartwire , "A number of studies have shown that self-reported angina is a risk factor for later ischemic heart disease comparable to that of increased cholesterol and blood pressure. It has been shown in long-term follow-up studies that the self-reporting of angina pectoris among 'healthy' younger individuals is associated with a significantly higher risk of later coronary heart disease."

Lund et al plan to continue to study the patterns they've seen in this study using outcomes data, including hospital admissions or deaths from ischemic heart disease, using Danish health registries.

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