Abstract
Coronary heart disease (CHD) is the leading cause of death for both men and women in the Western world. Some studies show that the observed decline in cardiovascular mortality is not as pronounced among women as among men. There is a growing awareness that most earlier studies both on primary and secondary risk factors, diagnosis, prognosis, and rehabilitation have focused mainly on men. Thus, there is a need to develop knowledge about women with CHD and to address gender issues in treatment and rehabilitation strategies. Negative affect and emotions increase risk and may interfere with effective cardiac rehabilitation. Therefore, methods for coping with emotional stress need to be included in treatment regimens after a coronary event. The feasibility of a stress management program for women with CHD was assessed in a pilot study. The program consisted of twenty 2-hr group sessions during 1 year, with 5 to 9 participants per group. The pilot study showed that this treatment program had a low dropout rate and resulted in improvement in quality of life and reduction in stress and symptoms. Further work to optimize psychosocial interventions for women with CHD is needed.
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Ades, P. A., Waldmann, M. L., McCann, W. J., & Weaver, S. O. (1992). Predictors of cardiac rehabilitation participation in older coronary patients. Archives of Internal Medicine, 152(5), 1033–1035.
Appels, A., Falger, P. R. J., & Schouten, E. G. W. (1993). Vital exhaustion as risk indicator for myocar-dial infarction in women. Journal of Psychosomatic Research, 37, 881–890.
Appels, A., Golombeckm, B., Gorgels, A., De Vreede, J., & van Breukelen, G. (2000). Behavioral risk factors of sudden cardiac arrest. Journal of Psychosomatic Research, 48(4-5), 463–469.
Appels, A., Höppener, P., & Mulder, P. (1987). A questionnaire to assess premonitory symptoms of myocardial infarction. International Journal of Cardiology, 17, 15–24.
Appels, A., & Mulder P. (1988). Excess fatigue as a precursor of myocardial infarction. European Heart Journal, 9, 758–764.
Ariyo, A. A., Haan, M., Tangenm C. M., Rutledge, J. C., Cushman, M., Dobs, A., & Furberg, C. D. (2000). Depressive symptoms and risks of coronary heart disease and mortality in elderly Americans. Cardiovascular Health Study Collaborative Research Group. Circulation, 102, 1773–1779.
Ayanian J. Z., Epstein A. M. (1991) Differences in the us of procedures between women and men hospitalized for corornary heart disease. New England Journal of Medicine, 325, 221.
Ayanian, J. Z., & Epstein, A. M. (1997). Attitudes about treatment of coronary heart disease among women and men presenting for exercise testing. Journal of General Internal Medicine, 12, 311–314.
Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford.
Boogaard, M. A. (1984). Rehabilitation of the female patient after myocardial infarction. Nursing Clinical Northern America, 19, 433.
Brezinska, V., & Kittel, F. (1995). Psychosocial factors of coronary heart disease in women: A review. Social Science Medicine, 42, 1351–1365.
Burell, G. (1996). Group psychotherapy in project New Life: Treatment of coronary prone behavior in coronary artery bypass graft surgery patients. In R. Allan & S. Scheidt (Eds.), Heart & mind: The practice of cardiac psychology (pp. 291–310). Washington, DC: American Psychological Association.
Burell, G., Öhman, A., Sundin, Ö., Ström, G., Ramund, B., Cullhed, I., & Thoresen, C. E. (1994). Modification of the Type A behavior pattern in post-myocardial infarction patients: A route to cardiac rehabilitation. International Journal of Behavioral Medicine, 1, 32–54.
Cannistra, L. B., Balady, G. J., O’Malley, C. J., Weiner, D. A., & Ryan, T. J. (1992). Comparison of the clinical profile and outcome of women and men in cardiac rehabilitation. American Journal of Cardiology, 69, 1274–1279.
Carney, R. M., Freedland, K. E., Rich, M. W., & Jaffe, A. S. (1995). Depression as a risk factor for cardiac events in established coronary heart disease: A review of possible mechanisms. Annals of Behavioral Medicine, 17, 142–149.
Cohen, S., Mermelstein, R., Kamarck, T., & Hoberman, H. M. (1985). Measuring the functional components of social support. In I. G. Sarason & B. R. Sarason (Eds.), Social support: Theory, research, and applications (pp. 73–94). Dordrecht, The Netherlands: Martinus Nijhoff.
Conn, V. S., Taylor, S. G, & Abele, P. B. (1991). Myocardial infarction survivors: Age and gender differences in physical health, psychosocial state, and regimen adherence. Journal of Advanced Nursing, 16, 1026–1034.
Contrada, R. J., Hill, D. R., Krantz, D. S., Durel, L. A., & Wright, R. A. (1986, August). Measuring cognitive and somatic anger and anxiety: Preliminary report. Paper presented at the Annual Meeting of the American Psychological Association, Washington, DC.
Denollet, J., Sys, S. U., Stroobant, N., Rombouts, H., Gillebert, T. C., & Brutsaert, D. L. (1996). Personality as independent predictor of long-term mortality in patients with coronary heart disease. Lancet, 347(8999), 417–421.
Dixon, J. P., Kison, J. K., Spinner J. C. (1991). Tensions between career and interpersonal commitments as a risk factor for cardiovascular disease amoung women. Women’s Health, 17(3), 33–57.
Eaker E. D. ((1989). Psychosocial factors in the epidemiology of coronary heart disease in women. Psychiatric Clinics of North America, 12, 167.
The ENRICHD Study Group. (2000). Enhancing recovery incoronary heart disease (ENRICHD) study: Design and rationale. American Heart Journal, 139, 1–9.
Downing J., Littman A. (1994). Gender differences in response to cardiac rehabilitation. In: Czajkowski S. M., Hill D. R., Clarkson T. B. (Eds.) Women, Behavior and Cardiovascular Disease. Washingon, DC: NIH Tublications, Vol 94, 3309.
The ENRICHD Study Group. (2001). Enhancing recovery in coronary heart disease (ENRICHD): Baseline characteristics. American Journal of Cardiology, 88, 316–322.
Ferketich, A. K., Schwartzbaum, J. A., Frid, D. J., & Moeschberger, M. L. (2000). Depression as an antecedent to heart disease among women and men in the NHANES I study. Archives of Internal Medicine, 160, 1261–1268.
Ford, D. E., Mead, L. A., Chang, P. P., Cooper-Patrick, L., Wang, N. Y., & Klag, M. J. (1998). Depression is a risk factor for coronary artery disease in men: The precursors study. Archives of Internal Medicine, 158, 1422–1426.
Frank, E., & Barr-Taylor, C. (1993). Coronary heart disease in women: Influences on diagnosis and treatment. Annals of Behavioral Medicine, 15, 156–161.
Frasure-Smith, N., Lespérance, F., Prince, R. H., Verrier, P., Garber R. A., Juneau, M., Wolfson, C., & Bourassa M. G. (1997). Randomised trial of home-based psychosocial nursing intervention for patients recovering from myocardial infarction. The Lancet, 350(9076), 473–479.
Frasure-Smith, N., Lespérance, F., & Talajic, M. (1993). Depression following myocardial infarction: impact on 6-month survival. Journal of the American Medical Association, 270, 1819–1825.
Frasure-Smith, N., Lespérance, F., & Talajic, M. (1995). Depression and 18-month prognosis after myocardial infarction. Circulation, 91(4), 999–1005.
Friedman, M., Thoresen, C. E., Gill, J. J., et al. (1986). Alteration of Type A behavior and its effect on cardiac recurrences in postmyocardial infarction patients: Summary results of the Recurrent Coronary Prevention Project. American Heart Journal, 112(4), 653–665.
Grossi, G., Soares, J. J. F., & Lundberg, U. (2000). Gender differences in coping with musculoskeletal pain. International Journal of Behavioral Medicine, 7, 305–321.
Hallman, T., Burell, G., Setterlind, S., Oden, A., & Lisspers, J. (2001). Psychosocial risk factors for coronary heart disease, their importance compared with other risk factors and gender differences in sensitivity. Journal of Cardiovascular Risk, 8, 39–49.
Hallstrom T., Lapidus L., Bengtsson C., Edström K. (1986). Psychosocial factors and risk of ischemic heart disease and death in women: A twelve-year follow-up of participants in the population study of women in Gothenburg, Sweden. Journal of Psychosomatic Research, 30(4), 451–459.
Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6, 278–296.
Haskell W. L., Alderman, E. L., Fair J. M., et al. (1994). Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. The Stanford Coronary Risk Intervention Project (SCRIP). Circulation, 89(3), 975–990.
Haynes S. G., Feinleib M. (1980). Women, work and coronary heart disease: Prospective findings from the Framingham heart study. American Journal of Public Health, 70(2), 133–141.
Horsten, M., Mittleman, M. A., Wamala, S. P., Schenck-Gustafsson, K., & Orth-Gomér, K. (1999). Social relations and the metabolic syndromein middle-aged Swedish women. Journal of Cardiovascular Risk, 6, 391–397.
Horsten, M., Mittleman, M. A., Wamala, S. P., Schenck-Gustafsson, K., & Orth-Gomér, K. (2000). Depressive symptoms and lack of social integration in relation to prognosis of CHD in middle-aged women: The Stockholm Female Coronary Risk Study. European Heart Journal, 21, 1072–1080.
Ladwig, K. H., Roll, G., Breithardt, G., Budde, T., & Borggrefe, M. (1994). Post-infarction depression and incomplete recovery six months after acute myocardial infarction. Lancet, 343(8888), 20–23.
Lerner, A. (2000). Gender differences in quality of life after coronary artery bypass grafting surgery. Report from the Department of Biomedical Laboratory Science, Umeå University, Sweden.
Lindahl, B., Burell, G., Granlund, B., & Asplund, K. Gender differences in emotional well-being in a healthy population. Manuscript in preparation.
Marrugat, J., Gil, M., & Sala, J. (1999). Sex differences in survival rates after acute myocardial infarction. Journal of Cardiovascular Risk, 6, 89–97.
Mendes de Leon, C. F., Kop, W. J., de Swart, H. B., Bar, F. W., & Appels, A. P. (1996). Psychosocial characteristics and recurrent events after percutaneous transluminal coronary angioplasty. American Journal of Cardiology, 77(4), 252–255.
Norrman, S. (2002, June). Abstract for the VI Nordic Congress on Cardiac Rehabilitation, Reykjavik, Iceland.
Öhman, A., Burell, G., Ramund, B., & Fleischman, N. (1992). Decomposing coronary-prone behavior: Dimensions of Type A behavior in the Videotaped Structured Interview. Journal of Psychopathology and Behavioral Assessment, 14, 21–54.
Orth-Gomér, K. (1998). Psychosocial risk factor profile in women with coronary heart disease. In K. Orth-Gomér & M. Chesney (Eds.), Women, stress, and heart disease. Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
Orth-Gomér, K., Moser, V., Blom, M., Wamala, S., & Schenck-Gustafsson, K. (1997). Kvinnostress kartläggs. Läkartidningen, 94, 632–638.
Orth-Gomér, K., & Schneiderman, N. (Eds.). (1996). Behavioral medicine approaches to cardiovascular disease prevention. Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
Orth-Gomér, K., Undén, A-L., & Edwards, M-E. (1988). Social isolation and mortalityin ischemic heart disease: A 10-year follow-up study of 150 middle-aged men. Acta Medica Scandinavica, 224, 2105–2215.
Orth-Gomér, K., Wamala, S. P., Horsten, M., Schenck-Gustafsson, K., Schneiderman, N., & Mittleman, M. A. (2000). Marital stress worsens prognosis in women with coronary heart disease: The Stockholm Female Coronary Risk Study. Journal of the American Medical Association, 284, 3008–3014.
Pearlin, L. I., & Schooler, C. (1976). The structure of coping. Journal of Health and Social Behavior, 19, 2–21.
Peltonen, M., Lundberg, V., Huhtasaari, F., & Asplund, K. (2000). Marked improvement in survival after acute myocardial infarction in middle-aged men but not in women: The Northern Sweden MONICA study 1985-1994. Journal of Internal Medicine, 247, 579–587.
Powell, L. H., Shaker, L. A., Jones, B. A., Vaccarino, L. V., Thoresen, C. E., & Patillo, J. R. (1993). Psychosocial predictors of mortality in 83 women with premature acute myocardial infarction. Psychosomatic Medicine, 55, 426–433.
Powell, L. H. (2002, March). The ENRICHD clinical trial: Main results. Paper presented at the annual meeting of the American Psychosomatic Society, Barcelona, Spain.
Schneiderman, N. (2002, March). The ENRICHD clinical trial: Impact on population subgroups. Paper presented at the annual meeting of the American Psychosomatic Society, Barcelona, Spain.
Schron, E. B., Pawitan, Y., Shumaker, S. A., & Hale, C. (1991). Health quality of life differences between men and women in a postinfarction study. Circulation, 84(Suppl. II), 245.
Schuster, P. M., & Waldron, J. (1991). Gender differences in cardiac rehabilitation patients. Rehabilitation Nursing, 69(16), 248–253.
Tibblin, G., Tibblin, B., Peciva, S., Kullman, S., & Svärdsudd, K. (1990). “The Göteborg Quality of Life Inventory”: Anassessment of well-being and symptoms among men born 1913 and 1923. Scandinavian Journal of Primary Health Care (Suppl 1), 33–38.
Toobert, D. J., Glasgow, R. E., Nettekoven, L. A., & Brown, J. E. (1998). Behavioral and psychosocial effects of intensive lifestyle management for women with coronary heart disease. Patient Education and Counseling, 35, 177–188.
Tunstall-Pedoe, H., Kuulasmaa, K., Amouyel, P., Arveiler, D., Rajakangas, A-M., & Pajak, A. (1994). Myocardial infarction and coronary deaths in the World Health Organization MONICA project. Circulation, 90.
Undén, A. L., & Orth-Gomér, K. (1989). Development of a social support instrument for use in population surveys. Social Science Medicine, 29, 1387–1392.
Wamala, S. P., Lynch, J., & Kaplan, G. A. (2001). Women’s exposure to early and later life socioeconomic disadvantage and coronary heart disease risk: the Stockholm Female Coronary Risk Study. International Journal of Epidemiology, 30, 275–284.
U.S. Department of Health and Human Services, National Heart, Lung, and Blood Institute. (1995). Cardiac rehabilitation. Clinical Practice Guideline, 17.
Wamala, S. P., Mittleman, M. A., Schenck-Gustafsson, K., & Orth-Gomér, K. (1999). Potential explanations for the educational gradient in coronary heart disease: A population-based case-control study of Swedish women. American Journal of Public Health, 89, 315–321.
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This research was funded by the National Board of Health and Welfare in Sweden.
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Burell, G., Granlund, B. Women’s hearts need special treatment. Int. J. Behav. Med. 9, 228–242 (2002). https://doi.org/10.1207/S15327558IJBM0903_05
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DOI: https://doi.org/10.1207/S15327558IJBM0903_05