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Psychosocial Factors Versus Single Predictors: A Factor Analytic Approach to Cardiovascular Outcomes in The Women's Ischemia Syndrome Evaluation (WISE) Study

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Technical Report

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Uniformed Services University Of The Health Sciences Bethesda United States

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Introduction Cardiovascular disease CVD is the leading cause of death among womenin all developed countriesRosamond, et al., 2008. There are important genderdifferences in the onset, diagnosis, and progression of CVD, particularly coronary arterydisease CAD. In addition to the traditional health-related risk factors for CAD, a varietyof psychosocial variables play a role in the etiology, onset and progression of CAD.Additionally, many of these psychosocial variables co-occur and cluster in the sameindividuals, and research suggests that several psychosocial variables overlap i.e., sharevariance. Relatively few studies have examined these issues in women. Methods Datawere analyzed from the National Heart, Lung, and Blood Institute-sponsored WomensIschemia Syndrome Evaluation WISE study Merz, et al., 1999 . Principal componentsfactor analysis with varimax rotation was conducted to examine the clustering ofpsychosocial factors and Cox proportional hazards regressions were used to evaluate thepredictive value of these factors for adverse cardiovascular CV events stroke,myocardial infarction, congestive heart failure, and cardiovascular related death.Results Factor analysis of psychosocial scales including BDI, STAI, SNI, Cook-Medley, and measure of panic and autonomic perception revealed 3 underlying factorsEigenvalues 1 Negative Affectivity, Hostility, and Social Support. In a diseaseadjustedCox regression model, the Social Support factor consisting primarily of theSNI was protective against CV events HR 0.78, 95 CI 0.61-0.99. In Cox regression analysis the addition of a block including the individual psychosocial variable amultivariate approach, was a significant addition to the model 2 1071.51, p0.001. Conclusions Factor analysis of multiple psychosocial scales yielded 3 factors Negative Affectivity, Hostility, and Social Support. The Social Support factor was protective against CV events in women with suspected CAD.

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