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Psychosocial factors and risk of coronary heart disease in women: an epidemiologic perspective.

OBJECTIVE
To review the associations between various psychosocial factors and risk of coronary heart disease in women.


DESIGN
Review of selected literature.


SETTING
Epidemiologic, clinical, and demographic studies.


PATIENTS
Adult women.


INTERVENTIONS
None.


MAIN OUTCOME MEASURES
Coronary heart disease incidence and mortality rates and elevations in levels of coronary risk factors.


RESULTS
Low educational attainment consistently has been associated with an increased risk of coronary heart disease in women. This association can be explained only partially by levels of known coronary risk factors and access to medical care; other intervening mechanisms remain unknown. Social networks and support have shown inconsistent associations with risk of coronary disease in women. Possible associations between greater numbers of children, multiple role commitments, and lack of emotional support with heart disease risk and prognosis are deserving of further study. Working outside the home has not proven to affect a woman's risk of heart disease. However, some research indicates that women employed in clerical and blue-collar jobs have higher rates of heart disease and higher levels of coronary risk factors than women employed in white-collar occupations. Higher smoking rates and levels of blood pressure and serum cholesterol have been related to jobs perceived as stressful. Depression has been related consistently to higher risk of heart disease in studies of men and women combined; its association among women in particular is an important area of future inquiry.


CONCLUSION
The research available at this time suggests a role for several psychosocial factors in the etiology and natural history of coronary heart disease in women. However, this area is in critical need of rigorous study before firm conclusions can be drawn and preventive interventions contemplated.