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Psychosomatic Medicine 68:355-361 (2006)
© 2006 American Psychosomatic Society

ORIGINAL ARTICLES

Positive and Negative Attributes and Risk for Coronary and Aortic Calcification in Healthy Women

Karen A. Matthews, PhD, Jane F. Owens, DrPH, Daniel Edmundowicz, MD, Laisze Lee, MS and Lewis H. Kuller, MD, DrPH

From the University of Pittsburgh, Department of Psychiatry (K.A.W., J.O., L.L.), Department of Medicine (D.E.), and Department of Epidemiology (L.H.K.), Pittsburgh, Pennsylvania.

Address correspondence and reprint requests to Karen A. Matthews, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213. E-mail: matthewska{at}upmc.edu


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 NOTES
 REFERENCES
 
Objective: Negative emotions predict the development of clinical coronary events, and some evidence suggests that negative emotions relate to subclinical atherosclerosis. Low levels of positive emotions and cognitions are relatively unexplored as predictors of cardiovascular risk. We tested the hypothesis that low positive and high negative affect and cognitions would be related to risk for coronary and aortic calcification in healthy women.

Methods: One hundred fifty-five healthy women had measures of positive and negative affect/cognitions obtained before or at the time of electron beam tomography scan of coronary and aortic calcification.

Results: Coronary calcification was unrelated to women’s psychosocial scores. High aortic calcification was consistently associated with low scores on the Pearlin Mastery Scale and Life Engagement Test and high scores on the CES-Depression Inventory and Negative Interactions Scale in multivariate analyses. Odds ratios (OR [95% confidence intervals (CI)]) from the multivariate binary logistic regression analyses for a SD above the mean scales scores were 0.55 (95% CI, 0.35–0.87) for Pearlin Mastery; 0.56 (95% CI, 0.36–0.86) for the Life Engagement Test; 0.63 (95% CI, 0.40–98) for Life Satisfaction; 1.57 (95% CI, 1.04–2.36) for the CES-Depression; 1.77 (95% CI, 1.15–2.74) for the Cook-Medley Hostility; 1.49 (95% CI, 0.98–2.26) for Spielberger Anger-In; and 2.35 (95% CI, 1.49–3.73) for the Negative Interaction scales.

Conclusions: Women’s psychosocial attributes were not related to coronary calcification, raising the possibility that psychosocial attributes are less important for early than late stages of coronary atherosclerosis. The observed associations of psychosocial attributes with aortic calcification may be due to somewhat different risk factors being important for atherosclerosis at different vascular beds. Positive attributes may be related to atherosclerosis and should be studied further.

Key Words: coronary atherosclerosis • aorta • women • psychosocial • emotion • longitudinal

Abbreviations: IMT = intima media thickness; EBT = electron beam tomography; HT = hormone therapy; PMBC = Pittsburgh Mind-Body Center; CES-D = Center for Epidemiological Studies-Depression scale; LET = Life Engagement Test.


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
METHODS
 RESULTS
 DISCUSSION
 NOTES
 REFERENCES
 
Understanding the psychosocial risk factors of coronary disease in women is handicapped by a number of factors. Observational studies usually rely on the onset of symptoms to adjudicate outcomes. Women’s initial symptom presentation is angina, which often is not accompanied by underlying atherosclerosis (1). Women are considerably older than are men when they are diagnosed with disease, and they usually have accompanying medical comorbidity that can obfuscate the psychosocial relationships with atherosclerosis. Women suffer from coronary disease at a relatively low rate until their 70s, and most studies are underpowered for predicting yes/no clinical events in women. Finally, physician bias in diagnosis and treatment options for women is well documented (2–4), although recent campaigns by National Institutes of Health, American Heart Association, and other groups, increasing awareness about women’s heart disease, have been effective.

New technologies are now available to measure reliably and safely subclinical atherosclerosis in the coronary, aorta, and carotid arteries. These measures predict clinical coronary events in observational studies and are elevated in patients with coronary disease in autopsy studies (5,6). They have the advantage of yielding continuous scores and are not subject to the physician or patient bias or expectations. Finally, they allow testing of psychosocial hypotheses regarding the predictors of early atherosclerosis, which could potentially differ from the predictors of rapid progression of atherosclerosis or triggering of clinical events in persons with compromised functioning.

Available literature on the predictors of subclinical disease in women focuses on negative emotions. Cook-Medley hostility scores predicted coronary calcification across 5 years in a subsample of black and white men and women in their 30s and 40s enrolled in Coronary Artery Risk Development In Young Adults (CARDIA); the sample was too small to permit sex-stratified analyses (7). A history of recurrent major depression was associated with carotid plaque and coronary and aortic calcification in women in their 40s and 50s enrolled in the Study of Women’s Health across the Nation (8,9) and current major depression was associated with carotid and coronary atherosclerosis in elderly women in the Rotterdam Study (10). In the Healthy Women Study (11), Cook-Medley Hostility and Spielberger Anger-In scores predicted carotid intima medial thickness (IMT) and plaque (Anger-In only). Elevated anxiety across 4 years was related to increased IMT in women (12). One purpose of the present investigation was to evaluate if observed associations between coronary calcification and clinical depression extended to depressive symptoms and if observed associations between carotid IMT and anxiety and ways of coping with anger were also observed with calcification.

In recent years, it has been debated whether positive emotions are the bipolar opposite of negative emotion or whether one can conceive of negative and positive emotions and associated cognitions as two somewhat independent dimensions. Much of the debate has rested on psychometric evaluations and relationships with mental health outcomes, but more recently, relationships with physical health outcomes have been considered (13). A small body of literature suggests that positive attitudes toward others, a sense of mastery and control, and high self-esteem are linked to positive physical health outcomes, including good prognosis after bypass surgery (14,15), angioplasty (16), breast cancer diagnosis (17), and less progression of IMT (18); that both positive and negative emotions are linked to increased cardiovascular reactivity to stress (13); and positive affect averaged across days is related to immune function (19). However, positive emotions do not trigger ischemia in heart patients (20). A second and perhaps more unique objective of the present study was to evaluate the relationship between positive attributes and extent of coronary and aortic calcification in women. Because the psychosocial assessment was part of a protocol designed to identify factors that might be important to diverse diseases as part of the Pittsburgh Mind-Body Center (PMBC), a number of positive attributes were measured, including sense of control, optimistic attitudes, purpose in life, life satisfaction, social support, and diverse social networks. Because atherosclerosis in the coronary arteries and aorta is only moderately associated and may develop at different rates, we evaluated the relationships at the two sites independently.


   METHODS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
RESULTS
 DISCUSSION
 NOTES
 REFERENCES
 
Participants
Participants were 155 women enrolled in the Healthy Women Study who also participated in a protocol developed by PMBC to assess whether there are common pathways to diverse diseases, had calcification measures after psychosocial assessment, and had no diagnosed cardiovascular disease (CVD). The PMBC protocol included assessment of psychological attributes, health behaviors, and stress responses. The University of Pittsburgh institutional review board approved all study procedures described below.

The Healthy Women Study started in 1983 with 541 premenopausal women ages 42 to 50 and assessed the cardiovascular risk factor and psychological changes as the women experienced the perimenopausal and postmenopausal transitions (21). Of the 421 women invited to participate in the PMBC protocol starting in 1999, 379 completed self-report measures of psychological attributes. Of these women, 332 also had assessments of coronary and aortic calcification, with 177 being conducted after the questionnaire administration through December 2005, median of 225 days (range = 1–928 days). Excluded from the analysis sample were 21 women who reported that they already had or were on medications for heart disease, stroke, or diabetes and 1 who was on chemotherapy at the time of the scan, resulting in an analysis sample of 155 for coronary calcification. For aortic calcification, 1 woman was missing data and 7 had poor readings due to lymph node deflection.

Assessment of Coronary and Aortic Calcification
After completing the psychosocial inventory, an electron beam tomography (EBT)–trained technician used an Imatron C150 scanner (Imatron, South San Francisco, CA) and its densitometric program to assess the extent of calcification in the coronary arteries and in the aorta. During coronary scanning, 30 to 40 contiguous 3-mm-thick transverse images were obtained from the level of the aortic root to the apex of the heart. During aortic scanning, 6-mm-thick contiguous images were obtained from the aortic arch to the iliac bifurcation. Each contiguous image (100-ms exposure) was acquired during the same phase of the cardiac cycle using electrocardiographic triggering. The participant was asked to hold her breath during the time of scanning. From these images, we derived Agatston (22) calcium scores for the coronary arteries and for the aorta. Coronary artery and aortic calcium lesions were considered to be present when three contiguous pixels greater than 130 Hounsfield units were detected. The total calcium score was a combination of volume and lesions. A previous report from the Healthy Women Study (23) demonstrated a high EBT scan-to-scan reproducibility of coronary and aortic calcium scores (interclass correlations = 0.99 for coronary calcium and 0.98 for aortic calcium). In the present sample, coronary and aortic calcium scores showed a moderate association, Spearman’s {rho} = 0.40, p < 0.001.

In line with prior reports from the Healthy Women Study (24), coronary and aortic calcium scores were skewed. The median coronary calcium score was 1.37 (range: 0–654), with the 42.6% of the women having a score of 0 and the upper 28% having a score of 20 or more. The median aortic calcium score was 117 (range: 0–5301), with the lower 25% of the women having a score of 9 or less and the upper 75% having a score of 632 or more.

Assessment of Cardiovascular Risk Factors
We assessed factors that have been associated with coronary and aortic calcification in prior reports (e.g., 24,25). At the examination closest to the EBT scan were measured age; current smoking status (coded as 0 = nonsmoker and 1 = current smoker); current use of hormone therapy (HT; coded as 0 = non-HT user and 1 = current HT user); kilocalories per week spent in leisure physical activity; resting systolic blood pressure (SBP) and diastolic blood pressure (DBP); body mass index (BMI); waist circumference; and 12-hour fasting concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, and glucose (see 21 for details regarding serum assay analyses). Because of their skewed distribution, triglyceride values were corrected with a natural log transformation before statistical analyses.

Assessment of Psychological Attributes
The PMBC protocol included a large number of scales because of the overall objective of PMBC to identify attributes that are important for diverse diseases. Table 1 identifies the scales, the number of items in each scale and how they are rated, and sample items. {alpha} Coefficients for the Healthy Women Study sample of 379 women are also included. The attributes measured included sense of mastery (26), optimistic attitudes (27), sense of purpose in life (28), overall life satisfaction (29), self-esteem (30), perceptions of stress (31), depressive symptoms (32), hostile attitudes (33), negative interactions with others (34), anger expression style (35), diversity of network as measured by the number of frequently contacted persons across all roles (36), and perceptions of tangible, belonging, and appraisal support (37). Abbreviated versions of the CES-Depression, Rosenberg Self-Esteem, Cook-Medley Hostility Inventory, and Interpersonal Social Evaluation List were used to make the overall protocol length tolerable, with item reduction based primarily on prior psychometric analyses (38).


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  		TABLE 1. Scales Used in PMBC Protocol

 

Statistical Analyses
Because there are no standard cutoffs for coronary and aortic calcification in nonpatient groups, calcification scores were highly skewed in our sample, and some readers wish to know factors that predict high calcification scores, we conducted the analyses in several different ways (39). We classified women into four approximately equally sized groups based on the distributions of aortic calcification scores and conducted ordinal logistic regression analyses. Because 42% of women had no coronary calcification, we could not use the same strategy. Instead, we considered women with 0, >0 and <20, and ≥20 and conducted ordinal logistic regressions. We also tested the associations between the psychosocial variables and being in the highest calcification group based on these cutoffs using binary logistic regression. Finally, we transformed the coronary calcification data by taking the log (coronary calcification score +1) and the aortic calcification data by taking the cubic root and conducted linear regression analyses on the transformed data.

We initially conducted univariate analyses testing the associations between calcification scores and psychosocial attributes. For those psychosocial analyses that approached statistical significance, p < .10, we also conducted multivariate analyses including the risk factors for calcification that were associated in univariate analyses with coronary and aortic calcification scores, p < .20.


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
DISCUSSION
 NOTES
 REFERENCES
 
Women in the study were in their midsixties at the time of the EBT (Table 2). Participants were mainly Caucasian because the exclusionary criteria for the Healthy Women Study required at study entry were hypertension, diabetes, and surgical menopause, all factors associated with being African American (11). Participants were well educated as a group, with more than half having some college coursework. Few were smokers, but a majority was overweight.


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  		TABLE 2. Sample Characteristics (N = 155)

 

Predictors of Coronary Calcification
At the time of or before the EBT scan, women who had elevated coronary calcification scores were more likely to be smokers and heavier (ordinal and linear) than their counterparts, ps < .05. None of the psychosocial attributes predicted coronary calcification as a continuous or categorical measure, ps > .15, with one exception. The Cook-Medley hostility scores tended to associated with increasing calcification in the ordinal logistic regression analysis, estimate = 0.26, p = .08. The multivariate model showed no association between the Cook-Medley Hostility Inventory scores and calcification, p = .26.

Predictors of Aortic Calcification
Women who had elevated aortic calcification scores were more likely to be smokers than nonsmokers and have elevated waist-hip ratios (ordinal and logistic) at the examination closest to the EBT scan, ps < .05. Women who were classified in the highest calcification group versus others had lower scores on the Pearlin Mastery Scale, and Life Engagement Test (LET), and had higher scores on the Cook-Medley Hostility Inventory Negative Interactions, Anger-In, and CES-D scales. See Table 3 for parameter estimates for the binary logistic regression analyses, as well as for the ordinal logistic and linear regression analyses.


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  		TABLE 3. Parameter Estimates and p Values From Univariate Regressions on Psychosocial Attributes and Aortic Calcification

 

There was a graded relationship between the four calcification groups and scores from the Pearlin Mastery, LET, and Negative Interactions scales and tended to be a graded relationship between the four calcification groups and scores on the CES-D and Cook-Medley Hostility scales. Linear regression analyses showed similar patterns of results as was observed in the ordinal logistic regression analyses for the Pearlin Mastery, LET, and Negative Interaction scales. For illustration, Table 4 shows the unadjusted mean scores for these scales according to the four aortic calcification groups.


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  		TABLE 4. Mean Psychosocial Characteristics According to Aortic Calcification Groups

 

Adjustment for all covariates that were significantly associated with calcification at p < .20 in univariate analyses showed similar results to those obtained in the univariate analyses for scores from the Pearlin Mastery scale, LET, CES-D, and Negative Interactions scale (see Table 5). Cook-Medley Hostility and Spielberger Anger-In scores were related only to being in the highest calcification group; low Life Satisfaction scores were related to being in the highest calcification group in multivariate analyses, although they were not related in the univariate logistic regression analysis. For illustrative purposes, Figure 1 shows the odds of being in the highest risk group at 1 SD above the mean on the above measures derived from the multivariate logistic regression analyses.


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  		TABLE 5. Parameter Estimates and p Values from Multivariate Regression on Psychosocial Attributes and Aortic calcification

 

Figure 11
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  		Figure 1. Odds of being in the highest quartile of aortic calcification scores for women 1 SD above mean psychosocial test score from multivariate analyses.

 


   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
NOTES
 REFERENCES
 
The present investigation tested the relationships between both negative and positive psychosocial attributes and the extent of coronary and aortic calcification in women free of coronary disease, stroke, and diabetes. Results showed no significant relationships between psychosocial factors and coronary calcification. The null result was unexpected because two prior reports showed that major depression was related to coronary calcification (9,10). However, those studies and one other also reported that depressive symptoms were not related to coronary calcification (40). These findings suggest that depression may have to occur above some threshold of frequency or intensity to have a long-term effect on the development of calcification. A secondary analysis in the present sample examining the highest 15% or highest one third of the distribution of CES-D scores versus others in relation to coronary calcification did not show any relationships (data not shown). These data, while not definitive, do raise the possibility that psychosocial attributes are less important early than later in the natural history of coronary atherosclerosis.

We did find that positive and negative attributes were related to extent of aortic calcification both in univariate and multivariate analyses. Specifically, women who had lower scores on measures of mastery and control and purpose and meaning in life and higher scores on measures of negative interactions and depressive symptoms had higher calcification scores. Hostile attitudes and holding anger-in and low life satisfaction were associated with being in the highest quartile of calcification scores in multivariate analyses. A few prior studies show that hostility, conflictual interactions, anger-in, and depressive symptoms are related to carotid atherosclerosis (11,41), and our results extend these findings to aortic atherosclerosis. To our knowledge, this is the first study to suggest that positive attributes are related to having elevated calcification scores.

We were surprised that measures of social support and networks were unrelated to calcification. The null effect may be due to these social network variables being more important for mortality than for cardiovascular morbidity, a suggestion that has been offered elsewhere (42). These findings do not mean that social relationships are unimportant. As noted above, a strong association was observed between frequent negative interactions and aortic atherosclerosis.

Why did the findings differ for coronary and aortic calcification? Although it is possible that the different patterns are simply due to chance, a number of issues should be considered. First, the prevalence of any coronary calcification was very low in this sample of healthy women and much lower than the prevalence of any aortic calcification. Thus, there was lower statistical power for detecting relationships for coronary calcification than for aortic calcification. An examination of the traditional risk factors associations with coronary and aortic calcification does not provide strong support for this argument though because a similar number of risk factors were associated with atherosclerosis in the coronary and aortic calcification scores. Nonetheless, continued follow-ups of these women are planned and may reveal more coronary calcification, with perhaps new relationships emerging.

Second, we reported here associations between psychosocial attributes measured before but close in time to the EBT scans. Persistently low positive emotions and elevated negative emotions since the time of study entry may yield a somewhat different picture in relation to coronary calcification. This possibility is consistent with the strong associations of coronary and aortic calcification and biological risk factors measured at study entry 11 years earlier (24) and that more risk factors measured at study entry were related to calcification than concurrently measured risk factors in the present sample (data not shown). We suggested elsewhere that the study entry risk factors were cumulative markers of exposure to elevated cardiovascular risk before the menopause and that concurrently measured risk factors when women were postmenopausal would require a longer incubation period before showing strong relationships with subsequent atherosclerosis (43).

Third, the risk factors that predict coronary and aortic calcification may be somewhat different. In support of this notion are autopsy data of nearly 3000 persons 15 to 34 years of age who died of external causes. In this sample, sex was a risk factor for raised lesions in the coronary artery but not in the abdominal aorta (44,45). Furthermore, smoking was strongly related to aortic atherosclerosis but not coronary atherosclerosis, whereas elevated glycohemoglobin was strongly related to coronary atherosclerosis but not aortic atherosclerosis. Perhaps psychosocial attributes are more related to aortic atherosclerosis, smoking, and high blood pressure as opposed to lipid abnormalities, which may be a more determinant of coronary atherosclerosis, at least in women. This notion is obviously speculative but worthy of further evaluation. It would be best to report associations of psychosocial and biological risk factors and atherosclerosis in multiple sites in the same individuals and in the same paper to evaluate this possibility.

The study has several limitations. First, the sample was relatively small and the prevalence of any coronary calcification was low, resulting in low statistical power. Second, the sample was composed primarily of Caucasian women who were well educated, which limits the generalizability of the findings. Third, the study was cross-sectional/longitudinal in design in that the psychosocial measures were near in time or before the EBT protocol. On the other hand, there were some advantages to the study, including a wide range of psychosocial measures, a unique measure of subclinical atherosclerosis, i.e., coronary and aortic calcification, and elimination of participants with frank disease that might confound associations. Finally, the study was composed of women, a group in which it has been difficult to test psychosocial hypotheses because of the natural history of atherosclerosis in women and associated methodological challenges.

In summary, healthy women who reported having a sense of mastery, control, and purpose in life were less likely to have aortic calcification, whereas women who reported having frequent negative interactions and depressive symptoms were more likely to have aortic atherosclerosis. The psychosocial attributes that predicted atherosclerosis varied by site in this study because there were no relationships with coronary calcification. To our knowledge, this is the first study reporting an association of psychosocial factors and aortic calcification and the first to report an association of positive attributes with calcification. We suggest that psychosocial features might be preferentially related to atherosclerosis at some sites in the circulation.

This research was supported by Grants HL065111, HL065112 and HL28266 from the National Institutes of Health, Bethesda, MD.


   NOTES
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 NOTES
REFERENCES
 

Received for publication July 8, 2005; revision received January 23, 2006.

DOI:10.1097/01.psy.0000221274.21709.d0


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 NOTES
 REFERENCES
 

  1. Wenger NK. Coronary heart disease in women: clinical syndromes, prognosis, and diagnostic testing. In: Douglas PS, ed. Heart Disease in Women. Philadelphia, PA: F.A. Davis; 1989:173–86.
  2. Shaw LJ, Miller DD, Romeis JC, Kargl D, Younis LT, Chaitman BR. Gender differences in the noninvasive evaluation and management of patients with suspected coronary artery disease. Ann Intern Med 1994;120:559–66.[Abstract/Free Full Text]
  3. Schulman KA, Berlin JA, Harless W, Kerner JF, Sistrunk S, Gersh BJ, Dube R, Taleghani CK, Burke JE, Williams S, Eisenberg JM, Escarce JJ. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med 1999;340:618–26.[Abstract/Free Full Text]
  4. Ayanian JZ, Epstein AM. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med 1991;325:221–5.[Abstract]
  5. Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR, Clegg LX. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol 1997;146:483–94.[Abstract/Free Full Text]
  6. Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS. Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area: a histopathologic correlative study. Circulation 1995;92:2157–62.[Abstract/Free Full Text]
  7. Iribarren C, Sidney S, Bild DE, Liu K, Markovitz JH, Roseman JM, Matthews KA. Association of hostility with coronary artery calcification in young adults: the CARDIA Study. JAMA 2000;283:2546–51.[Abstract/Free Full Text]
  8. Jones DJ, Bromberger JT, Sutton-Tyrrell K, Matthews KA. Lifetime history of depression and carotid atherosclerosis in middle-aged women. Arch Gen Psychiatry 2003;60:153–60.[Abstract/Free Full Text]
  9. Agatisa PK, Matthews KA, Bromberger JT, Edmumdowicz D, Chang YF, Sutton-Tyrrell K. Coronary and aortic calcification in women with major depression history. Arch Intern Med 2005;165:1229–36.[Abstract/Free Full Text]
  10. Tiemeier H, van Dijck W, Hoffman A, Witteman JCM, Stijnen T, Breteler MMB. Relationship between atherosclerosis and late-life depression. Arch Gen Psychiatry 2004;63:369–76.
  11. Matthews KA, Owens JF, Kuller LH, Sutton-Tyrrell K, Jansen-McWilliams L. Are hostility and anxiety associated with carotid atherosclerosis in healthy postmenopausal women? Psychosom Med 1998;60:633–8.[Abstract/Free Full Text]
  12. Paterniti S, Zureik M, Ducimetiere P, Touboul PJ, Feve JM, Alperovitch A. Sustained anxiety and 4-year progression of carotid atherosclerosis. Arterioscler Thromb Vasc Biol 2001;21:136–41.[Abstract/Free Full Text]
  13. Pressman SD, Cohen S. Does positive affect influence health? Psychol Bull. 2005;131:925–71.[CrossRef][Medline]
  14. Scheier MF, Matthews KA, Owens JF, Schulz R, Bridges MW, Magovern GJ, Carver CS. Optimism and rehospitalization following coronary artery bypass graft surgery. Arch Intern Med 1999;159:829–35.[Abstract/Free Full Text]
  15. Fitzgerald TE, Tennen H, Affleck G, Pransky GS. The relative importance of dispositional optimism and control appraisals in quality of life after coronary artery bypass surgery. J Behav Med 1993;16:25–43.[CrossRef][Medline]
  16. Helgeson VS, Fritz HL. Cognitive adaptation as a predictor of new coronary events following percutaneous transluminal coronary angioplasty. Psychosom Med 1999;61:488–95.[Abstract/Free Full Text]
  17. Schulz R, Bookwala J, Knapp JE, Scheier MF, Williamson GM. Pessimism, age and cancer mortality. Psychol Aging 1996;11:304–9.[CrossRef][Medline]
  18. Matthews KA, Räikkönen K, Sutton-Tyrrell K, Kuller LH. Optimistic attitudes protect against progression of carotid atherosclerosis in healthy middle-aged women. Psychosom Med 2004;66:640–4.[Abstract/Free Full Text]
  19. Flory JD, Manuck SB, Matthews KA, Muldoon MF. Serotonergic function in the central nervous system is associated with daily ratings of positive mood. Psychiatry Res 2005;129:11–9.[CrossRef]
  20. Gullette EC, Blumnethal JA, Babyak M, Jiang W, Waugh, RA, Frid DJ, O’Connor CM, Morris JJ, Krantz DS. Effects of mental stress on myocardial ischemia during daily life. JAMA 1997;277:1521–6.[Abstract/Free Full Text]
  21. Matthews KA, Kelsey SF, Meilahn EN, Kuller LH, Wing RR. Educational attainment and behavioral and biologic risk factors for coronary heart disease in middle-aged women. Am J Epidemiol 1989;129:1132–44.[Abstract/Free Full Text]
  22. Agatson AS, Janowitz WR, Hildner FJ, Zuamer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computer tomography. J Am Coll Cardiol 1990;15:827–32.[Abstract]
  23. Sutton-Tyrrell K, Kuller LH, Edmundowicz D, Feldman A, Holubkov R, Givens L, Matthews KA. Usefulness of electron beam tomography to detect progression of coronary and aortic calcium in middle-aged women. Am J Cardiol 2001;87:560–4.[CrossRef][Medline]
  24. Kuller LH, Matthews KA, Sutton-Tyrrell K, Edmundowicz D, Bunker CH. Coronary and aortic calcification among women 8 years after menopause and their premenopausal risk factors: the Healthy Women Study. Arterioscler Thromb Vasc Biol 1999;19:2189–98.[Abstract/Free Full Text]
  25. Mahoney LT, Burns TL, Stanford W, Thompson BH, Witt JD, Rost CA, Lauer RM. Coronary risk factors measured in childhood and young adult life are associated with coronary artery calcification in young adults: the Muscatine Study. J Am Coll Cardiol 1996;27:277–84.[Abstract]
  26. Pearlin LI, Schooler C. The structure of coping. J Health Soc Behav 1978;19:2–21.[CrossRef][Medline]
  27. Scheier MF, Carver CS, Bridges MW. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a re-evaluation of the Life Orientation Test. J Pers Soc Psychol 1994;67:1063–78.[CrossRef][Medline]
  28. Scheier MF, Wrosch C, Zdaniuk B, Cohen S, Matthews KA, Schulz R. Life Engagement Test (LET): assessing purpose in life. Behav Med. In press.
  29. Diener E, Emmons RA, Larson RJ, Griffin S. The satisfaction with life scale. J Pers Assess 1985;49:71–5.[CrossRef][Medline]
  30. Rosenberg M. Society and Adolescent Self-image. Princeton, NJ: Princeton University Press; 1965.
  31. Cohen S, Williamson GM. Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S, eds. The Social Psychology of Health. Newbury Park, CA: Sage; 1988.
  32. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measure 1977;1:385–401.[CrossRef]
  33. Cook WW, Medley DM. Proposed hostility and pharisaic-virtue scales for the MMPI. J Appl Psychol 1954;38:414–8.[CrossRef]
  34. Krause N. Negative interaction and satisfaction with social support among older adults. J Gerontol Psychol Sci 1995;50B:59–73.
  35. Spielberger CD, Johnson EH, Russell SF, Crane RJ, Jacobs GA, Worden TJ. The experience and expression of anger: construction and validation of an anger expression scale. In: Chesney MA, Rosenman RH, eds. Anger and Hostility in Cardiovascular and Behavioral Disorders. Cambridge: Hemisphere; 1985:5–30.
  36. Cohen S, Doyle WJ, Skoner DP, Rabin BS, Gwaltney JM. Social ties and susceptibility to the common cold. JAMA 1997;277:1940–4.[Abstract/Free Full Text]
  37. Cohen S, Mermelstein R, Kamarck T, Hoberman H. Measuring the functional components of social support. In: Sarason IG, Sarason B, eds. Social Support: Theory, Research and Applications. The Hague: Martinus Nijhoff; 1985:73–94.
  38. Barefoot KC, Dodge KA, Peterson BL, Dahlstrom WG, Williams RB. The Cook-Medley Hostility Scale: item content and ability to predict survival. Psychosom Med 1989;62:17–25.
  39. Reilly MP, Wolfe ML, Localio AR, Raer DJ. Coronary artery calcification and cardiovascular risk factors: impact of the analytic approach. Atherosclerosis 2004;173:69–78.[CrossRef][Medline]
  40. O’Malley PG, Jones DL, Feuerstein IM, Taylor AJ. Lack of correlation between psychological factors and subclinical coronary artery disease. N Engl J Med 2000;343:1298–304.[Abstract/Free Full Text]
  41. Julkunen J, Salonen R, Kaplan GA, Chesney MA, Salonen JT. Hostility and the progression of carotid atheroclerosis. Psychosom Med 1994;56:519–25.[Abstract/Free Full Text]
  42. House JS, Landis KR, Umberson D. Social relationships and health. Science 1988;241:540–5.[Abstract/Free Full Text]
  43. Matthews KA, Kuller LH, Sutton-Tyrrell K, Chang Y. Changes in cardiovascular risk factors during the perimenopause and postmenopause and carotid artery atherosclerosis in healthy women. Stroke 2001;32:1104–11.[Abstract/Free Full Text]
  44. McGill HC, McMahan A, Zieske AW, Sloop GD, Walcott JV, Troxclair DA, Malcom, GT, Tracy RE, Oalmann MC, Strong JP, for the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. Arterioscler Thromb Vasc Biol 2000;20:1998–2004.[Abstract/Free Full Text]
  45. McGill HC, McMahan A, and the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Determinants of atherosclerosis in the young. Am J Cardiol 1998;82:30T–6.[Medline]



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